Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Paddocks Hilperton Road Trowbridge Wiltshire BA14 7JQ The quality rating for this care home is:
two star good 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: Roy Gregory
Date: 0 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 32 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 32 Information about the care home
Name of care home: Address: The Paddocks Hilperton Road Trowbridge Wiltshire BA14 7JQ 01225752018 01225755427 manager.thepaddocks@osjctwilts.co.uk 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) : The Orders Of St John Care Trust care home 30 Number of places (if applicable): Under 65 Over 65 14 3 30 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 No more than 14 service users with dementia may be accommodated at any one time. No more than 3 service users with a mental disorder may be accommodated at any one time. The maximum number of service users who may be accommodated in the home at any one time is 30. Date of last inspection Brief description of the care home The Paddocks was purpose-built in the 1970s. All bedrooms and communal areas are on the ground floor, centred on a dining room and adjoining lounge area. There are two other sitting areas, close to bedrooms, and an activities room is being developed. In addition there is an attractive enclosed garden with summerhouse. Bedrooms have vanity units but toilets and bathrooms are shared. One room is reserved for short stays. Care Homes for Older People
Page 4 of 32 Brief description of the care home The home is one of a large number of homes provided by the Orders of St John Care Trust in Wiltshire and in three other counties. It is situated in its own grounds, off one of the main roads into Trowbridge. There are good bus and rail links to neighbouring towns, and the home has its own car park. The registered manager, Anna Lovesey, is supported by a team of care leaders and an administrator. Care workers are provided throughout the day and night. There are housekeeping and kitchen staff, and the home has its own handyperson. Weekly fee levels range between £430 and £585, according to assessed dependency. Where people are placed and part-funded by the local authority, the contracted fees are slightly less. Care Homes for Older People Page 5 of 32 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: two star good 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 visited The Paddocks unannounced on Thursday 8th January 2009 between 9:30 a.m. and 6:30 p.m. During the inspection there was direct contact with a number of residents, in the communal rooms and individual rooms, and by joining three residents for lunch in the dining room. This allowed for observation of care interactions, the service of meals, and administration of medicines. We looked around all parts of the home. Anna Lovesey, the registered manager, was available throughout the inspection time. We spoke with various staff on duty, including a care leader, carers, a housekeeper, kitchen staff and the administrator. The homes locality manager from the Orders of St John Care Trust joined Anna Lovesey and the inspector for feedback at the end of the Care Homes for Older People
Page 6 of 32 inspection. Records examined during the inspection included care plans and records of care, medication records, evidence of activities provided, incident records and records of staff training and supervision. It was also possible to look at the results of the homes annual internal survey of residents and relatives opinions, from 2008, and the associated action plan. Prior to the inspection visit, Anna Lovesey had returned the homes Annual Quality Assurance Assessment, which we require from all registered services. We also took account of notifications of events and incidents received from the home since our previous inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the home. They take into account the views and experiences of people who live there. What the care home does well: There are thorough assessments of prospective residents, so that people are not admitted unless there is confidence that their needs can be met. This also enables care planning to be started before someone moves in, so their essential care needs are known and planned for in readiness. All care plans included risk assessments in respect of pressure area vulnerability and risk of falls, with measures taken to reduce identified risks. These were reviewed regularly. Care plans considered peoples needs in relation to specific health conditions. For example, it was clear from one persons plan what was necessary to assist them to manage angina. Where a person had dementia, several parts of their care plan referred to the impact of this and how staff could help compensate for it, which was good practice. Care plans were backed up by good quality records by care staff, which showed alertness to signs of peoples wellbeing and ill health indicators. Residents told us they had no worries about their health needs being recognised and attended to. Notifications of incidents and accidents have also demonstrated prompt and appropriate responses to health concerns and accidents resulting in suspected injury. Residents we spoke to considered their privacy and dignity were upheld by all staff. We observed high