Inspection on 28/01/09 for The Close Nursing & Residential Home

This inspection was carried out on 28th 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Close Nursing & Residential... 28/01/08

The Close Nursing & Residential... 05/01/07

The Close Nursing & Residential... 27/01/06

The Close Nursing & Residential... 08/09/05

The Close Nursing & Residential... 22/11/04

The Close Nursing & Residential... 29/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Close Nursing & Residential Home The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP     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: Ruth Lough     Date: 2 8 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 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 36 Information about the care home Name of care home: Address: The Close Nursing & Residential Home The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP 01865407343 01865407734 closenhome@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cavendish Close Limited Name of registered manager (if applicable) Mrs Nyembezi Chipara Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 97 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Close is situated close to the market town of Abingdon and approximately 6 miles south of the city of Oxford. The home is set in 4 acres of grounds with access to the banks of the river Thames. An extensive new building has replaced the previously outdated and unsuitable facilities at the front of the home in 2005 and 2006. These comprise of purpose-built Care Homes for Older People Page 4 of 36 care home 97 Over 65 97 0 Brief description of the care home two-storey buildings, with 51 en-suite bedrooms, offices, and new kitchen and laundry facilities serving the whole site. The remaining older part of the home to the side and rear of the site has accommodation for a further 46 residents in sixteen single and fifteen shared rooms. The range of fees is from £542 to £850 per week. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in January 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service and the staff who give the support were consulted about their opinion of what is provided, through surveys and during the day. Care Homes for Older People Page 6 of 36 A health professional who has been involved with the service was also contacted. From this visit it was found that a number of requirements and recommendations that were made to improve the service during the last inspection process have been met, although some recommendations still have not been fully followed up. There were some areas that will need to continue to improve as to protect the people they support and six requirements were made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: They should improve the information provided in the Statement of Purpose and Service User Guide to prospective and current residents to give them sufficient information to reflect the actual services and facilities provided. They should continue to improve the record keeping for care planning for individuals. The care plans should reflect that the information obtained from the initial assessment have been followed through and suitable interventions by care and nursing staff put in place to meet the persons needs. There should also be detailed instruction given to staff, of how the identified support is to be provided as to ensure that there is a consistent delivery of care. Again the personal interests, activities of the individual should be noted in better depth and time should be given to provide a planned approach to meeting these. They should practices in place so that there are no gaps in residents receiving the support they need at mealtimes. Care Homes for Older People Page 8 of 36 The complaints procedure should have the necessary information to inform the complainant of to whom they could refer their concerns to, the timescales they can anticipate a response, and the correct information in regard to the commission. Parts of the environment and facilities of the home need to be upgraded, to provide a better quality experience for the people living there. The condition of some of the bathrooms in Waterside continue to compromise the management of controlling the spread of infection around the home, therefore putting residents at risk. Care should be taken to ensure that sufficient information is obtained, verified, and evidence kept that staff have been recruited appropriately. There are gaps in the management and practices for fire safety, food hygiene, and control of substances hazardous to health regulations (COSHH). All of these have the potential to put residents, staff, and visitors to the home at risk. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 9 of 36 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 36 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 looking for a care home are not given sufficient information to make an informed choice to use it. They will have their needs assessed and be given the chance to experience what the service has to offer before making a final decision to stay. Evidence: The experiences of residents entering the home and the information they were provided with, were reviewed to see if the process was a positive one. Of the eleven residents who returned surveys to the commission, one stated they had not received a contract and did not have enough information given to them before they moved to the home. Another put, If I have (received a contract) I cannot remember it. Care Homes for Older People Page 11 of 36 Evidence: Another stated that they had enough information about the home and had, A very prompt interview with the matron/manager who was very helpful. One person wrote, I was given quite a lot of information and came to visit, too. Further comments from others were: It was recommended by social