Key inspection report
Care homes for older people
Name: Address: The Rosary Nursing Home Mayfield Drive Durleigh Bridgwater Somerset TA6 7JQ The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Laver
Date: 2 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home
Name of care home: Address: The Rosary Nursing Home Mayfield Drive Durleigh Bridgwater Somerset TA6 7JQ 01278431164 01278446739 ltaly(rosarycarehome)@sanctuaryhousing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Care Ltd care home 103 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 103. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (Code OP) - maximum of 63 places Dementia (Code DE) maximum of 40 places Date of last inspection Brief description of the care home The Rosary Nursing Home is located on the outskirts of Bridgwater. It is owned by Sanctuary Care Ltd. It was purpose built in 1994 as a Nursing Home. The home was initially registered as a Care Home with Nursing , to accommodate up to a total of 63 persons. There were sixty-one single bedrooms and one double bedroom. One bed provides regular respite care. All, except three bedrooms, have an en suite facility, Care Homes for Older People
Page 4 of 33 Over 65 0 63 40 0 Brief description of the care home which includes a wash hand basin and toilet, two of these rooms have a shared facility and one a bathroom is adjacent to the bedroom. The home is fully equippped to provide nursing care and is now known as Primrose House. In 2009 a new 40 bed building Snowdrop House was completed. This service has been designed and built to the highest standards and provides care for people with dementia. There are spacious en-suite rooms, attractive communal areas and an enclosed garden. There are a full range of health and safety measures and the whole home is fully adapted to meet the needs of the people who live there. There is a high standard of decoration and furnishing throughout the home. All bedrooms are fitted with telephone sockets. There are Registered Nurses on duty at all times. The current fee range is £625.00 to £695.00 This does not include toiletries, chiropody and newspapers Care Homes for Older People Page 5 of 33 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor 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: Before we visited the home we had received the Annual Quality Assurance Assessment. This is completed by the manager of the home and gives us information about the achievements and challenges experienced by the home in the previous year. The AQAA was completed in depth and gave a great deal of information about the home. Two inspectors visited the home for two days. We were able to meet with the manager Lyn Taylor and some of the staff. We were also able to meet the Regional Manager Annette Denson and the Sanctuary Dementia Care Lead Maria Parsons. We made a tour of both Primrose House which was the existing Rosary Nursing Home for 63 people and of Snowdrop House which is the new building purpose built as a home for people with dementia. We asked for care and staff records which were all made readily available to us. Care Homes for Older People
Page 6 of 33 We talked to people who lived in the home, their relatives as they were visiting, and to staff that we met in the home. We asked for surveys to be sent to people who lived in the home, to staff and to health and social care professionals. 70 surveys for people who live in the home were sent out for distribution. At the time of writing the report we had received 18 surveys from people who lived in the home and their relatives. We sent out 25 staff surveys and 20 for healthcare and social care professionals. Six staff and five health and social care professionals returned surveys. We were also supplied with information from the community nurses who visit the home. We found that responses from all sources were very varied. It was interesting to note that whilst some people in the home and indeed some health professionals were satisfied with the care in the home others expressed real concerns. This conclusion was drawn from the content of the limited number of surveys that were returned, from talking to people during the inspection and from information supplied to the Care Quality Commission as part of a Safeguarding investigation. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The manager wrote in the AQAA It has been difficult to implement major changes. Building work has been very draining on residents, visitors and staff who have had to accept a constantly changing environment. We have strived to minimise the disruption by planning ahead and keeping people informed about what is happening. Whilst in the short term it has been disruptive in the longer term the improvements will benefit the service users who will be living in pleasant surroundings. One person said There has been a remarkable change in the building The 40 bed new block Snowdrop House has been built and substantial redecoration has taken place in Primrose House. There has been replacement of carpets and chairs. Divan beds have been replaced with profiling (adjustable) beds. Bedrooms have been redecorated with a choice of colour schemes. Ten outdated en-suite bathrooms have been up-graded and Care Homes for Older People
Page 8 of 33 now contain showers. In preparation for the opening of the Snowdrop unit 30 staff have been recruited. 27 staff have received an initial training in Dementia Care. Table top menus have been brought in and notice boards are used to give information about activities. Snacks between meals are more available and cool drinks can be accessed more easily. There have been further initiatives in staff training. 10 staff have undertaken a distance learning course in Equality and Diversity. Staff in the kitchen have undertaken a nutrition course and domestic staff have gained National Vocational Qualifications in Housekeeping. What they could do better: There were comments and requests about the staffing levels from people who live in the home and staff. I have nothing major to complain about. Only the time taken to answer the bell. They take care of me and are always polite. Another survey said They should have more staff on so that the bells would be answered within 10 minutes and not 30-40 minutes. The manager confirmed that the time taken to answer bells is audited and monitored and the average response time is 5 minutes. There were some specific concerns about the assessment, planning and delivery of some aspects of care that has resulted in this overall poor rating. The details of this evidence are recorded in the health and social care section of the report. We were alerted to possible problems in some aspects of care by two complaints from relatives that became the subject of safeguarding issues. We received other information from professionals visiting the home and from relatives. It was of concern that tissue viability and prevention of pressure damage was a common theme. We are aware of the pressure that the major building programme must have imposed on staff. During this time, according to the AQAA 41 people were admitted for long term care and 27 for short stay or respite. 