quality interactions between staff and residents. A number of staff had received training about end of life care, death and bereavement from a local hospice. This had helped raise awareness and encouraged practical steps in addressing deaths of people in the home. There was provision for celebrating the lives of deceased residents. One member of staff was designated as an activities co-ordinator. She planned daily activities in the home. There was some emphasis on group activities in the mornings, such as quizzes, which were very popular, ball games and reminiscence sessions. The co-ordinator recognised that not all people engage readily in group activities, and she promoted an individualised approach to activity and occupation. People could receive one-to-one conversation and manicures, or encouragement to pursue identified interests. All care staff had some involvement in providing activities. Residents we spoke to felt Christmas and related activities had been very enjoyable. They appreciated that they received very individual presents. Other special events included seasonal celebrations and events, such as Halloween and a 100th birthday party that was being planned. One person said they had great reservations about moving into a care home, but they now considered they had a much better quality of life as a result, because of social stimulation and opportunities. The visiting relatives of another person expressed a similar view. They regarded this aspect of the care offered as a particular strength of the home. People told us they felt they could pick and choose from what was on offer. Meals could be taken in the dining room or in peoples own rooms. It was easy to choose between company or solitary interests. Most people had televisions in their rooms. They chose when to get up and go to bed. Care Homes for Older People Page 8 of 32 Service and presentation of meals were both excellent. People were not hurried, and they received portion sizes that suited them. From residents we heard consistently positive comments during the day about the catering. The home had received a large number of written compliments over the preceding year. Where there had been a complaint, we could see that the Trusts complaints procedure had been followed. The complaint had been upheld and an apology given. All staff received update training in abuse awareness during 2008. The home has worked co-operatively with safeguarding processes. All the home presented well in terms of decor and cleanliness, with many homely touches. Many private rooms were highly personalised. People we spoke to were pleased with their private accommodation. The provider Trust has good arrangements for training staff. A computerised system allows for tracking of what training individuals have achieved, and when refresher training needs to be arranged. All care staff are required to undertake dementia awareness training, accredited by the Alzheimers Society. A version of this was being made available to non-care staff. Visitors we spoke to commented on Anna Loveseys approachability and organisational skills. People living in the home knew her well and felt they were kept in touch with decisions that affected them. People were able to express views and wishes through cluster group meetings, and through an annual internal quality survey. We saw that issues flagged up in that way received attention through an action plan. For example, there had been changes to the menu and to laundry arrangements as a result. The Orders of St John Care Trust also provided effective monitoring and auditing of standards in the home. What has improved since the last inspection? The home met our previous requirement that care plans must fully identify individual needs. The Orders of St John Care Trust had introduced a new person-centred care planning format to all of its homes. The plans we saw demonstrated a consistent approach. They had been audited in detail, to ensure consistency of approach within the home, and with other homes run by the Trust. Fluid charts were totalled daily, as recommended at our previous inspection. Two small sitting rooms had been attractively refurbished. Many areas of the home had been re-carpeted. A visitor commented on the homeliness of the environment, and said there had been evident improvements over the past two years. Some guidance had been obtained on developing signage to help people find their way around the home, and to identify rooms such as toilets. The signs appeared effective, without being demeaning to people that did not need such aids. It was a requirement at the previous inspection that the provision of staffing should be reviewed to ensure peoples care needs are met, and to clarify care leaders administrative and care duties. An increase in care hours provided enabled Ms Lovesey Care Homes for Older People Page 9 of 32 to target care provision to those times when demand is highest. Seven hours of care leaders time per week is now off rota, to enable some administrative tasks to be accomplished without compromising their role as part of the care team. We talked to a range of staff, and residents. All considered staffing levels to be sufficient. It was encouraging that staff and residents spoke of time being available for conversation between them, outside care tasks, which we found to be