Inspection on 16/06/09 for Summerdyne Nursing Home

This inspection was carried out on 16th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Summerdyne Nursing Home 26/07/07

Summerdyne Nursing Home 03/10/06

Summerdyne Nursing Home 10/10/05

Summerdyne Nursing Home 03/05/05

Summerdyne Nursing Home 21/10/04

Summerdyne Nursing Home 28/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Summerdyne Nursing Home Cleobury Road Bewdley Worcestershire DY12 2QQ     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: Sandra Bromige     Date: 1 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Summerdyne Nursing Home Cleobury Road Bewdley Worcestershire DY12 2QQ 01299403260 01299403174 tuulapage@heritagemanor.co.uk Heritagemanor.co.uk Heritage Manor Limited care home 27 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 27, Old age, not falling within any other category (OP) 27 Date of last inspection Brief description of the care home Summerdyne Nursing Home is situated on the outskirts of Bewdley on a bus route. It is an adapted house with a purpose built extension. The service provides personal and nursing care for up to twenty-seven older residents of either sex who may have physical or mental frailty that requires continuing care. Accommodation is provided in seventeen single rooms, thirteen of which are ensuite. The remaining rooms are all ensuite double rooms. There is a shaft lift to facilitate movement between floors and there is a small garden and gazebo for the residents. Care Homes for Older People Page 4 of 34 Over 65 0 27 27 0 Brief description of the care home The registered provider is Heritage Manor Ltd. The registered manager is Mrs Tuula Page. Up-to-date information relating to the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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, the commission completed the last inspection of this service on 26th July 2007. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well Care Homes for Older People Page 6 of 34 outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, health professionals who visit the service and staff working at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 The information provided by the home for prospective people who may choose to move into the home needs to be available in alternative formats such as large print and audio to ensure they are able to meet the diverse needs of the people they provide a service for. The approach to care is not person centred and records are not fully completed and up-to-date which has the potential to place people at risk of not receiving the care they need. The home must ensure care plans are updated as peoples needs change so that staff are aware of, and are able to meet peoples individual needs. Improvements are needed to the management of medication to ensure people receive medicines as prescribed and are not placed at risk of harm through medicines being stored incorrectly. There are weaknesses in the environment which may compromise the privacy and dignity of the people living in the home. The home need to review how privacy curtains are fitted in an identified shared room and to provide approved door locks for bedrooms, en-suites, toilets and bathrooms. High calorie foods should be provided for people according to individual assessed needs and not for all people living in the home to ensure they receive a diet suitable for their individual health care needs and choice. People living in the home should be asked if they would like audio books and newspapers provided to ensure people with failing sight have the opportunity to maintain their interests. Improvement is needed to signage in the home so that people with dementia can identify the homes facilities and improve their independence. The management of infection control is generally well managed although staff need to be stopped from using the kitchen as access to staff rest facilities to ensure there is no risk of cross infection. The home need to ensure staff are not deployed to work in the kitchen in the same uniform when they have been cleaning the home or attending to peoples dirty laundry to prevent cross infection. The owners need to consider providing more communal space for people living in the home to enable people to sit in social groups and to provide an area where they can sit quietly away from the noise of the television or music playing. 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 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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, what they hope for and want to achieve, and the support they need. Evidence: The Statement of Purpose and Service User Guide is available at the entrance to the home for people to read. It is not available in any alternative format such as large print or audio. This needs to be addressed so they are able to meet the diverse needs of the people they offer a service for, for example partially sighted and people with dementia. The records for a person who had recently moved into the home contained a preadmission assessment carried out by the manager by telephone. The home had also obtained a copy of the Community Care Assessment summary from Social Services. Care Homes for Older People Page 11 of 34 Evidence: There were two parts of the assessment which had not been completed, which related to safety and risk for this person. There was enough information in the assessment to enable the staff at the home to prepare for the admission of this person. Information had been given to the person about the home. The Annual Quality Assurance Assessment (AQAA) told us all residents have an indepth pre-admission assessment, this is done just prior to admission to ensure the home is able to meet the individual needs of the resident. Information is gathered from staff currently caring for the resident e.g. ward