services. I inspected the room and approved. I spoke to several residents who said they liked it. The care manager was helpful and very efficient and so was her deputy. To be able to assess the quality and detail of the information given to individuals, the current Statement of Purpose and Service User Guide were reviewed. The information is provided in a glossy brochure with copies of the required documents plus samples of the homes mission statement, menu, and activity programme. The Statement of Purpose document that was reviewed did not have the required information, much of which should be included such as details of the provider, size of rooms, the range of needs that the home can meet, and the arrangement for dealing with complaints were not found. Additional information had been given in the Service User Guide document. However, neither provided the full details required by legislation as to ensure that prospective residents and their families have sufficient information about the home before they move into the home. There has not been any changes made in the fabric and facilities of the buildings named the Waterside, the previously established part of the home, since the last inspection visit in January 2008. Therefore the detail in the glossy brochure remains misleading to prospective residents. With room sizes, and the lack of formally recognised en suite facilities not clearly outlined in the information. From information given on these documents the Statement of Purpose had been revised in July 2008 and Service User Guide in October 2008. The care records for four residents were reviewed as to establish how detailed and thorough the assessment of individuals needs process is. Three were from one unit of the home, the fourth from another. From the sampled documents the original assessment of need record is not kept with the current daily care records. Two records that were available to view showed that sufficient information is taken about the key Care Homes for Older People Page 12 of 36 Evidence: needs of the person concerned and in addition some of the personal and social history is recorded. The manager and the deputy manager take the responsibility of carrying out any assessment of need process. From discussion with the manager and from information provided residents are given an opportunity to visit the home and stay for a trial period before they give a firm commitment to live there. Care Homes for Older People Page 13 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning records do not ensure that residents can expect to recieve a consistant standard of support from staff as instructions of how to meet their needs are not always clearly outlined. The practices for medication administration are safe and protect the people living in the home. Evidence: Residents responded positively in the survey to the question about obtaining the support and medical care that they need. Some of the comments were; The staff are helpful and caring. They will help if they can. All the staff are so caring and kind. One relative suggested that the home use the services of a physiotherapist for those less mobile and nursed or cared for usually in bed or sit in their chairs for long periods. Care Homes for Older People Page 14 of 36 Evidence: Another wrote that they were under the impression before their relative moved in that physiotherapy would be made available once a week. This impression could have been assumed from the brochure information given with the Statement of Purpose and Service User Guide, indicating that physiotherapy was provided by the service. To the question,do the staff listen and act on what you say, one relative wrote on the residents behalf, The staff are very good, if my mother needs something I ask and they come to deal with whatever the situation very quickly. The care planning is provided in a fixed format of documents that will lead the reader through the various topics for care provision. From the sampled records the nursing staff extract the information from the needs assessment process, any health or social care professionals referrals, or input from the individual concerned. What was evident was that for the two available initial assessment records some of the information had not been transferred. This was with particular reference to the reason why the individual needed to have support from within a care and nursing home environment, and the personal and social history that had been obtained. During the previous inspection in January 2008 it was identified that in the sampled documents there were gaps in some of the care planning, with records not completed and the lack of clear instruction provided to staff of how to achieve meeting the needs of the individual. This was also an area that was identified in November 2008, by an independent auditor engaged by the provider, as having improved but needed more work to ensure that a satisfactory standard was made over all the care planning records in the home. From this inspection assessment there remains some gaps in information given to staff,but generally they had improved. An example of this could be seen in one record in regard to guidance on recognising abnormalities in a persons faeces, but not providing in the care planning the reason for this as to be included, what was normal for the person, what action they would take to monitor changes, and how they would care for them. Again, as previously identified in the commissions and the auditors reports of 2008, the staff did provide detailed verbal information about the people they support. However, this knowledge was not always reflected in the care planning records that were examined. A sample of the processes for providing support for an individual with a PEG (Percutaneous Endoscopic Gastronomy) tube inserted for nutritional and medication needs, were reviewed