36 people were admitted straight from hospital including two from out of county placements. 28 people have died in the home and 8 have died in hospital having been admitted from the home. The staff have been implementing a care planning system since October 2008 which is complex and contains much information. Instructions to staff regarding care required to be given were not always clear as detailed in the health and social care section of the report. We were concerned about the variation in peoples experience of care across the home. Some people and their relatives could not be more satisfied. We found that in the care plans we reviewed written assessment and care planning relating to the prevention of pressure damage was not robust. There were occasions Care Homes for Older People
Page 9 of 33 when people developed pressure damage. In the files we sampled we observed that when people are identified as being at high risk there was not enough evidence of what guidance and monitoring carers were to give to prevent damage occurring. We saw from the written records that a few frail people were assessed as being at risk of malnutrition. The planning to try and prevent further weight loss in the files we saw was weak. The monitoring and review of what people were eating and the decision making regarding further action regarding diet was not robust. There is information in the care plans regarding the estimation of the amount of fluid people should be drinking but this was not being used. When a persons fluid needed to be monitored recording was patchy and charts were not added up. The monitoring of charts by trained nurses and the decision to change a care plan or take further action if a person was not drinking was not seen. We were concerned about the record keeping and practise related to one wound that was deteriorating although there was also evidence that other people had had their wounds healed in the home. The AQAA says that the home wants to provide training so that nurses are more proactive in taking a leadership role. This training would help nurses to understand their role in ensuring that the care assessments and directions given support care staff in understanding their roles in the above areas of concern. Snowdrop building the home is large and seeks to care for people with dementia and nursing needs. There must be a review of the management structure of the home with clear descriptions of responsibility and accountability. The management structures of the home must address the ways in which the carers work together and are supervised. The AQAA says that there are plans to allocate staff to particular areas and to maintain continuity of staff. As there does seem to be a variation in the outcomes experienced by people the home management should review the quality assurance systems in the home to ensure that all people receive care that meets their needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a range of information available to people before they come to the home. The home has a system of pre-admission assessment in place that includes visits from trained nurses. Evidence: The home has an established record of completing pre-admission assessments before people come to the home. People are visited by trained staff at home or in hospital and information from the Standard Assessment Process (SAP) and hospital discharge information is used to begin completing the care plans. Health professionals who returned a survey to us concluded that the care services assessment arrangements usually ensure that accurate information is gathered and that the right service is planned for people. Care Homes for Older People Page 12 of 33 Evidence: The AQAA stated that last year 41 people were admitted to the home permanently and that further short stay and respite care was provided. The home also provides day care to a small number of people. Admissions to Snowdrop House are staged so that no more then three people arrive at the home in one week. The senior registered nurse David Heath conducts the assessments. Sanctuary Care employs a dementia care specialist who is planning further training in Snowdrop House to ensure all staff are aware of the needs of people there and how they may be met. The assessment process continues once the person has arrived at the home and the comments relating to these assessments are included in the health and personal care section. On the day of the inspection we saw an attractive brochure in Snowdrop House giving information about the Rosary however it was not clear from the brochure who would benefit from care at the home. The manager informed us that up-dated information packs are available and are sent to people who may come and live in Snowdrop House. People who returned surveys to us said that they had received enough information before they come to the home. As befits a nursing home people admitted are often very frail. The most recent admissions had included one person for palliative care and one person admitted with pressure damage. The home must review the admission policy to ensure they can fully meet peoples needs at all times. Care Homes for Older People Page 13 of 33 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst some people were very satisfied with the care in the home there is evidence that some aspects of nursing and personal care must be improved. There must be improvements to the assessment, planning and monitoring of key aspects of nursing and care. Evidence: We asked people who in our surveys if they received the care and support they needed. Of the 15 who responded 3 said always 9 said usually and 3 said sometimes. We observed that people resting in bed appeared comfortable and looked clean and well presented. We looked at eight care plans and included an in-depth analysis of one plan as there had been a safeguarding alert raised about this person which is still on-going. We focused on some areas that caused concern. There is a care planning system in place that has been developed by the company.
