Inspection on 07/01/09 for Stubby Leas Nursing Home

This inspection was carried out on 7th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stubby Leas Nursing Home 10/06/09

Stubby Leas Nursing Home 13/02/08

Stubby Leas Nursing Home 12/06/07

Stubby Leas Nursing Home 29/11/06

Stubby Leas Nursing Home 25/06/06

Stubby Leas Nursing Home 06/01/06

Stubby Leas Nursing Home 18/05/05

Stubby Leas Nursing Home 15/03/05

Stubby Leas Nursing Home 14/07/04

Stubby Leas Nursing Home 15/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT     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: Keith Jones     Date: 0 7 0 1 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT 01827383496 01827383086 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) First Care Ltd Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 48 DE (Dementia) - Minimum age 60 years on admission. 5 Dementia (DE) - Minimum age 55 years on admission. Date of last inspection Brief description of the care home Stubby Leas Care home provides personal and nursing care for up to 48 people suffering with forms of dementia related illnesses. The home is situated in its own grounds on the edge of Fisherwick, a rural hamlet fairly close to the city of Tamworth, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. Rooms are provided on all levels of the home with a mixture of single or double rooms, some with en suite facilities. Communal areas are on the ground floor and there is a separate Care Homes for Older People Page 4 of 34 48 Over 65 48 Brief description of the care home smoking area. The home has a purpose built activity room where people have the opportunity to maintain their skills and hobbies or to enjoy new interests. The full range of fees were not detailed in the service Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We conducted this unannounced inspection with the acting care manager, the Operational Director First Care Limited, senior nursing and care staff on duty, and an expert by experience, whose input contributed to this report. An expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 39 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with nursing and personal care needs. Care Homes for Older People Page 6 of 34 To do this we looked at (case tracked) five peoples files from admission referral to the present time, and five staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and nine survey forms returned we sent out to people who use the service, some weeks before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed an inspection report feedback, involving the Opertional Director and acting care manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. What the care home does well: What has improved since the last inspection? We were satisfied that the Registered Provider has complied with all requirements, and have dealt with, or are in the process of dealing with, those recommendations made at the last key inspection. The home has moved forward in promoting a more structured activity programme through the appointment of an activity co-ordinator, and the provision of facilities and resources to establish the effort as a significant particle in the planning and delivery of care. We have recognised that a considerable capital investment has been undertaken to upgrade facilities and services to create a more homely and pleasing environment for people to live in. We found that the Provider has responded positively in completing an extensive redecoration and refurbishment of bedrooms, significantly improving peoples Care Homes for Older People Page 8 of 34 living environment. We acknowledge that relationships with the new Medical Practice has greatly enhanced the clinical care support offered to people who use the service, through their weekly visits. Much liaison and planning with this relationship has enabled a robust and positive rapport with the visiting Doctors, which is essential on delivering quality medical care Various comments through surveying from people in the home: If I need help there is always someone available. We spoke with the General Practioner who helps to provide cover for the home, who indicated his approval of good standards of care, the recent improvements made in care planning, and arrangements for the provision of medical cover in general. We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 34 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who may use the service are assessed before they are offered a place. A more detailed record of assessment of need had not been consistent for all people before they moved into the home. Therefore it could not be guaranteed that their needs could be met on entering the home. Evidence: We examined the services recently revised Statement of Purpose and Service User Guide, and found them to provide an informative description of Stubby Leas aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, although information concerning fees payable were not included in the Service User Guide. We were advised that the Service User Guide is produced in large print as and when necessary; and was acknowledged that an audio and pictorial version would help people to make an more informed choice. Care Homes for Older People Page 12 of 34 Evidence: It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Some comments we received from surveys we sent out before the inspection: I remember signing a form, and My brother looked around for me and said it was a good place. Our examination of five peoples care records and plans, indicated that each person had an individualised pre-admission assessment, but the amount of information recorded was only adequate in forming a superficial appraisal of that persons needs and capabilities, being poor in assessing the social background, and were inconsistent with dating and signatures of the assessor. We identified that the Operations Director, Acting Care Manager or his deputy, at the point of referral, conducts the pre-admission assessment. We advised that each record showed the attention to details of individuality to allow the formulation of a care support plan, based on assessed, individual needs. However we found through our discussions with relatives that their involvement was taken into account, and that they felt included. A relative we talked to informed us: The care plan has been started, but during the care plan meeting there has been a lot of interruptions such as staff been called away, the door bell or the telephone ringing. A comment received by the homes surveying of relatives views (12/09/08): We had a long discussion at my house with the male nurse about my wifes care needs, and her liking for music and chatting. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. We are satisfied that people are informed of those facilities, but have indicated that this process would be greatly enhanced with a more detailed assessment report. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. From our inspection of records we identified that service user contracts were in place, and specified the number or name of the room to be occupied. No intermediate care took place in the home. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are not always appropriately and consistently assessed. Medicine administration systems need to be reviewed to increase safety and effectiveness. Evidence: Our examination of care records and case tracking showed an inconsistency of quality of assessment, although individual care plans were developed for people admitted to the home, with some recent admissions based on barely adequate profiling. We found that the pre-admission assessment is recognised as the foundation for a care planning process, which we found included risk assessments for mobility and falls, continence, tissue viability and nutrition. Each persons health, personal and social care needs were found to be assessed in an individual plan of care that is now reviewed monthly, to reflect their changing needs, and adapting care profiles, supported with a substantial and informative daily progress report. It was recognised that there had been a lapse in the review process, which has Care Homes for Older People Page 14 of 34 Evidence: now been re-established. The AQAA stated, and we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and monitoring systems of care plans. This was evidenced in talking with relatives and staff. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and District Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles, now established as a monthly routine by the acting care manager and Registered Nurses. Risk assessments were carried out on an individual basis, and now reviewed at a regular frequency. Included in the care records were applications of established monitoring systems, following a process of recognition and evaluation. A purposeful daily report is maintained to control monitoring, and offer an account of care and service given. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives, and the care they were receiving at Stubby Leas Comments from surveys organised by Stubby Leas on the 12/09/08: Im very happy with the way that mum is looked after here. My mother has been here only three weeks, but within this time mum has received very good care. All the staff are caring, understanding and respect mums privacy. Similar comments were received from surveys we sent out before the inspection: Happy with care received. Always someone to talk to about things. Care and support is satisfactory for me. If I need help there is always someone available. The expert by experience was able to talk with a number of people using the service and their visiting relatives. One visiting husband stated that he was Very happy with the care that his wife is receiving in the home. He also said that His wife is treated with respect and dignity, and she is always clean and well presented. Another visitor told the expert by experience that The standard of care given was the most important thing, one could be sitting in a chair made from gold but if the care is not good, then that means nothing. The administration of medicines generally adhered to procedures, although there were some inconsistencies requiring a review of procedures, to maximise protection to people. We saw that general storage was secure, but the controlled drugs locked cabinet requires securing with Rag Bolts to the wall to ensure full security. We looked Care Homes for Older People Page 15 of 34 Evidence: at the controlled drug register, and found it to be in order. Random checks of medicine stocks against the Medicines Administration Record (MAR) sheets confirmed an inconsistent recording of medicines received, administered and disposed of. Self medication and risk assessment policies were seen to be satisfactory, with no one at the time who wished to participate in the scheme. We confirmed that only nursing staff administer medication, all having received updated training in the Safe Handling of Medications. The Homely remedy policy was examined and in need of updating with current doctors approval. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, although the records need updating. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. We understood that Church of England services are held each two weeks. The minister was visiting at the time and seen chatting with people. His comments were very complimentary of the standards of care and of the home in general: Ive been coming to Stubby Leas for many years, and have always found the atmosphere to be loving, warm and generous. Roman Catholic priests attends on request, and no other diverse religious needs were identified at the time of inspection. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. One comment offered to the expert was that he was happy with the physical and nursing care given to my wife so far. He praised the home for sorting out his wifes medication quickly, as he had problems with this before his wife was admitted to the home. He stated that staff were kind, and did the best that they can for the residents. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We recommend that a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. We are informed that part time activity coordinators has been appointed for several hours a day, working from a large activities room, which had displays of art and craft work. We recognised that there has been some work done in creating a sensory room, although as yet unfinished, it represents an improvement in facilities being made available for people. We were informed that the Home is planning extended activities Care Homes for Older People Page 17 of 34 Evidence: to add to those already in place, including a mix of individual and group activities, whilst recognising that normal daily routines such as personal care procedures should be a social interaction. On the day of inspection the activity coordinator was day off, with little evidence of an ongoing, planned structure of events taking place in the lounge areas, although we observed a new member of staff playing Connect Four with a person, whilst overseeing another who was colouring a drawing. Several people were asked about activities at the home, one would like to have singers and dancers brought in on a regular basis, the other would like to be taken out on day trips. Other comments we received from people who use the service were: Every effort is made to engage residents in group activities. Not interested in activities. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Staff were seen to supervise people in the dining and lounge areas. An observation from the expert by experience: The residents and staff appeared to interact well with each other, with people seeming to be confident in speaking to staff. The staff spoke to the residents in a polite manner, taking time to listen to residents, explaining their actions, providing reassurance and giving their full attention to the residents. During the serving of lunch I noticed that a member staff and two residents were singing away to the songs that were playing in the background. They knew the words to the songs which indicated to me that the music was played a regular basis. I noticed during lunch both staff and residents said thank you to each other. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and individuality are respected in policy and action, which we found to be generally true. Those individuals rooms inspected showed a positive influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. We found that the standards of catering offered a satisfactory service, to which those people we spoke with were in the main complimentary of quality and presentation. A menu on a four weekly cycle offered a wholesome, varied and suitable choice. We observed a pleasant lunch served during inspection, with a choice of casserole of chicken, or tuna salad, with optional preferences matched, served in comfortable and pleasantly furnished dining rooms. Several comments we received indicated: Okay meals, Always happy to provide what I like. Kitchen staff work hard to produce good wholesome meals and the main mid day meal that I have seen and tasted would be enjoyed by anyone. Can ask for different things, and Served up nicely. Care Homes for Older People Page 18 of 34 Evidence: We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people using the service. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We found that peoples legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies in place, for example, the complaints procedure, which we examined. Since the last inspection there have been four complaints received by us, each had been dealt with by the Provider in a satisfactory manner. There had been six allegations submitted requiring Safeguarding intervention, none being sustained. We feel that all complaints would be better dealt with through a record of concerns, complaints and safeguarding, to record peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that matters were handled immediately, discretely and to the satisfaction of all concerned. We saw evidence in case tracking that people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. Comments we received from people who use the service, through the surveys returned: Dont know who to Care Homes for Older People Page 20 of 34 Evidence: speak to if not happy. Usually some one to speak to. Our discussion with the care manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. It is stated in the AQAA that emphasis is placed on staff training and raising abuse issues at supervision sessions. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined five staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, satisfactorily maintained, clean and comfortable environment for the people who live there. Evidence: Stubby Leas Care home is situated in its own, extensive grounds, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure, and we were informed, used extensively during the summer months. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. The new reception area was found to be secure, although a recent incident highlighted the potential risks involved when security is relaxed. Since the incident a heightened level of attention has been maintained. The general state of exterior repair and maintenance was found to be satisfactory. We were informed that on admission the acting care manager assesses each individuals needs for equipment and necessary adaptations, we found this to be correct, and saw those facilities available throughout the home, with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors; wheelchair access was satisfactory throughout the home. We observed that people had access to all communal areas, allowing relative freedom, including wheelchair access, in an improved, maintained, clean and safe Care Homes for Older People Page 22 of 34 Evidence: environment. The Fire Officer report for the 05/01/09 had been received, with no major concerns. Our inspection showed us that fire doors were secure, equipment recently maintained and staff training in progress. One fire extinguisher was found to be free standing in the corridor passageway. which was immediately made secure. Communal areas present much improved, pleasantly furnished areas to accommodate social or reflective needs, in a homely setting. There are four main lounges, each providing a comfortable seating area, with a good standard of furnishings. On the day of inspection staff were seen to be deployed in lounges with people, and actively engaged in interactions. There are two pleasant dining rooms, clean and fresh smelling. A large activity room is recognised as an activity centre, although poorly used by people in the home. There was evidence of good quality craftwork and art that people has achieved since the activity coordinator has been in post. A sensory area has been identified, but not completed, remaining locked due to the unsafe situation with equipment stored, and unfinished work. Efforts had been made to provide a homely atmosphere and the decor throughout was found to be of a much improved standard. Recent redecoration of bedrooms, new carpets and upgrades to bathrooms were satisfactory. The lounge spaces allow activities to be presented in pleasant areas of the home, with furniture and fittings of a good quality. The dining area is well furnished, and presented to provide a good quality, conducive environment, to enjoy a good meal. We observed that staff supervision is available throughout the day. We found sufficient evidence to confirm the progressive refurbishment programme, as presented in the AQAA. Bedroom areas were seen to be generally better maintained, decorated and furnished; some seen to have been personalised with peoples possessions, and some personal furniture brought in with them. The ongoing