staff, social worker, care plans and family as well as the resident themselves. The assessment determines the homes ability to meet the needs of the resident. Surveys completed by people who use the service told us they were given enough information about the home to decide if the home was the right place for them before they moved in. Care Homes for Older People Page 12 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. People receive personal support from staff in the way they prefer and want. Their physical and emotional care needs are generally met, although the approach to care is not person centred and records are not fully completed and up-to-date which has the potential to place people at risk of not receiving the care they need. Improvements are needed to the management of medication to ensure people receive medicines as presribed and are not placed at risk of harm through medicines being stored incorrectly. The staff treat people with kindness and respect their privacy and dignity, although there are weaknesses in the environment which may compromise the privacy and dignity of the people living in the home. Evidence: We tracked the care of two people living in the home. We looked at the care records for these two people and found there were areas which needed improvement to ensure staff have the information they need to meet the needs of these people. Care records are available for care staff to read, although care staff told us they had not read the care plan for a recently admitted person and they do not refer to them each day whilst giving personal care. The care plan for a person admitted to the home Care Homes for Older People Page 13 of 34 Evidence: seven days prior to the inspection visit was not complete. For example, the admission sheet was not signed or dated by the trained nurse who completed it and there was no information about the persons past medical history or their medication on admission. There were two care plans identifying problems and needs of confusion and personal hygiene. These had been written three to five days after admission. We spoke to the trained nurse who told us this person wore an incontinence pad but there was no care plan for continence to ensure care staff were aware of this. The pre-admission assessment stated this person was diabetic, although there was no care plan for this. An assessment of this persons activities of daily living was completed, this was very informative but the detailed information in the assessment had not been included in the care plan. For example, the assessment gave good information about this persons preferences regarding hair care, perfume and jewellery but this was not in the care plan. The second care plan we looked at was informative and had been reviewed on a regular basis, but it also had areas which had not been reviewed for over a month and following changes to care needs. For example, the care plan for diabetes said observe for sign of hyper or hypoglycaemic attack, but what these are and what action staff need to take was not available. This person is assessed as being at risk nutritionally and is being weighed weekly. The Malnutrition Universal Screening Tool (MUST) risk assessment dated 25th May 2009 was not fully completed. The care plan for sleep refers to the use of bed rails and there is a risk assessment for the use of bed rails which was last reviewed in April 2009. The bed rail risk assessment says Does the service user have dementia?. No is circled on the completed assessment. This is not accurate as an entry in the care records dated May 2009 mentions a diagnosis of vascular dementia for this person. We looked at this persons bedroom and saw there were no bed rails in use. We spoke to care staff who were looking after these two people on the day of the inspection. Overall they had a good knowledge of their care needs but they were not using the care plans as a point of reference each day. There was some significant information about these two people living in the home which they did not know, either because they were not reading the care plan or the care plan did not contain this information. For example, one person was registered partially sighted and one person wore continence pads. We could see from entries in the care records that health professionals such as the general practitioner, specialist doctors and nurses are contacted by the home when people are unwell or their needs change. Comments in surveys completed by health professionals told us it is a very caring service, thoughtful and appropriate re calls for medical review. Residents care is their priority. The nursing home provides a caring service to all of its residents. Relatives appreciate the homely atmosphere, the Care Homes for Older People Page 14 of 34 Evidence: courtesy of the staff and the amount of information available at all times regarding their own relatives in the home. The manager told us she had a meeting with the trained staff last week to discuss care plans and the new format which they are implementing to ensure a person centred approach to care planning. We spoke to three relatives of people living in the home and they were all very complimentary about the home. One person told us their relatives health had improved since they moved into the home. Comments in surveys completed by people who use the service and their relatives told us, the care is first class, residents are treated with respect and relatives always made to feel welcome. The care X (persons name) receives at Summerdyne is first class. The staff keep me fully informed on Xs care and welfare and discuss any issues or problems that may arise from time to time. I cannot fault the care X receives. Comments in surveys completed by staff told us, the staff work as a team, supporting each other to ensure that the residents care is the best. We look after