lacking at the previous inspection. Personnel files were in very good order, showing clearly when each stage of the appointment process was completed, in contrast to the quality of records we saw at the previous inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 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 admitted only after a comprehensive assessment, based on a wide range of information including a visit to the person concerned. Evidence: We looked at the assessment for a person who had moved into the home the previous day. There was a community care assessment from the referring local authority that arranged the placement. The home had obtained further clarifying information from the social worker. There was a full assessment also by the home that showed they would be able to meet the persons needs. Initial care plans for the person were begun on the basis of assessment information, four days before the persons admission, so the essential care needs were known and planned for in readiness. Care records for the person showed that on their first day at the home, a lot of time was spent with them. This helped their adjustment to the home and enabled further detail to be added to assessment information. All people had a further review of their needs, and how the
Care Homes for Older People Page 12 of 32 Evidence: home was meeting them, a month after admission. This gave them the opportunity to decide if the placement was meeting needs as planned, and to refine care plans. For people that had been resident for over a year, we saw that the home was pro-active in seeking annual review meetings with local authority care managers. One bedroom in The Paddocks is used to provide a short-stay respite place. This facility is booked in advance and tends to be used mainly by people already known to the home, either because of previous respite stays, or because they attend the home for one or more days per week for day care. An assessment and care plan were put in place for people staying short-term. The Trusts locality manager had meetings with the local authority contracts department to discuss issues around emergency placements, because of the difficulties in carrying out sufficient assessment in such circumstances. When residents spent time in hospital, a re-assessment of their needs was carried out, so the home could be sure the person could be cared for in The Paddocks environment. The Paddocks does not provide intermediate care and therefore Standard 6 is not relevant to this service. Care Homes for Older People Page 13 of 32 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. Peoples personal and health care needs are met through care planning. People are treated with respect and their right to privacy is upheld. Residents are protected by the homes procedures for the safe handling of medicines. Evidence: The Orders of St John Care Trust had introduced a new care planning format to all of its homes. This provided for a person-centred approach to care plans. The plans we saw demonstrated a consistent approach. This meant the same important areas of care were addressed for each resident, but on an individual level, drawing on initial assessment and subsequent experience in the home. The care planning process had been audited in detail, to ensure consistency of approach within the home, and with other homes run by the Trust. There was some ongoing debate within the home about the nature of reviews of care plans, which took place monthly. Some evaluations were good, showing how far planned care interventions were meeting the aims of the care plan, and therefore whether any change to the care plan was indicated. Some that merely restated what the intervention was, were rightly seen by staff as timeCare Homes for Older People Page 14 of 32 Evidence: consuming and repetitive. The home met our previous requirement that care plans must fully identify individual needs. Care plans were signed by the residents to whom they related, or by relatives. One plan showed efforts that staff had made to discuss care plans with a relative and to secure their signed agreement. Care reviews were held six-monthly, as a further check on updating of care plans. These provided a good opportunity for residents and their supporters to express satisfaction or any concern about the nature of care provided. The record of one persons six-monthly review covered discussion with relatives about how a fall had been sustained. The meeting agreed that a referral would be made for assessment by an occupational therapist, and that staff needed to spend more time assisting the person to communicate their wishes. These issues in turn led to amendments to the care plan. A further means of focusing on individual needs was provided by resident of the day. This meant that once every month, for each resident, care and housekeeping staff ensured that records for the individual were up to date, and that personal care needs and environmental needs were as the person wished. A checklist was used to make sure all aspects of resident of the day were completed. All care plans included risk assessments in respect of pressure area vulnerability and risk of falls, with measures taken to reduce identified risks. These were reviewed regularly. Where a person had spent a short time in hospital, their escalated