as to see what they have in place. The central care records for Care Homes for Older People Page 15 of 36 Evidence: this did provide some information for staff about the support the individual required. However, the care records did not indicate that care staff did not undertake these tasks for the individual or that there were instructions provided by the specialist nurse for caring for the tube or the person for this need. These instructions could be found in the individuals room, from which could be seen that they had been implemented some time ago and there was no indicator that these were up to date for how the care was to be provided. From what could be found in these records the persons fluid balance was routinely monitored over a 24 hour period but there was no method of monitoring the overall pattern. Monitoring these records and the daily outcomes for the person concerned would assist in assuring that they are provided with their planned care and their overall general state of health. The care planning records did evidence that staff were seeking support for individuals for any external health care or treatment that the person needed. These included any specialist practitioner or those for support with eyesight, dental or hearing needs. One relative commented, The nurses are very good if they think there is a problem, they put my relation (on the GP list) to been seen by the Dr. The processes for managing and administrating medications in the home were reviewed. A sample of MAR(Medication Administration Record) charts and those for any controlled medications held in the home, showed that staff are recording appropriately any medications given. The visiting pharmacist stated about the services attitude to medication administration,The service takes the supply and administration of residents medicines very seriously. Care Homes for Older People Page 16 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available did not support that staff are given enough instruction about the individuals chosen lifestyle and interests, as to assist them to meet them. Meals and mealtimes meet some of the residents needs and preferences, there are gaps in ensuring that some residents obtain the support they require. Evidence: The information to identify individuals choices and wishes of how they wish to live, the interests they have and any activities they wish to be supported with, were reviewed in the sampled care plans. From what information was available it was clear that some of these details that were obtained during the assessment process have not been transferred to the care planning. The care records do have a separate section for noting personal preferences and participation in any activity. However, nothing is recorded about how people need support to achieve this or the level of enjoyment they have expressed from them. Care Homes for Older People Page 17 of 36 Evidence: One relative made an observation that those residents who remained in their rooms or were less able to use their television or the remotes for them, did not always get the support from staff to use them. Another put, Excellent entertainment most days. The care records also did not give much information about individuals daily routines, this is with particular reference to those who are unable to communicate well or not at all. A recorded daily routine for these individuals would ensure that staff follow a more consistent person centred approach to the delivery of their care and provide them with opportunities for some stimulation. Again through discussion with staff and some relatives, staff provided greater support/communication than which is indicated in the care records. What was good, was the level of interest and support given by some of the non nursing and care staff to ensure that some of the residents preferences, such as listening to their music, are supported, especially when visiting the individuals rooms. The home has two members of staff employed specifically for providing activities and supporting people with their interests. From the information available there is a good programme of events for residents to join in with, such as quizzes, bingo for the less active, some practical events like sweet making and entertainment in the form of musical performers are brought in. During the day of the inspection the home were anticipating a visit from the pat a dog service and a musician was due to entertain residents in the afternoon. A small group of residents were involved with a board game in one of the lounges of the home, others were watching TV. The manager did state that residents were encouraged and supported to visit the different lounges in the home as to enjoy what was going on that area of the home. Other residents could be seen in their rooms or in the communal lounges without being provided with any activities or focus. Apart from being provided with a drink in front of them they had not been left with anything tactile or something to occupy them. This observation was passed back to the activities coordinator during the day. The relatives we spoke to did state that they were encouraged and welcomed to visit the home when they wished. One resident put in the survey that they only liked the meals sometimes and added, Frozen vegetables not cooked properly and the dinners all taste the same, despite Care Homes for Older People Page 18 of 36 Evidence: being given fancy names on the menu. Not enough fresh vegetables. Puddings meagre and mostly inedible. One relative put on a relatives behalf about the meals, Never complains about the food. Always excellent. Another wrote, My mother has always enjoyed her food here The menu plan for residents meals is put on display in various parts of the home including in the lobby of the main entrance for visitors to see. From the information available the residents