our residents very well. We treat them as an individual and they are given a choice. All the family are well informed on what is happening to their relatives that live in Summerdyne. We looked at the management of medication for these two people living in the home. The medicine charts are handwritten. We saw some medication for one person was prescribed to be given when required. The handwritten entries for this medication had not been signed by the trained nurse and it had not been checked for accuracy by a second trained nurse to ensure the correct medicine and dosage had been written on the chart. There was no information in the care records to inform staff why this person was prescribed this medication and no care plan for the use and management of the medication. We were unable to do an audit of any medication for one person as the home had not recorded the medication they received when this person came into the home. We carried out an audit of some of the medication prescribed for diabetes for the other person we tracked. Neither of the audits showed the correct amount of medication remaining. The staff are recording medication received on a separate sheet, they are not recording this information on the medication administration records. We looked at the homes medication policy which was reviewed in January 2009. The policy states for receipt of medicines, quantity received is recorded on the MAR sheet and signed by the nurse checking. The trained staff are not following the homes medicine policy and procedures. We looked at the controlled drugs. The fixing Care Homes for Older People Page 15 of 34 Evidence: of the controlled drug cupboard does not comply with legislation. We checked the controlled drug stock and this was correct. The home are not monitoring the temperature of the room where they store medication to ensure it is being stored within the recommended temperature range to prevent it going off. The records of the fridge where medication is stored showed the temperature was within the range recommended by the manufacturers. We saw staff respecting peoples privacy and dignity by knocking on doors before they went into the room and closing doors whilst giving personal care. We saw two shared bedrooms, they both had privacy curtains, but in one room they did not fully enclose both beds. This needs to be addressed by the home. The last inspection report identified a shortfall in the environment that had the potential to compromise privacy. This was in relation to locks to bedroom doors, en-suites and bathrooms. The manager and Director of Care told us this had not been addressed. We saw the rooms of the people we tracked and they were not able to lock their bedroom doors from the inside to enable them to ensure their privacy if required. This was discussed with the Director of Care and manager of the home and as an interim measure they agreed to ask people upon admission if they wish to be able to lock their bedroom from the inside and if so a lock approved by the fire authority would be fitted. The remaining locks for bedrooms and communal facilities will be fitted to rooms as part of the planned refurbishment of rooms in the home. 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. People have opportunities to develop their social and recreational interests. This is because the staff provide the opportunity within and outside the home and support them to join in. People choose and participate in suitable leisure activities. People have healthy, well presented meals and snacks, at a time and place to suit them. Evidence: The information in the AQAA told us the home have a Diversional Therapist in post who offers a variety of activities aimed at physical and mental stimulation e.g. quizzes, chairobics and we have visiting entertainers. Residents are taken out on a trip once a year. Residents live to their own routine, choosing when to rise and retire, timing of bathing, preferred method of bathing, choice of who to socialise with or where to spend their day. Residents are encouraged to personalise their own rooms and we have a handyman who can assist with this. We believe social activities, religious beliefs and personal relationships are supported to enable the resident to have a fulfilling life. We saw in the care records of the two people we tracked the times they wish to rise and retire to bed and how often they would like a shower or bath. One person was having a bath every day. The homes Service User Guide has information about Care Homes for Older People Page 17 of 34 Evidence: religious services and visiting the home. The social carer told us they have communion and a church service once a month. We spoke to a relative who told us they visit at all times of the day. We spoke to the social carer whose role it is to provide a programme of social care for each person living in the home. This person had a good knowledge of the hobbies and interests of the two people we tracked and we were shown records of activities attended for one person. Care records had information about peoples life history and their preferred hobbies but there were no social care plans in place. Activities and events for the year are displayed on the notice board and for people who choose to spend all or most of their time in their own room, the social carer tells them what events are planned. Activities are provided Monday to Friday and occasionally at weekends. Activities are held for groups of people or one-to-one with people. Religious festivals such as Easter are celebrated in the home. Group activities are planned, which are appropriate to the age and gender of the people living in the home. For example, quizzes, discussions about farming and machinery, music and movement. Two visitors told us they had attended a fish & chip supper and bingo event at the home. The home has entertainment brought