risk of falling was identified by review of their risk assessment on their return.Care plans considered peoples needs in relation to specific health conditions. For example, it was clear from one persons plan what was necessary to assist them to manage angina. Where a person had dementia, several parts of their care plan referred to the impact of this and how staff could help compensate for it, which was good practice. Care plans were backed up by good quality records by care staff, which showed alertness to signs of peoples wellbeing and ill health indicators. For example, a carer had noted a persons pain, a care leader had contacted the persons GP surgery, and a prescription for stronger pain relief was available to the person before the end of the day. When a persons care needs were such that intake of food or fluids, or use of the toilet, needed to be monitored, appropriate charts were in use. Fluid charts were totalled daily, as recommended at our previous inspection. Team meeting minutes included reminders to care staff of the importance of such tasks. Residents told us they had no worries about their health needs being recognised and attended to. Notifications of incidents and accidents have also demonstrated prompt and appropriate responses to health concerns and accidents resulting in suspected injury. One of the care leaders had overall responsibility for medications in the home. She carried out six-monthly competency checks on those care staff who carried out administration of medicines. Medicines Administration Record (MAR) charts were well
Care Homes for Older People Page 15 of 32 Evidence: kept. For a person admitted to the home the previous day, a new handwritten MAR chart had been started, and had been counter-signed to show a second member of staff had checked it for accuracy. A MAR folder had been set up for recording application by care staff of prescribed topical creams. For residents who retained responsibility themselves for this task, risk assessments were on file. Where any medicine was prescribed to be used as needed, care plans showed the way this was to be administered. We saw that these care plan guidelines were followed, with accompanying good recording. An internal audit of the handling of medicines in the home had identified some shortfalls against the Trusts medications policy. These had been acted on, showing it was an effective audit system. There was evidence of more frequent audit of controlled drugs used in the home. Storage and recording of these were as required. We discussed some medication errors that had occurred within the home since the previous inspection. The manager and staff had drawn learning points from these, to implement improved systems where possible and guard against risk of repetition. The most recent error concerned failure to act on a slight change to a persons prescription when they had returned from a hospital stay. Accordingly a fail-safe system had been devised to take account of similar situations. Staff responsible for errors were required to undertake retraining and could face disciplinary action, where appropriate. Residents we spoke to considered their privacy and dignity were upheld by all staff. We saw that care plans highlighted peoples preferred forms of address. When residents were dining, a carer was quick to close a door to shut out noise, when a vacuum cleaner was started near the dining room. People were given a choice about where they had eyedrops or eardrops administered. A number of staff had received training about end of life care, death and bereavement from a local hospice. This had helped raise awareness and encourage practical steps in addressing deaths of people in the home. There was now provision for celebrating the lives of deceased residents. A book of remembrance had been started. This contained, for example, photos and funeral orders of service, which residents and staff could look at or contribute to at any time. Care Homes for Older People Page 16 of 32 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. The home is active in identifying and meeting peoples social, religious and recreational needs. People keep in contact with family and friends. They are able to exercise choices. People enjoy varied meals in pleasant surroundings. Evidence: One member of staff was designated as an activities co-ordinator. This role was combined with responsibilities for provision for people attending the home for day care. The co-ordinator planned daily activities in the home. There was some emphasis on group activities in the mornings, such as quizzes, which were very popular, ball games and reminiscence sessions. The co-ordinator recognised that not all people engage readily in group activities, and she promoted an individualised approach to activity and occupation. People could receive one-to-one conversation and manicures, or encouragement to pursue identified interests. Care planning included recognition of peoples interests, and there was a life history sheet in which care staff could record significant information that could help inform about a persons interests and experiences. Care staff endeavoured to provide some activity input on every shift. Film nights comprised showing a film on DVD, together with provision of snacks and drinks and general encouragement of participation.