are offered the choice of a cooked breakfast or cereal in the morning and a choice of two main meals at midday, and hot and cold supper dishes in the evening. Residents are asked their preferences the previous day by staff. The numbers of residents who partake in a cooked breakfast is unknown. Staff indicated that generally residents ate their breakfasts and evening meals in their rooms or the lounges and that they encouraged them to come to the dining rooms or areas for the midday meal. From reviewing the facilities around the various parts of the home there are not sufficient specific dining room spaces for all the residents to use at one time, although staff make use of parts of the lounge communal areas for this. The midday meal that was provided on the day of inspection was a choice of a vegetarian meal or stewed beef with various vegetables. The inspector accompanied two residents in the dining room of The Willows unit for the meal. From what was observed and sampled the beef was cooked well but the chunks were quite large and required cutting up before eating, the boiled potatoes were possibly from frozen and the butter beans were hard. Both residents stated they enjoyed their main course, although one appeared to struggle with cutting and chewing the meat. The sweet was easily managed and enjoyed by both. Staff did not appear to check with the residents that they still would like their ordered meal or that they would like a choice of sweet. One member of staff was observed to take time with a resident who needed assistance in the dining room. Staff appeared to have left a resident in the lounge of The Willows alone with their meal going cold in front of them whist supporting three others with their sweets sitting at table in the same room. Other staff were occupied returning the residents who do not participate in meal times to rest in bed in their rooms. The concern that this resident was not getting the support they required to have their meal was passed back to the manager who quickly instigated support for this individual. Care Homes for Older People Page 19 of 36 Evidence: However, it was uncertain that this was a common occurrence. Dietary needs or preferences information was not seen in great detail of the care records that were reviewed, although the reason for this could be the particular health needs of the person concerned. Other records for meal planning and information were not reviewed. Staff stated that the catering department were kept informed of any specialist dietary or nutritional needs that residents may have. Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information given to residents and their relatives does not set out clear details of how a complaint will be handled should they wish to express concerns. Residents can be confident that the staff have had the necessary training and knowledge to protect them from possible harm or abuse. Evidence: The processes for listening and responding to any concerns or complaints were reviewed. This was to see if they are managed well and suitable actions taken. As previously identified the complaints procedure is not provided within the Statement of Purpose document, it is included at the end of the Service User Guide. However, the copy of the complaints procedure that was seen did not provide the necessary information it should do, including the timescales that complainants can anticipate investigation and a response, who to make an initial complaint to, and the detail about the role and current contact number and address for the commission. The information about making a complaint was on display at various points in the home, but they again did not have the necessary information required. Included in the returned survey were opinions of how the staff responded to concerns: Care Homes for Older People Page 21 of 36 Evidence: No problems finding someone. Was a comment from one relative in regard to speaking to a member of staff if they are unhappy. One relative expressed that they did not know how to make a complaint. If there is a problem I usually go to the manager or deputy manager and it soon gets sorted out. The manager uses a book to record any formal complaints made. The current method of recording complaints, the subsequent investigation and any outcomes from the process carried out are logged together and from records seen could possilby compromise the confidentiality of some of the personal information. There is no formal process for noting minor concerns received by any of the staff in the home as for quality assurance processes. The logging of complaints was an area that was identified during the last inspection process in the body of the report as to be improved to show the outcomes and processes. A further recommendation was given during this visit to enable them to use the information with greater extent for quality assurance monitoring. The manager provided information in the Annual Quality Assurance Assessment, selfassessment document submitted before the inspection visit that they had received one complaint during the last 12 months. The commission has not been in receipt of any concerns or complaints about the home in this period either. The information given by the manager did support that staff had been provided with the necessary training and information in regard to identifying, prevention, and how to respond to concerns of possible abuse or harm to the vulnerable group of people they support. Staff have abuse training as part of their initial induction programme and then attend further updates periodically. From the records available there is a programme of training for the Mental Capacity Act. Staffs knowledge of Abuse and safeguarding procedures was not explored fully during this inspection visit. Care Homes for Older People Page 22 of 36 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. The