Care Homes for Older People Page 14 of 33 Evidence: The system is extensive and contains many forms. Staff were not confident with the system and we were told that it was being reviewed. We saw that there are several assessment charts at the beginning of the care plan folder. Some, for example a falls risk and waterlow (risk of developing pressure damage ) chart had not been added up. As guidance relating to the care of people was based on the numerical total these charts were not helpful. In one care plan where this was an issue the person had developed pressure damage. Some assessments in care plans we reviewed were not completed, for example those for mental health and bowel assessments. These would seem to be relevant to all people in a nursing home even if the assessment results in stating that the person is independent in this area and needs no further intervention. We discussed with the dementia care specialist the appropriateness of care plans written in first person if a person is not able to able to express an opinion. Some care plans had been signed and agreed by next of kin, others showed no involvement with people who use the service or their families. We were concerned with the care planning seen in some of the files we reveiwed. We saw that in at least four care plans people had been assessed as being at a high risk of falls. There was no plan of care as how falls might be avoided or minimised. We saw that the care planning and recording relating to the maintenance of fluids and diet for frail people in the home was incomplete and not sufficiently robust. In four care plans we saw that people had been assessed as being at risk of malnutrition There were no specific care plans in place. Some were incomplete as for example the person receiving thickening agent for their drinks. There was no reference to this in the care plan. It was not clear what people were eating in some cases and also what help they needed in order to feed themselves. The care plan for one very frail person who was losing weight said offer help. In one area of the home we saw that unfinished meals were removed from people and were concerned that the system for informing nurses about the quantity and type of meal eaten was not robust. Other care plans checked indicated that people maintained their weight in the home Care Homes for Older People Page 15 of 33 Evidence: and flourished. We were concerned about the monitoring of fluids in the care home. Charts we saw were filled incompletely and although in the care plan documentation there was guidance for staff concerning the amount of fluid that people should be taking each day this was not written on the charts. Some charts were not totalled or did not have any indication of urine output. The manager confirmed that drinks are offered regularly throughout the day and that fluids are freely available at all times. In one care plan we saw that documentation relating to wound care was not adequate. An assessment for a sacral sore was very limited and gave little guidance to staff. It was not clear when to change or review dressings. In another plan wound assessments were missing. One wound was clearly deteriorating. There was no plan in place to no review the treatment. There were no photographs of wounds. We saw other records that showed people had been admitted to the home with pressure damage and their wounds had been healed by treatment in the home. The Annual Quality Assurance Assessment identifies being more proactive in in preventing pressure damage as an area in which the home could improve. This is supported by the evidence we saw during the inspection. We saw that people did not have changes of position recorded. Care plans may say turn two hourly but there are no individual charts to show a change of position. The staff undertake turns rounds but there were no individual records. Concerns have been expressed on three occasions about the prevention of pressure damage in the home. The home regularly admits very vulnerable people who are very high risk of developing pressure damage and this fundamental area of nursing and care must be improved. The home has a good supply of pressure relieving mattresses and adjustable beds. We heard from one health care professional that there should be more attention to the seating arrangements for people at risk of pressure damage. There were records that indicated health care professionals visited the home. General Practitioners made regular visits to the home. We received comment cards from five health care professionals. When asked the question Are peoples social and health care needs properly monitored , reviewed and met by the service all ticked the box for Care Homes for Older People Page 16 of 33 Evidence: usually. They felt that the home usually sought advice and acted on it when there were concerns about peoples health needs. There was a sign in the main lounge in Primrose specifying when toileting could occur. We asked that this was removed as it did not promote the dignity