Care Homes for Older People Page 17 of 32 Evidence: There had been a full programme of events for residents through December 2008, inevitably centred on Christmas. Residents we spoke to felt Christmas and related activities had been very enjoyable. They appreciated that they received very individual presents. Other special events included seasonal celebrations and events, such as Halloween and a 100th birthday party that was being planned. One person said they had great reservations about moving into a care home, but they now considered they had a much better quality of life as a result, because of social stimulation and opportunities. The visiting relatives of another person expressed a similar view. They regarded this aspect of the care offered as a particular strength of the home. People told us they felt they could pick and choose from what was on offer. Peoples participation in and response to provided activities was recorded, so it was possible for the activities co-ordinator to identify anyone being missed, and to pursue this further. Care plans included plans for promoting social engagement and interests as individuals wished. There is scope for the co-ordinator to develop and evaluate these, in association with peoples key workers. Care plans identified if people had faith choices, so that these could be facilitated. A development in the home was creation of an activities room, which was at an early stage. This will allow, for example, for craft-based activities to be undertaken, without the need to clear away between sessions. Some guinea pigs were being kept there during inclement winter weather, which was popular with some people. Another facility in the home was a quiet room with a library, stocked by the mobile library service. This was shared with staff, who used the room as a resource and e-learning room. A mobile touch-screen computer, with web-cam, was available for residents use. This had been little developed, and may benefit from a champion among the staff, to explore the opportunities it creates for residents. Visitors to the home said they were always made very welcome. One said they felt they shared the care needs of their relative with the staff of the home. People could meet their visitors in their bedrooms, shared sitting rooms or the quiet room. People felt they made daily choices about how they used the resources of the home. Meals could be taken in the dining room or in peoples own rooms. It was easy to choose between company or solitary interests. Most people had televisions in their rooms. They chose when to get up and go to bed. We joined some residents at table to share lunch. The menu for the day was written on a blackboard. People made their choice, from two meals offered, at the table. All the food served was of good quality and included fresh vegetables. Service and
Care Homes for Older People Page 18 of 32 Evidence: presentation of meals were both excellent. People were not hurried, and they received portion sizes that suited them. From residents we heard consistently positive comments during the day about the catering. Some issues had been identified, and addressed, through the homes internal quality assurance monitoring in 2008. For example, there had been changes to the timing of meals and to the range of choice at tea time. Care plans included guidance on peoples needs in respect of diet, nutrition and presentation of meals, for example, one persons need to have some parts of their meals cut up. The kitchen staff confirmed that at the time they were not required to cater for any special diets, but they reported no difficulty doing so on an individual level whenever required. Chefs in Trust homes are supported by meetings with each other to share experiences and develop what they provide and there is a catering adviser employed by the Trust. Activity co-ordinators would benefit from similar arrangements to develop their area of work. Care Homes for Older People Page 19 of 32 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. There is provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. Evidence: Residents said they saw a lot of Anna Lovesey around the home and they would regard her or the care leaders as the first point of contact about any complaint or concern. Managers of Trust homes are required to make a monthly return of any complaints received, and how they have been handled through the Trusts complaints procedure. Details of this procedure are provided to all residents and their families, and are publicised in the home. One complaint had been received since the previous inspection. Records showed the complaints procedure had been followed. The complaint had been upheld and an apology given. However, another issue mentioned in a monthly monitoring report of the home, whilst clearly addressed, had not been recorded within the formal complaints procedure. Ms Lovesey had not considered it to cross the threshold of seriousness to be a formal complaint. When this is the case, it is nevertheless important to keep a record in complaints or quality monitoring data, in case of any need to refer back to it at a later stage. A large number of written compliments had been received over the preceding year. Staff at all levels have demonstrated understanding of safeguarding processes and how to refer to them. For example, staff had recently been concerned by issues arising
Care Homes for Older People Page 20 of 32 Evidence: with a person attending for day care, and a referral had been made to local interagency safeguarding procedures. All staff received update training in abuse awareness during 2008. The home has worked co-operatively with safeguarding processes. There was information in the home about availability of a local advocacy service, so people could be assisted to have their views taken into account if assessed care needs indicated a need for possible infringement of their freedom of movement or privacy. A resident had given signed agreement to night staff making hourly checks on their wellbeing. For a resident with dementia, a relative had given signed agreement to use of a bed rail to keep them safe, and had acknowledged the persons inability to use the call bell provided. Care Homes for Older People Page 21 of 32 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an environment that is clean, comfortable and well maintained, although choice of bathing facilities is restricted. Evidence: All of the home