redecoration and maintenance are continuing, evidencing the Providers commitment, as stated in the AQAA. Bedrooms were individually and naturally ventilated, and windows were provided with restrainers for safety and security reasons. Radiators and hot water temperatures were regulated to reduce the risks of accidents from scalds, and all personal electrical equipment were seen to be tested. People we spoke to during the course of the Inspection expressed their general approval of their accommodation standards. Some comments we received from people who use the service: A bit difficult at times to find somewhere private, but it is very comfortable. In spite of ongoing refurbishment the cleaning staff do a very good job of keeping the home fresh, clean and tidy. Seasonal Care Homes for Older People Page 23 of 34 Evidence: and topical displays have helped to brighten communal areas and I thought the hand made flower arrangements on the dining room tables was inspired. Someone always cleans every day. Bedroom always nice and clean. The expert by experiences report highlighted specific areas of observation: I had the opportunity to see some of the residents bedrooms with the Inspector and the senior carer who showed us around. I observed that the carer knocked before entering each room. The decoration of the home is of a reasonable standard, and there is new carpet throughout, apart from two rooms, one of which I viewed. There were no unpleasant odour. The standard and presentation of all the toilets and bathrooms continued to be an improving quality of decoration and decoration, having been recently refurbished. They were seen to be clean, uncluttered and odour-free. Toilets are accessible to all, and within close proximity to all communal areas. The domestic services in the Home were seen to be of a good standard. The home presented to us a clean and pleasant atmosphere, much to the credit of the staff. To complement the presentation there were a number of floral and decorative displays. Those people we spoke to, and the assessor remarked, that they found the environment very clean, and fresh. The kitchen was inspected with the cook, and found to present a well equipped and organised area. All fridges and freezers were seen to be used in the appropriate manner, although two freezers were heavily damaged due to wear and tear, but were checked daily by the kitchen staff. A cleaning schedule was in place, that needed daily records to be accurate, up to date and comprehensive. The kitchen floor was found to be very slippery, due to the type of cleaning agent used. We spoke with the cook who confirmed to us that she actively engages with people who use the service, to determine their needs and little ways. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further staff training, monitoring and supervision are required to ensure staff have the appropriate skills and knowledge to meet peoples needs. Recruitment processes are inconsistent and need review to ensure protection of the people who use the service from harm and abuse. Evidence: There were 39 people using the service on the day of inspection, which included 26 people requiring nursing care. Three weeks of duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. We recognised that the care manager is supernumerary to the staffing rota. Flexible rostering, with agreed overtime, are used to accommodate shortfalls due to sickness and absence; agency staff are infrequently employed. The staffing establishments were examined and found to be satisfactory in meeting the staffing standards. The acting care manager is supported by a team of Registered Nurses and experienced senior carers. It is recognised that there has been a positive commitment to decrease the reliance on agency nurses. The administrative, catering, domestic and laundry staff were found to be appropriate for the size of the home, and the needs of the people who use the service. We were informed through the AQAA that 19 (80 ) care staff have National Vocation Care Homes for Older People Page 25 of 34 Evidence: Qualification (NVQ) II or III, with new staff committed to undertaking training. This was confirmed on examination of training records, and speaking with staff. We have noted through our examination of staff records, and discussions with staff that a training programme is drawn up, although the records have not been kept up to date to evidence the effort. It is recognised that staff received a meaningful induction programme to meet their level of experience, and that mandatory training is given. A training matrix has been drawn up for implementing, but due to the recognised trainer leaving, the programme has fallen behind. It was agreed that a Registered Nurse would take up the responsibility for ensuring that training took place at the appropriate times, and that staff records be kept up to date. Staff supervision has not taken place since last October 2008, and it was agreed with the acting care manager that the programme be reintroduced as soon as possible to build on the good efforts of last year. The Provider and Care Manager have established, and continue to pursue a satisfactory procedure for interview, selection and appointment of staff. The thoroughness of improved staff selection has a significant effect upon the provision of care to ensure protection of people who use the service. Five staff files were examined and confirmed that the policies in place were inconsistently acted upon. The manager was advised to ensure a thoroughness in adopting appointment procedures and maintaining records. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. Five staff were interviewed and confirmed the policies and procedures in practice. All staff have the General Social Care Council code of conduct. We advised that the staff record be reviewed in the way information is organised and presented. Discussion with staff demonstrated the need for an ongoing process of supervised practice, to take place six times a year. Several comments we received from people who use the service and their relatives: All the staff at Stubby Leas are friendly and caring. They are like a big family. Im happy to know my wife is in good hands. Never had any problems with staff, and Nice staff. Often difficult to find the nurse, or someone in charge, at weekends and evening times. Nurses keep changing. One visitor told the expert Staff were kind and did the best that they can for the residents. However, he felt that the staff worked very hard, and he was of the opinion that more care staff were needed to ease the pressure on the current carers. Another visitor said to her: She can ask the staff for anything, and nothing was too much of a bother for them. The expert by experience commented: Care Homes for Older People Page 26 of 34 Evidence: The interaction between the staff members on the floor appear to be good. The staff appear to be happy, talking to each other, smiling and working as a team. I did not see or feel any uneasiness amongst neither the staff who were interacting with the residents, nor the staff who were carrying out their domestic duties. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can expect that the home is run in their interests, based on openness and respect. Evidence: The registered manager had ceased employment, and a new acting manager has been in post since September 2008. He is a Registered Mental Nurse with eight years experience, working in a variety of care setting, including that of nurse team leader in HM Prison Service. He had not submitted an application form for registration with us at the time of inspection, but stated that it was in the process of being addressed. We recognise that he has been appointed to head a team of Registered Nurses that represent a new, inexperienced team. We have, however found a willingness to demonstrate a more assertive commitment to the management task in hand, in Care Homes for Older People Page 28 of 34 Evidence: addressing assessments, care records and risk assessments for review, and inadequate maintenance of the staff supervision and training programmes. There was however sufficient evidence to show that a good standard of care practice has been observed, with many comments addressing clinical competence, and a very caring attitude and environment. We spoke with the General Practioner who helps to provide cover for the home, who indicated his approval of good standards of care, the recent improvements made in care planning, and arrangements for the provision of medical cover in general. Surveys sent out to people who use the service before the inspection: The owners have made many improvements to this old property. Senior staff work hard to keep the home working smoothly, junior staff are helpful and pleasant. Would like to stay in bed in the mornings. Happy with home and settled. A lovely home very relaxed, friendly, homely atmosphere. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning, review and monitoring, and of the general environment, these are to be reviewed to encompass peoples security and safety, including a full unit inventory of risk. Recent inspections by a Health and Safety Officer and a Fire Officer have been completed, both with no serious concerns. Health and safety notices can be seen throughout the Home, although chemicals safety notices should be prominent in areas of use and storage. The organisation operates a quality assurance system, which includes a number of audits and questionnaires for people who use the service and their relatives. Our examination of administrative, monitoring, planning and care records showed to us a period of inactivity in the review process, which has been addressed, showing a positive attitude to effective, meaningful care, and essential management record keeping. We found them to be much improved over the past few weeks, generally well maintained in ensuring that the peoples rights and best interests are safeguarded. Records inspected included surveys asking people who use the service their opinion, which are conducted annually by Stubby Leas. The acting manager offered evidence of procedure reviews, and safe working practices. We examined the accident records and found them to be in order, with a regular, and effective follow through of action taken, including a review of care plans and risk assessments, if necessary. We were informed through the AQAA, and by the manager that financial arrangements are supervised and controlled by the Registered Provider and the home administrator, in respect of personal allowances, comfort fund and petty cash management. Care Homes for Older People Page 29 of 34 Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 11 The acting care manager is to be registered with the CSCI. To ensure that a suitably qualified and experienced person is in place to run the home. 01/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 That the Statement of Purpose and Service User Guide be updated to reflect change and that consideration be given to producing the documents in larger print and audio versions, to assist people with poor eyesight to make an informed decision. That peoples care plans are generated from a comprehensive assessment in a consistent manner, to provide the basis for care to be delivered and reviewed at least once a month. That the storage of Controlled Drugs be secured by Rag Bolting to the medicines cabinet, to ensure a secure control over Controlled Drugs at all times. That inconsistencies in MAR sheet administration be reviewed and the approved policy be reinforced, to ensure 2 7 3 9 4 9 Care Homes for Older People Page 32 of 34 a satisfactory audit trail for the receipt, administration and disposal of medicines. 5 12 That people are given opportunities for stimulation through leisure and recreational activities in a consistent and structured programme. These should suit peoples needs, preferences and capabilities. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. Ensure access to all storage rooms be secure to casual entry by people who use the service, to minimise risk of injury. That a full unit risk assessment programme be updated, to enable the management to review safety, and appraise facilities on a regular basis. That thermometers be placed in each bedroom, and all communal areas to monitor the central heating, in ensuring a consistent temperature is maintained. That the kitchen floor be made safe from slipping That the Provider operates a thorough staff recruitment and appointment procedure, ensuring the protection of people who use the service. That the Provider produce a staff training development plan for 2009/10, to identify needs and resources to effect a suitably trained workforce, and that training records be kept up to date. That the acting manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. This will address the maintenance of effective care planning, risk assessment, review and monitoring of care. Regular formal staff supervision, should be undertaken by competent trained staff in order to support and guide staff, and enhance outcomes for residents. 6 7 16 19 8 19 9 25 10 11 26 29 12 30 13 32 14 36 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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