of people in the home and it was done. We looked at the medication system of storage and administration. Overall the system was safe and well organised. The Medication Administration documents were completed accurately. There is a system of audits in place. We did see that one controlled drug was out of date. Health professionals supported the view that peoples privacy and dignity was supported Care Homes for Older People Page 17 of 33 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People make choices about how they spend their days. There is an activities and social events programme in the home which should be further developed. People can chose from a nutritious and varied menu. Evidence: We saw evidence in both buildings that people are able to make choices about how they spend their days. One person who returned a survey wrote I would like to be washed and dressed earlier. Sometimes it is nearly lunch time by the time they get to me. We saw that people were able to access communal rooms or to remain in their rooms. People spoke to us about attending church meetings and services and going out with their families. People said that their visitors were always welcome in the home. One of the questions in our survey was Does the home arrange activities that you can take part in if you want? People said always Care Homes for Older People Page 18 of 33 Evidence: We saw the programme of activities and understand that a fuller programme is planned in the future. The programme for week ending 27/09/09 gave information about one activity per am and pm. On Mondays there is one to one in residents rooms, manicure and hand massage in the afternoon. On Wednesday there is a library service. The events in the lounge include Bingo on a Thursday afternoon and cookery on a Tuesday afternoon. There had been a Harvest Festival on Friday afternoon. There should be a review of social events and entertainments offered. The home is very large and will always have people who are not able to leave their rooms. It should be possible to have one to one support for people in their rooms and an event going on in the lounge. It would be useful to conduct a survey to quantify what people would like to do as individuals and in small groups and relaunch the programme. There are plans to develop activities further within Snowdrop House. There will still be links to Primrose however there will be development of the environment to include a reminiscence corner and rummage boxes We were told that one of the things the home had done well was to access large print books for people and ensure their television was working. By contrast in another persons care plan it said that she liked music but there was nothing available in her room. The home operates a four week menu and we saw an example. There is plenty of choice . In addition to the main menu there are also jacket potatoes, salads and omelets. There is a choice at lunch of hot or cold dessert or ice cream yogurt or fruit. The kitchen provides home made cakes and scones for afternoon tea. We saw menus on the tables in Snowdrop. The dining room was seen to be attractively laid with napkins and condiments each table. A menu is displayed on each table and the choice of meals is indicated. On the day of the inspection there was Irish stew or mushroom omelet. People are generally pleased with the meals although two people said to us during the inspection that they could be hotter at times. One survey returned to us also made this comment. People on Snow drop can chose meals on the day. Pictorial menus are being considered. Lunch observed appetising very pleasant experience. Records on Snowdrop show detailed daily entries. One record included with staff walking round the garden listening to music Outcomes are recorded in the care plans. Care Homes for Older People Page 19 of 33 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to protect people from abuse. Some areas of good practice relating to safeguarding people with dementia should be further developed. Evidence: Approximately three quarters of people who returned a survey to us said that they knew how to make a formal complaint. One person said that he had spoken to members of staff at different times regarding issues that needed addressing. We looked at the records of complaints. The manager confirmed that only one formal complaint was received in the last twelve months. This complaint led to an investigation by Community Health Safeguarding lead. At the time of the inspection one person was the subject of a Safeguarding review and we have concerns expressed by a relative concerning care in the home. During the inspection one relative talked to us about the care and environment in the home and action was later taken by the deputy manager. The regional and home manager have co-operated fully in the Safeguarding process and have been pro-active in addressing concerns. There have been 7 minor incidents or niggles this year. A system of recording verbal concerns hjas commenced.