presented well in terms of decor and cleanliness, with many homely touches. Many private rooms were highly personalised. People we spoke to were pleased with their private accommodation and often proud of their rooms. Some people commented on the relative lack of communal sitting space. The main facility was a lounge area that was an extension of the dining room, but it was also a throughway between the front and rear ends of the home. Two small sitting rooms, which had bedrooms opening onto them, had been attractively refurbished, but were little used. Many areas of the home had been re-carpeted. A visitor commented on the homeliness of the environment, and said there had been evident improvements over the past two years. Some guidance had been obtained on developing signage to help people find their way around the home, and to identify rooms such as toilets. The signs appeared effective, without being demeaning to people that did not need such aids. There was good provision for safe access to the outside grounds when weather permitted. Care Homes for Older People Page 22 of 32 Evidence: It was recommended at the previous inspection that an unusable bathroom should be provided with an assisted bath, because both usable baths were within one wing of the home. It had been hoped that an assisted bath would be moved to The Paddocks from another Trust home that closed, but this had not happened and the availability of baths remains as it was a year previously. We were informed during the inspection that plans were progressing for replacement of The Paddocks, meaning further environmental investment there may now be limited. However, it remains a recommendation that increased choice of bathing facilities should be made available to residents of the home. Residents do not have a choice of a shower as an alternative to a bath, yet many people admitted are likely to have been accustomed to showers in their own homes. Therefore consideration should be given to converting the unused bathroom into a wet room. Two housekeepers were provided daily to maintain good levels of hygiene in the home. A part time handyman played a significant role in meeting day-to-day maintenance needs. There was evidence that he had close working relationships with care and housekeeping staff and, like them, he benefited from infection control training. The homes internal quality survey of residents in 2008 had shown some had experienced shortcomings in the collection and return of laundry items. The identified issues had been addressed. Care Homes for Older People Page 23 of 32 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 are supported by trained, competent staff, available in sufficient numbers. Safe recruitment practices are in place. Evidence: It was a requirement at the previous inspection that the provision of staffing should be reviewed to ensure peoples care needs are met, and to clarify care leaders administrative and care duties. There has been an increase in care hours provided, so Ms Lovesey has been able to target care provision to those times when demand is highest. Additionally, the home now benefits from care support hours. This role provides for such tasks as making beds, and also provides a good introduction to the care field for people considering such a career. Seven hours of care leaders time per week is now off rota, to enable some administrative tasks to be accomplished without compromising their role as part of the care team. We talked to a range of staff, and residents. All considered staffing levels to be sufficient, other than that when some evening shifts reduced to three care staff, it was difficult to ensure an activity was provided. It was encouraging that staff and residents spoke of time being available for conversation between them, outside care tasks, which we found to be lacking at the previous inspection. Care Homes for Older People Page 24 of 32 Evidence: At the time of inspection, three members of staff were away on maternity leave, making it necessary to deploy some agency staff. An agency worker on duty said, and demonstrated, that she was familiar with the home and residents, and with policies and care plans. Records of staff recently recruited showed all had initially submitted application forms and had been unable to progress from successful interview to commencement of duties until two references had been received and all checks on their backgrounds were complete. They underwent an induction. Personnel files were in very good order, showing clearly when each stage of the appointment process was completed, in contrast to the quality of records we saw at the previous inspection. The provider Trust has good arrangements for training staff in mandatory and additional fields. A computerised system allowed for tracking of what training individuals have achieved, and when refresher training needs to be arranged. All care staff wererequired to undertake dementia awareness training, accredited by the Alzheimers Society, and a version of this was now being made available to non-care staff. Around a third of the homes care staff had achieved NVQ (National Vocational Qualification) in care to level 2, with others working towards this baseline qualification. Care leaders worked to NVQ level 3. Kitchen and housekeeping staff were also encouraged to gain NVQs relevant to their roles. Care Homes for Older People Page 25 of 32 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. An experienced and qualified person with a hands on approach runs the home. Monitoring and auditing processes lead to improvements being made when shortfalls are identified. Health and safety are well managed, subject to maintaining up to date risk assessments. Residents financial interests are protected. Planning takes account of views obtained from people who live in the home. Evidence: Anna Lovesey completed the Registered Managers Award in December 2008. She has demonstrated an ability to retain close involvement with the every day life of the home, whilst maintaining the distance necessary to be an effective manager. She submitted an informative Annual Quality Assurance Assessment and has shown that requirements and recommendations from the previous inspection have received close attention. Visitors we spoke to commented on her approachability and organisational skills. People living in the home knew her well and felt they were kept in touch with decisions that affected them.