home provides some of the residents with a well-maintained, pleasant environment with the necessary facilities and good communal spaces. Others do not have an equal quality of environment and therefore live with below standard bathrooms, small shared and single bedrooms. Evidence: The home is set in large grounds and provides accommodation in three main areas, all in varying degrees of quality for the facilities. The newer parts to the home to the front of the home, built in 2005 and 2006 can offer 51 residents, good-sized single en suite bedrooms with plenty of comfortable communal spaces to enjoy. The communal bathroom and showers are spacious and have the necessary aids and equipment for those who are less able bodied. It is decorated and furnished well and is bright and welcoming. For the 46 other residents with accommodation in the parts of the original home do not have such good facilities, fixtures and fittings and personal space. Of these rooms, 15 are still used as shared accommodation; the others are in small single rooms. Very few of these rooms actually have recognised en suite facilities, most consist of a shared washbasin. Care Homes for Older People Page 23 of 36 Evidence: The shared bedrooms when viewed provided very little private space, extremely restricted room to move aids such as hoists, and limited storage for personal possessions. The screening between beds did offer some privacy, although how this could be preserved when staff are moving lifting hoists or equipment to use with the individuals, this was uncertain. The sample of bathrooms viewed in this part of the home, called The Waterside, showed that they did have fitted lifting hoists to assist residents to use the baths. Records also supported these were routinely checked for safety. Otherwise, the general decoration, fixtures and fittings looked very tired and worn. An example of the poor quality was the paintwork was worn and damaged, the flooring torn and lifting from the edges. The condition of both these areas make managing the control of infection difficult. Areas of the lino in the bathrooms reviewed showed that staff had difficultly cleaning around pipe work on floor levels. The concerns about the quality of these bathrooms, were identified during the last inspection, where in the body of the report a recommendation was made to improve the facilities. This appears to have not been carried out. This area of the home offers two main areas for communal space, one very large L shaped room, that had areas that could be partitioned off, and a smaller rectangular room which residents and visitors have to pass through to access bedrooms at the far end of the building. There is no space for communal dining in the smaller lounge here apart from individuals eating their meals off small tables. Throughout the Waterside building the long corridors appear narrow for people to pass properly, especially if they are using frames or there is equipment like hoists or trolleys in the vicinity. Each unit has kitchen/serving open plan areas in the communal living and dining spaces and those in the new build are generally in a good state. The areas in the older part of the building appear less well cared for. The commission has been informed in the past that the service intends to upgrade the building and the facilities at the rear of the property to offer equal if not better that those built in 2005. This plan was re-affirmed by the Responsible Individual during this inspection visit, although a timescale for implementation was not given. Residents laundry is taken care of in the homes own laundry room situated on the lower ground floor of the most recently built part of the home. The facility has the necessary equipment and sufficient space to manage the dirty laundry produced in the Care Homes for Older People Page 24 of 36 Evidence: home. There are specific members of staff to provide laundry services in the home. During the early evening of the inspection visit, a number of clean sheets had been left on the floor. The manager returned these to be washed again. Care should be taken to ensure that clean laundry is not left or sorted on the laundry room floor as this has the potential for the spread of infection. One relative on the residents behalf stated that there had been a problem with personal clothing going missing and woollen jumpers not being cared for appropriately, despite a polite request for staff not to wash them. Generally the home is kept clean, tidy, and maintained well, the exception is as previously mentioned, parts of the Waterside especially the bathrooms. Some of the comments from relatives were: I dont know how they manage it, everywhere is spotlessly clean. Another wrote, It doesnt smell like a care home for old people at all. I like that. Another commented that better care should be taken over the care of the carpets in the areas that they visit frequently. Spills of medications and food make the carpet sticky. Ventilation can be an issue, because whilst it is needed, it keeps being switched off as it feels too cold. This should be looked into. This last comment given by a relative was difficult to establish which area of the home they were referring to. Therefore it was passed back to the manager during the day. The home has for good practices installed a CCTV camera system in significant places external to the home and at access points to the building. The system has some limitations that were discussed with the manager and deputy manager as possible areas where they could improve the practices for protecting the people who live and work in the home. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment practices carried out are not sufficiently robust and cannot assure that the people in receipt of support are protected from possibly inappropriate staff being employed in the home. Staff have and will be provided with, a good training programme to ensure that they will be able to meet the needs of the people they support. Evidence: Comments from relatives about the staff included, We find the staff generally very pleasant and helpful, and The staff are very friendly and helpful. Others expressed, The staff are helpful and kind, but there are some communication difficulties when they are not native English speakers. Another also made similar comments about the language barrier. They also added their concerns about the number of staff on duty at times. Particularly the registered nurses in the evening when assistance may be required and the staff are in another part of the home. One member of staff also indicated that they thought there were not enough staff on duty at times. Care Homes for Older People Page 26 of 36 Evidence: During the previous inspection in January 2008 it was identified that there were some concerns about the staffing levels in the home. In the Annual Quality Assurance Assessment, self-assessment document completed by the manager information was given to state that the situation had improved, with sixty-two staff employed instead of the fifty-eight noted during the last inspection. From information available there appears to adequate staff employed in the home, although it clearly could be seen that at times when peak activities like mealtimes the staffing level may effect how support is provided. Through discussion with the manager and deputy manager the home is staffing is organised into four main areas, with a registered nurse in charge of each shift in these locations. From this it was identified that out of office hours the manager and deputy manager have on call duties for the home, which they manage on a rotational basis. The recruitment and employment records for two members of staff employed in the last few months were reviewed to see if the necessary checks are carried out and that the process is robust. From what could be seen from these records is that there were gaps in the information obtained and the evidencing that the necessary assessment of their capabilities to do the roles had been omitted. This could be seen particularly in one record where the applicants full work history had not been recorded fully or gaps explored, the qualifications they stated they had had not been evidenced, and a reference had not been obtained from their last employer which was in a position of providing care and support to vulnerable people. The applicant had not been required to state in what role they had known the referee, those seen were personal references and from a tutor in an educational establishment. They were advised to look at the quality and depth of information requested in the application form, obtaining greater confirmation about the applicants health status, including immunisation, they may have had. Supporting documents showed that the Criminal Records Bureau and POVA First check had been carried out. They do use an employment check-list to assist them to obtain the necessary information. However, this is not used effectively as some of the required information had not been obtained or retained. Care Homes for Older People Page 27 of 36 Evidence: The home has a system of shadowing for new staff that is part of the processes in place to ensure that they have the support they need when they start working in the home. This is not recorded in detail and with the weak information about what is given for training for the induction period, parallel with not using a training needs analysis process, this is an area they could improve as to give them a better structured approach to training new staff. The home does have the support of a training coordinator who now is taking the lead in this area. From information given staff appear to receive training for the core health and safety topics such as moving and handling, first aid, and food hygiene. All staff have now received training on the Mental Capacity Act. The nurses and carers have had training for meeting nutritional needs of the residents. Updates for care planning and record keeping have also been reviewed as to improve the quality of the records found during the last inspection process. Planned training in the future includes, dementia, infection control, bereavement and loss, and palliative care. One of the three members of staff put in a survey returned to the commission that they thought they did not get the training they needed. The other two did. The numbers of care staff who have attained and are in the process of achieving an NVQ 2 or above in care have increased since the last inspection. The figures given in the Annual Quality Assurance Assessment by the home, show that there are twelve members of staff with an NVQ qualification instead of four previously seen in 2008. The recommendations given in the Audit carried out by an independent assessor to the organisation in November 2008 also directed the management to use a checklist for recruitment practices and review the quality of the application form. As yet these recommendations have not been commenced. Care Homes for Older People Page 28 of 36 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. Residents, their relatives, and the staff, find the manager approachable and professional. The gaps in the practices for maintaining the safety and well being of the people who live and work in the home could compromise their well being and put them at risk. Evidence: Comments made in the surveys were complimentary about the management of the home. They included; The Matron/manager is always ready to listen and try to solve any problems, she is friendly, approachable and professional. The manager has been in her role for approximately six years and is a registered nurse with a management qualification, who has also achieved a