Care Homes for Older People Page 20 of 33 Evidence: Health professionals who returned surveys to us supported the view that home usually responded appropriately to any concerns raised. On Snowdrop one person had been identified as being at risk of wandering away from the home. There was no missing person profile recorded although staff do record what clothes are are being worn that day. Whilst the National Minimum Standards do not specifically refer to the need for a missing person procedure it is considered good practise. It is also important to ensure all staff are kept informed of who is in Snowdrop. One staff was expressing concern that she could not find a person who lived in the home when infact she had gone out to lunch with her husband who had not informed care staff. There is a robust recruitment system that is designed to keep people safe. Staff have received training in Safeguarding Adults and some evidence was seen in staff files. We were not able to see the status of up-dates for all staff. Care Homes for Older People Page 21 of 33 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe well maintained environment. Following the completion of major building work the home now offers a comfortable and attractive environment. Evidence: Over the past months Snowdrop House has been built in the grounds of the existing home, now Primrose House. At the time of the inspection the work is nearing completion although there was still considerable disruption to the outside space as the care park was re-instated. People visiting the home, staff and health professionals were parking in the surrounding residential streets. All bedrooms in Snowdrop House have en-suite facilities and those occupied were clean and fresh smelling. They are personalised and well equipped with profiling beds. On our first visit there were no names or personal orientation on bedroom doors although there was provision for this. By our second visit this had been addressed. Rooms contained profiling beds. There is ample attractive communal space in both buildings. The grounds around the home are being landscaped and there is already an enclosed garden that is attractive and accessible. There have been extensive refurbishments in Primrose House. At the time of the inspection refurbishment to the dining room was still in progress.
Care Homes for Older People Page 22 of 33 Evidence: There are plenty of staff handwashing facilities including liquid soap and paper towels . The home is taking part in an Infection Control project wth the Health authority. all staff have received infection control training. Care Homes for Older People Page 23 of 33 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a sound recruitment policy in place. The home should review the numbers and deployment of staff to ensure peoples needs can be met. Evidence: We were able to see staff rotas for two weeks. We received comments from staff and people who live in the home stating that there were not enough staff. These are quotes from surveys returned to us. Staff who returned surveys saidemploy more staff. When asked what could the home do better we saw better staffing levels and staffing has been an issue here. Families wrote Increase the staff on shift and two more relatives outlined where they believed that shortage of staff impacted on care. People mentioned the length of time taken to answer a bell. There were positive comments about care staff. Staff are very kind and helpful. Members of staff wrote I think more staff will let us give excellent care to the resident. Staff said there was usually or sometimes enough staff. There was also evidence that the way in which staff are deployed should also be reviewed. In the Annual Qualitative review there are plans to use a team based approach. Care Homes for Older People Page 24 of 33 Evidence: When the home is full at 103 beds the manager will have to ensure that people receive care through designated teams of care staff lead by trained nurses who proactive in a leadership role. Where there are issues regarding the numbers of trained nurses these must be addressed before more admissions are taken. Some staff have already undertaken training in awareness of dementia care. During the inspection we were able to meet the Dementia Care Lead for the company Maria Parsons. We were told of the companys plans to develop the training offered to staff regarding dementia care. We asked the trained nurses about the training they had received recently. One nurse particularly praised the Tissue Viability day recently attended. The trained nurses we spoke to had not had any training in staff supervision or management. They felt that had sufficient support from care staff to enable them to concentrate on nursing care. We looked at five staff files in order to review the recruitment and training records. We saw that prospective staff had completed application forms and that references had been obtained prior to the commencement of employment. We saw that staff had all had Criminal Record Bureau checks and had completed health questionnaires. There was a clear system in place and files were well organised. We saw that training was occurring in the home as each of the files we looked at had training certificates. Staff that we spoke to during the inspection told us about their last training. There is a staff matrix recording all training. There should be a system that enables the manager to see very easily which staff have completed what training and which are due for an up-date. The regional Manager told us that this piece of work was in progress. We received five surveys from staff who worked at the home. All said they were satisfied with the recruitment, induction and training they had received at the home. Care staff said that the home was a friendly nice place to work. Care Homes for Older People Page 25 of 33 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is established and works hard in the interests of people who live in the home. The management structure of the home should be reviewed to ensure that it is sufficiently robust to ensure the effective day to day management of care. There is a planned system of monitoring and maintenance that promotes peoples health and safety. Evidence: There as praise for the manager Lyn Taylor from a several sources. One health care professional wrote Matron is excellent (and her deputy.) Well organised and courteous. The manager has been working long hours and has tried hard to steer the home through the period of disruption and development. The manager has a open door policy and is always willing to talk to relatives and