Care Homes for Older People Page 26 of 32 Evidence: The Orders of St John Care Trust retains close oversight of its homes by way of monthly operational visits, and an annual audit process to ensure its expected levels of provision are upheld. Shortfalls, such as those identified in the operation of the Trusts medication policy at The Paddocks, are then addressed and further monitored. At the level of the home, there is an internal annual quality survey of residents and their supporters to identify areas of satisfaction and areas for improvement, based directly on peoples experiences. The manager then devises an action plan to address those things that matter to people living in the home. As seen earlier in this report, issues addressed in this way in 2008 included meals provision and laundry arrangements. Residents views were also sought by infrequent cluster groups, usually facilitated by the activities co-ordinator. On the last occasion, these had included the chef. Many residents placed small amounts of their personal monies, for the home to hold safely. The manager and administrator managed the system. The resident concerned, or a second member of staff, countersigned records when money was drawn, and receipts were in place to demonstrate expenditures. The records were regularly audited. As peoples needs or abilities may change over time, it would be worth checking as part of resident of the day that people remain satisfied with their arrangements for accessing money, whether they currently use the safe keeping facility or not. There was a chain of staff supervision. Care leaders were each responsible for giving regular one-to-one supervision to a group of care staff, and were themselves supervised by the manager. Ms Lovesey was in turn supported and supervised by her locality manager. Records showed supervision happened on a planned and regular basis and was also linked to annual appraisal of all staff. Staff meetings were held on a needs basis, sometimes for discrete staff groups, such as night carers. Care leaders had been meeting two-monthly as a senior team with Ms Lovesey, but it was planned to increase them to monthly, to fit with the county managers meetings attended by Ms Lovesey. The health and safety needs of residents and staff were met by routine maintenance of environmental factors, mainly arranged directly by the Trust, and by a range of reviewed risk assessments in the home. A shortfall identified was a need to risk assess the keeping of pets in the home. A risk assessment for the smoking room was out of date, as that room was now the activities room and therefore required assessment for a new set of risks. There was monitoring of falls that occurred in the home, to assist planning to reduce the incidence of falls. For incidents that occur, the Trust had introduced a recording sheet that ensured essential information was captured in a consistent way and made sure appropriate people were notified. Body maps were used
Care Homes for Older People Page 27 of 32 Evidence: where necessary to record injuries or marks accurately. There was good crossreferencing between such records and daily records of care. Care Homes for Older People Page 28 of 32 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 29 of 32 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 38 13 Unnecessary risks to the 27/03/2009 health or safety of service users must be identified and so far as possible eliminated. The keeping of pets, and designation of an activities room, must each be subject of risk assessments. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Ensure evaluations of care plans demonstrate how care interventions impact upon peoples lives. Evaluations should not become confused with care directions. The activities co-ordinator should be involved in routine evaluation of each persons social and activity needs care plan, together with the persons key worker. The Trust should consider ways to develop resources and supports for activities co-ordinators. Consider inviting a member of staff to take on a champion role to encourage residents use of their computer. 2 12 3 4 12 14 Care Homes for Older People Page 30 of 32 5 16 Matters of complaint that are considered not to merit use of the formal complaints procedure should be recorded in such a way as to enable review of all complaints each year. Seek to extend choice of the nature and availability of bathing facilities by conversion of the identified bathroom to a wet room. Use resident of the day to check that people remain satisfied with arrangements they have made for managing their personal monies. 6 21 7 35 Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