in once a month and people are offered the opportunity to go out into the community with staff on a individual basis or on a planned trip to a place of interest. Information in surveys from staff working at the home said there is a very good programme of social care, including entertainment, outings and one to one activities. There is a family atmosphere wihtin the home which is very welcoming. Staff told us the home have a library of books for people to read, these include large print books for people with sight problems. They do not have any audio books for people who are not able to read the large print books. The information in the AQAA told us the home has a varied flexible menu which is changed to accommodate the preferences of the residents. Cooked meals are offered three times a day and include a full English breakfast if required. We looked at the menus for a two week period. These show a choice of continental breakfast including fruit and porridge and a cooked breakfast each day. Dinner menus show a choice of main meal each day, a vegetarian option is not available every day but the manager told us they do not have any vegetarians at present. Roast dinner every Sunday and sometimes one day during the week. There is a daily dessert with a choice of fresh fruit salad each day and some days a milk pudding is available. Puddings suitable for people with diabetes are provided. We ate lunch at the home of Care Homes for Older People Page 18 of 34 Evidence: pork loin with duchesse potato and carrots, sweetcorn and peas followed by a dessert of creme caramel. The meal was nicely presented, hot,tasty and the meat was very tender. One person we tracked was not eating well and their weight was fluctuating. We spoke to the chef and asked them how they provided high calorie food for people who need a high protein diet. They told us they put cream in the mashed potato for everyone. This is not good practice as it is not a person centred approach to care and some people living in the home may need a low fat or low calorie diet. We spoke to relatives of people living in the home and they told us they had attended a recent meeting with people living in the home. The home manager asked for any suggestions about the food and activities provided in the home. They told us everyone at the meeting was satisfied with the quality of the menus and activities provided by the home. A comment from a relative in a completed surveys said they would like a bit more variety for evening meals. X (persons name) gets a bit fed up with sandwiches most evenings and something a bit more substantial as X doesnt always eat their lunch and has lost a lot of weight. This is due to their dementia but X needs to be encouraged to eat. Information in surveys from staff working at the home said the food is excellent with a variety to choose from. We saw staff assisting people to eat in the dining room and taking meals to and assisting people to eat in their bedrooms. We saw one visitor come into the home and order lunch. Staff told us they eat lunch at the home alternate days with their relative. We saw the person and visitor eating lunch together in the privacy of the bedroom. 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. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and harm and takes action to follow up any allegations. Evidence: The information in the AQAA told us all new residents and their families receive a copy of our complaints procedure. There is also a copy displayed in reception and in the Service Users Guide, with all appropriate options on where to make a complaint. The numerical information in the AQAA told us they had not received any complaints or made any safeguarding referrals in the last twelve months. Information in five surveys from people who use the service all told us there is always someone they can speak to if they are unhappy. We saw a copy of the homes complaints procedure in the Statement of Purpose and Service User Guide which is on display in the entrance to the home. It is not available in alternative formats such as large print or audio versions. This needs to be addressed. We looked at the homes complaints records and no complaints have been received in the last twelve months. We spoke to a visitor who told us there is always someone to speak to - any concerns are addressed immediately. We spoke to care staff who were all aware of the homes complaints procedure and what to do if they Care Homes for Older People Page 20 of 34 Evidence: received a complaint. The information in the AQAA told us residents are protected against abuse through policies and procedures, staff training, supervision and induction. Staff undergo POVA training so they are able to identify any sort of abuse and report it promptly. Staff undergo a thorough recruitment process. We spoke to staff working in the home and they had all received training about protecting people from abuse. They told us they had a recent staff meeting and the manager gave them a leaflet about whistle blowing. They were all very clear of the action they would take if they suspected any kind of abuse in the home. The manager told us she had attended a seminar the day before which was organised by Worcestershire County Council who are the lead agency for co-ordinating safeguarding investigations. The seminar was about abuse of elderly people. We spoke to a member of staff who had recently been employed by the home. They told us they had to complete a Criminal Records Bureau(CRB) check and provide references prior to being accepted to start work in the home. This is good practice and protects people from any potential harm from abuse. The information in surveys completed by seven staff all told us the employer carried out CRB checks and obtained references before they started work at the home. The organisation has just produced a new