Care Homes for Older People Page 26 of 33 Evidence: people who live in the home. The AQAA contains evidence that the manager is aware of the need to implement a more formal system of management in the home to ensure effective communication and to monitor the effectiveness of staff roles. The AQAA identifies the need to form staff teams that are working in one area of the home. The AQAA identifies the need for the nurses to take on a strong leadership role. There should be an assessment of the possible ways of managing this very large home to ensure that peoples health and social care needs are met and that staff are guided and supported. Meetings are held for staff,relatives and people who live in the home. We saw minutes of meetings for trained staff and general staff meetings. We saw that the home receives Regulation 26 visits from the Regional Manger to monitor quality in the home. A deputy manager has been appointed this year and the home has a full time administrator. The AQAA identifies that there are plans for the manager and deputy to undertake training in National Vocational Qualifications in Management and Leadership at Level 4. Records were easily accessed and were stored appropriately. There is a system of administering and safeguarding peoples money in the home. There is an annual survey for people who live in the home. The results of the survey are collated and an action plan formulated. We saw the results of the 2008 survey. When people are unable to complete a survey it is important that other systems of quality assurance are used. This is particularly important when people seem to divided in their views of the home. The management will want to know what the factors are that contribute a persons satisfactory care and also where the delivery of good care has broken down and the reasons for this. The home has 30 permanent beds and 1 respite bed contracted to Somerset Community Directorate who undertake contract and individual reviews with people. The home has the Investors In People award. Care Homes for Older People Page 27 of 33 Evidence: There was evidence of planned maintenance. Records for hoists services, fire alarm checks and emergency lighting were all seen to be up to date. We reviewed the accident records and discussed the monitoring of accidents with the registered manager. The monthly monitoring report does not identify such as time and location which would enable patterns to be determined and action to be taken to reduce events. The kitchen has been awarded five stars by Environmental Health. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 The admission of new people 30/10/2009 to the home must be regulated to ensure that there needs can be fully met. With the current staffing arrangements there may be insufficient staff to ensure that frail people receive access to the skilled care they need. 2 7 15 The care plan for people who 16/11/2009 live in the home must set out in detail the action which needs to be taken to ensure that all aspects of health and personal care needs are met. Care staff need clear guidance and direction in the care to be delivered. This includes action to be taken to prevent falls and pressure damage. Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 3 8 12 The home must review the wound care protocols to ensure that is unified clear guidance available to all nurses. There must be clear assessment and review of all wounds in the home. 16/11/2009 4 8 14 The home must review the system of nutritional screening, recording of food intake and protocols for action to be taken in the event of weight loss or gain. People are identified as being at nutrtional risk howeever the action taken to meet this need is not always clear. 16/10/2009 5 8 12 The home must improve the nursing and care practise relating to the prevention of pressure damage. pressure There must be clearer assessment and identification of risk for people. Appropriate interventions for of prevention and treatment of pressure damage must reflect current best practise. 16/11/2009 6 18 13 There must be policies and procedures in place particularly in Snowdrop 15/11/2009 Care Homes for Older People Page 31 of 33 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 House that safeguard people at risk of leaving the building. People must be protected from the risk of leaving the building unescorted. 7 31 10 The management structure of the home must be reviewed to ensure the effective day to day management of care. There must be clear lines of accountability for the delivery of care in the home. u 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 30/11/2009 1 12 The provision of activities and social events should be increased and developed to reflect the home size and prefereneces of people who live there. There should be a review of the management structure in the home to ensure there staff are supervised and supported effectively. The manager should review the management systems in the home to ensure there is sufficient information and direction is available regarding key aspects of care. 2 31 3 32 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!