Registered Managers Award. She provided information that she has continued to develop her role since the Care Homes for Older People Page 29 of 36 Evidence: last inspection process with undertaking training for palliative care, care planning and documentation, dementia and some health and safety topics. The home has some internal and external processes to assess the quality of the services they provide. Residents and their relatives are given the opportunity to comment in annual surveys and there are residents meetings. They have recently purchased the services of an external auditor to review the service in line with the national minimum standards and regulations, so that they can develop the quality of what they provide to the people who use the service. From this assessment in November 2008, the auditor identified a number of areas that need to be developed to improve care delivery, record keeping, and management of the service. From what could be seen some of the areas had been improved but some of the recommendations given had not been implemented. One of the recommendations was to implement an audit process for the care records as to improve the quality of the documented information, from this assessment this has not yet been fully implemented. According to information given by staff there are regular staff meetings and a good pattern of supervision carried out. The home does not handle money on residents behalf, any sundries purchased by them such as toiletries, newspapers, and hairdressing are invoiced to the person responsible for their finances. A sample of the records for safe working practices, were reviewed to see if good practices are carried out. From what could be seen the home has regular safety and maintenance checks for lifts and hoists used in the home. The records also show that there is a routine fire safety checks and drills carried out by the staff. However, it was identified during the review of the facilities of the Waterside unit that some of the bedroom doors do not close properly and the fire safety door guard mechanism for one did not work effectively and the door was held open by the doorknob of a wardrobe behind it. The manager dealt with this immediately and alerted the maintenance team to rectify the problem. A recommendation was made to review the quality of the checks carried out for this purpose as soon as possible. Staff are provided with safe food handling training and although this is in place, some of the practices carried out in the kitchen serverys did not support that they are Care Homes for Older People Page 30 of 36 Evidence: following them. The containers for the decanted cereals did not look very clean and were stored with non-food items. The items in the fridges did not have opening dates on them and there was a dish of butter, not covered, in one of the fridges in the Waterside unit. Better care should also be taken to not leave items that should be stored within the Control of Substances Hazardous to Health Regulations (COSHH) unsecured, such as washing up liquids, accessible to people who have varying degrees of dementia. There were some generally positive comments about the service given in the surveys returned to the commission. They included; On the whole I am glad I came here. One relative wrote, This is a very special place. Homely, warm and bright. Care Homes for Older People Page 31 of 36 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 32 of 36 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 1 4 That the Statement of Purpose document holds the required information that prospective service users should be provided with. Prospective service users should be given the necessary information in this document as to ensure that they have sufficent information about the home before they make a decision to live there. 30/04/2009 2 2 5 That the Service User Guide 30/04/2009 document holds the required information that prospective service users should be provided with. These documents should hold enough clear detail of what the service can offer should the individual choose to live there. Care Homes for Older People Page 33 of 36 3 19 23 The premises should be maintained well and meet the needs of the people living there. You should ensure that the facilities are kept maintained and fit for purpose. The bathrooms in the part of the home called Waterside have not been kept in a good decorative condition which compromises the management of the control of infection. 30/04/2009 4 29 19 The registered person shall 30/04/2009 not employ a person to work at the care home unless they have obtained the necessary information and made the required checks to ensure that they are fit to work there. You have a responsibility to carry out a thorough and robust recruitment and employment procedure as to evidence that you have made the upmost checks to protect the vulnerable group of people you support from possible harm or inappropriate people working with them. 5 38 13 The registered person should make arrangements as to prevent the spread of infection around the home. You should make sure that the food storage and handling practices are of the 31/03/2009 Care Homes for Older People Page 34 of 36 highest standard and do not put the health and well being of the residents at risk. 6 38 13 The registered person shall ensure that all parts of the home are free from hazards to their safety. You should make sure that staff comply with the instruction and guidance for the storage of items that should be kept in accordance to the Control of Substances Hazardous to Health 1988. You put your residents at risk from harm from items left out unsecured. 31/03/2009 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 Care Homes for Older People Page 35 of 36 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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