policy about the deprivation of liberty safeguards, which has now been given to the manager to implement in the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well maintained home that is homely, clean, comfortable, pleasant and hygienic. Improvement is needed to signage in the home so that people with dementia can identify the homes facilities and improve their independence. Infection control is generally well managed but certain established practice needs addressing to protect people from harm due to cross infection. Evidence: The information in the AQAA told us the home have improved the following for the comfort and enjoyment of the people living in the home; purchased some new specialist nursing beds, re-decorated several bedrooms and the lounge, developed a patio area in the garden and trees have been cut back to give more light. New garden furniture. New large flat screen television and CD player for the lounge. The numerical data in the AQAA told us all equipment has been serviced within the required timescales. Assessments are in place for any chemicals used in the home for cleaning. An action plan is in place for infection control and all staff have receive training. We were notified of an outbreak of diarrhoea and vomiting in the home and the action taken by the home to prevent any cross infection was excellent. We looked at the parts of the home being used by the people whose care we tracked. The bedrooms were nicely decorated with matching bedspreads and curtains. People had brought in their own furniture and pictures. They had a lockable drawer provided Care Homes for Older People Page 22 of 34 Evidence: so they can lock any valuables away. Window restrictors were in place in both of the bedrooms and bathroom seen on the first floor to prevent people injuring themselves. The en-suite toilets were of a good size and were clean and tidy. Wash bowls were clean and dry. The bathroom had an assisted bath. The hoist had a sticker on it which said it had last been serviced in April 2009. The flooring was non-slip. We saw plenty of gloves in all of the rooms and hand washing facilities for staff to prevent cross infection. Staff have been provided with individual bottles of alcohol gel which are pinned to their uniform and used as an added precaution to prevent cross infection. All parts of the home was clean and tidy and there were no bad odours. Surveys from people who use the service told us, the home is always clean. Staff told us in surveys it is a clean and homely environment to live and work. A health professional said the home is always clean. There is one lounge in the home. Due to the size and shape of the lounge and space is also needed to use a hoist for people who are not able to stand; the chairs are all situated around the outside of the room and are not in social groups enabling people to chat to each other. The manager told us she would like a conservatory built to provide more day space. The visit by a representative for the owner in February 2009 under the section What other improvements, if any, do you plan to make as a result of this visit? stated, it would be nice if a conservatory could be built onto the lounge area to increase the available space for residents. In the care records for one person we tracked it stated under likes & dislikes, dislikes noise, likes peace and quiet. We observed this person sitting in the lounge, the television was on one end and music was playing the other end of the lounge. There was no communal quiet area for them to sit and they shared a bedroom with another person. There is no loop system for people with hearing difficulties who use a hearing aid to assist them to listen to the television in the lounge. Comments in surveys from staff said people who use the service need more space in the lounge. The lounge can be congested and noisy when there are visitors, so an extension would help. The lounge can get very noisy in the afternoons it would be nice to have a quiet room where the residents could go and sit to just talk or play cards. The home offers specialised care for people who have dementia. There is no pictorial signage around the home to enable people with dementia to identify toilets and bathrooms and their own bedroom. This needs to be addressed. The last inspection report dated July 2007 made a recommendation about the need for Care Homes for Older People Page 23 of 34 Evidence: approved bedroom and ensuite door locks. The manager confirmed this has not been addressed. Please refer to the health and personal care section of this report. The last inspection report dated July 2007 made a recommendation about staff access to the laundry and the facilities provided. We saw laundry staff taking washing to and from the laundry via the front door of the building. Staff told us the laundry staff collect the dirty laundry from the bathrooms. The laundry is carried by the staff. We asked to see the moving and handling risk assessment for this task. A specific risk assessment was not available. We discussed the potential health and safety risk to staff by carrying bags of laundry from the home into the laundry room. The Director of Care agreed this needed addressing immediately by providing laundry skips on wheels and ramped access from the home and into the laundry room. Improvements have been made to the laundry as a coded lock has been installed to prevent any unauthorised access and a hand wash basin has been installed for staff to wash their hands to prevent cross infection. We raised two areas of concern with the manager and Director of Care relating to cross infection. We saw two staff using the kitchen as a corridor to the home from the staff room/laundry area. We saw a member of staff during the morning of the inspection cleaning the home, they were then working in the laundry and were also deployed to help in the kitchen at lunchtime. This is high risk with regards to cross infection. Although we were told the employee would have changed their apron and washed their hands thoroughly before going into the kitchen, they were wearing the same uniform in the kitchen as they were cleaning all areas of the home and washing soiled laundry. This is poor practice and must be addressed. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified 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. Evidence: The information in the AQAA told us the home is staffed to a good standard, with an established team and staff turnover is low. Home is staffed according to dependency and layout. Appropriate skill mixes are on duty for each shift. All night staff are waking staff and there is always a registered nurse on duty. Staff survey information told us there are always or usually enough staff on duty to meet the needs of the people wo use the service. Surveys from people who use the service told us there are always or usually staff available when they need them. On the day of the inspection visit there were 24 people in the home. On duty there was the manager whose hours are mostly supernumery, a trained nurse and five care staff. The social carer works eight oclock until four oclock Monday to Friday. The same staffing levels were available in the afternoon. The manager told us they have one trained nurse and two care staff at night. These staffing levels were confirmed by looking at the current staff rotas and by speaking to the staff in the home. Staff told us they always had enough staff on duty. The home employs a multi-cultural team of Care Homes for Older People Page 25 of 34 Evidence: male and female staff. The staffing rota for the two week period showed a trained nurse worked 100 hours between the 6th-13th June 2009 followed by one day off and then worked 64.5 hours between 16th-20th June. These excessive hours worked without a day off is of concern as it is in excess of the Working Time Directive and may place people using the service at risk due to staff being over tired. This needs to be addressed by the home manager. A visitor told us the girls are lovely. Comments in surveys said, we admire how everyone takes a pride in running this home 100 efficient. Staff are excellent, very patient and polite. Staff told us in surveys, we always work as a team, help each other and communicate with each other. I enjoy working at Summerdyne, and find that it is rewarding. The information in the AQAA told us 98 of the care staff have NVQ 2 and above, with nine staff at NVQ 3 level. All new staff have one weeks supernumery shifts, to familiarise themselves with the home and the policies and procedures. The recruitment process is followed as laid out in standard 29. Nursing staff PIN numbers are checked prior to employment. All staff have a training record in place and are paid for the training they attend including in house. Information in staff surveys told us their induction covered everything they needed to know and they are receiving training relevant to their job giving them up to date knowledge about health care. We spoke to a new employee and they told us they were interviewed by the manager and all recruitment checks had been done prior to them starting work at the home to ensure people with the right people skills and good character are employed. They had a weeks induction which also included fire training and the theory of moving and handling. We looked at the recruitment file for this person and this confirmed all checks had been carried out by the home prior to employment. There was no written information to show the person had been interviewed. The manager was advised this needs to be recorded. We saw a certificate showing they had attended fire training and the induction booklet showed they had covered all the theoretical mandatory training, but they had not received any practical moving and handling training since starting work at the home. The employee told us they were using the lifting equipment in the home. This needs to be addressed straight away. All other staff we spoke to had received mandatory and additional training within the last twelve months. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. The home need to develop their processes for consulting people who use the service and internal audits to enable them to monitor the standards provided. The environment is safe for the people and staff because health and safety practices are carried out. Evidence: The information in the AQAA told us the manager is a registered nurse of 40 years experience the last 20 years dedicated to the private sector and the last five years in a management role. The manager also holds the RMA. The manager updates herself on a regular basis attending appropriate courses to enable her to fulfill her role and a good understanding of the care standards. We saw a certificate in the managers office for NVQ level 4 (Registered Managers Award) undertaken in March 2006. The manager told us she had renewed her Personal Identification Number(PIN) with the Nursing & Midwifery Council(NMC) in March 2009. Care Homes for Older People Page 27 of 34 Evidence: She has undertaken refresher training for all mandatory training in the last twelve months with the exception of moving and handling. She agreed to arrange to update this straight away. She has renewed her First Aid at Work certificate and has attended course updates for skin care, care planning, the use of syringe drivers and diabetes. She has also attended training about new legislation such as the Mental Capacity Act and the deprivation of liberty safeguards. Visitors and staff told us the manager had held meetings recently with them and people living in the home. Visitors told us the manager asked for any suggestions, comments or concerns about the menus, house keeping and activities and reminded people she was available if they wished to go and speak with her. Staff told us they had a meeting last week and all the staff attended. They were reminded about the need to whistle blow if they had any concerns about the care of the people living in the home. This is evident of a very open approach to managing the home. Staff told us, I enjoy coming to work, residents get full care and all equipment needed. Its lovely to work here. Surveys completed by staff said, our manager is very considerate and caring she is so kindhearted, responding to anything you have reported with such care. The manager is very supportive and kind to staff. The manager is always there if we need to talk. The AQAA told us the home are in the process of implementing quality assessment audits. The manager told us they have carried out the first medication audit recently. Their first major audit of the quality of the service was carried out at the beginning of June, although no action plan has been developed in response to the results of the audit. The same applies to a recent health and safety audit. The manager told us she consulted relatives and people who use the service in February through sending out questionnaires, but has not collated the information yet and any action plan needed. A recent catering audit has been completed and an action plan put into place. The information in the AQAA shows there are a number of policies which the home do not have in place, for example annual development plan for quality assurance, bullying, continence promotion. The Director of Care told us they are aware there are policies not in place and will produce them in order of priority. They have just completed a policy for deprivation of liberty safeguards which will be implemented by the home manager. The information in the AQAA told us all monies and valubles held for residents are kept secure with appropriate records and receipts. We looked at the money held for the people we tracked. We saw receipts for all expenditure and the amounts held was checked and correct. There was only one signature for receipts and expenditure, this is not in line with homes policy. The manager was advised two signatures are needed at all times for any entries. Care Homes for Older People Page 28 of 34 Evidence: We asked to see the reports of the monthly visits by a representative of the company as required through regulation. The manager told us she does not receive them. We told her she must be given a copy each month. It was evident from discussion with the manager these visits are not unannounced as required. We discussed this with the Director of Care who agreed to ensure any future visits are unannounced. The numerical information in the AQAA told us all equipment has been serviced within the required timescales. We looked at the maintenance record checks for the following; window restrictors, bed rails, the prevention of Legionella and water temperatures. We saw that regular checks had been recorded. Staff spoken with had received their statutory health and safety training, although two staff need moving and handling training as soon as possible. Approved door locks need to be fitted. Please refer to the health and personal care and environment sections of this report. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (2)(b) You must ensure that care plans are kept up to date and are amended to reflect peoples changing needs. This is so that staff are aware of, and are able to meet, peoples individual needs. 31/07/2009 2 9 13 (2) To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. To ensure controlled drugs are being stored safely and securely to prevent misuse. 19/08/2009 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 13 (2) To make arrangements to ensure that medication is stored securely and at the correct temperature recommended by the manufacturer. To ensure medication does not deteriorate which can make the medication ineffective and possibly harmful to people living in the home. 31/07/2009 4 9 13 (2) To make arrangements 31/07/2009 to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on a when required basis and what constitutes needed for a named person. To ensure staff know when and how to give the medication. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should be available in alternative formats so that it meets the Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations diverse needs of the people they provide a service for. 2 10 The privacy curtains in shared rooms should fully enclose both beds to ensure peoples privacy and dignity is maintained at all times whilst assisting with personal care. High calorie foods should be provided for people according to individual assessed needs and not for all people living in the home to ensure they receive a diet suitable for their individual health care needs and choice. People living in the home should be asked if they would like audio books and newspapers provided to ensure people with failing sight have the opportunity to maintain their interests. Doors locks should be provided which are approved by the fire authority which enable people to lock the bedroom, ensuite, and bathroom doors from the inside to ensure their privacy is maintained and respected at all times. Consideration should be given to increasing the communal space in the home to enable people to sit in social groups and to provide a quiet area for people. Consideration should be given to providing pictorial signage in the home to enable people with dementia to identify the facilities in the home and supporting more independence. Staff should not walk through the kitchen to access the staffroom and laundry facilities to prevent cross infection. 3 15 4 15 5 19 6 19 7 19 8 26 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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