Inspection on 31/01/08 for The Seaton

This inspection was carried out on 31st January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Seaton 12/10/09

The Seaton 17/08/06

The Seaton 11/10/05

The Seaton 16/02/05

The Seaton 06/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Seaton The Old Manor Fore Street Seaton Devon EX12 2AN Lead Inspector Ms Rachel Fleet Unannounced Inspection 31 January 2008 09:15 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Seaton Address The Old Manor Fore Street Seaton Devon EX12 2AN 01297 20882 01297 625175 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Healthcare (Wessex) Ltd Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection: 17/08/06 Brief Description of the Service: The Seaton provides nursing and personal care to up to 31 people over retirement age. The home is a Georgian building standing in its own grounds, in a residential area close to Seaton town centre. There are car-parking facilities at the entrance to the property. Accommodation is on two floors, including newer extensions, with lift access between floors. Platform lifts and slopes provide level access where there are changes in levels within the original house. The home has two lounges and a dining room; one of these lounges also has a dining area, and doors onto a decked area and garden. There is a shower room on the ground floor, with specialist baths also provided on both floors. There are 25 bedrooms are for single occupancy, with 14 having en suite toilet facilities. Two rooms have their own private bath as well. Three double rooms are available, one having en suite facilities. All bedrooms have hand basins as a minimum. Although two single rooms are below the recommended size, many are of a very good size in relation to the minimum standards. Weekly fees at the time of the inspection were £550 - £825. They vary according to assessed care needs - including whether nursing care from the home’s staff is required - and rates for particular rooms. Weekly fees do not include the cost of newspapers, clothing, transport (including hospital transport), spectacles (although eye tests are free) and toiletries - all charged at cost price; hairdressing (£5 minimum); and chiropody (£7 minimum). The most recent inspection report produced by the Commission for Social Care Inspection (CSCI) about the home is available in a file next to the reception table, in the home’s entrance hall. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. There were 31 people living at the home when we carried out this unannounced inspection, all except five of them needing nursing care. Our visit to the home lasted 11 hours, over two days (31/1/08 and 1/2/08). Katy Twidle, the manager, had previously returned our pre-inspection questionnaire (the Annual Quality Assurance Assessment, or AQAA). This included current information about the service, staff and people living at the home, as well as the home’s assessment of what they do well, and plans to improve the service. Completed questionnaires were also returned from five people living at the home (of 14 questionnaires sent out), who had been helped to complete them by their families. Eight were returned of 14 sent to relatives of people at the home. Five of six care staff who were sent surveys returned them, two of these being returned after our visit. We sent surveys to eight community-based health or social care professionals with links to people living at the home; three returned them, and we spoke with a fourth. We spoke with ten people (both men and women) around the home, and met with two who were unable to speak with us due to their frailty. We also spoke with four family visitors, two visiting social care professionals, four care staff (including a nurse), the administrator, the cook on duty, as well as the manager. We ‘case-tracked’ three people. This included people new to the home, people with some needs different to their peers (in some cases different to the needs of people usually admitted to the home), and people we wished to follow up as a result of information from surveys or in relation to issues raised at the last inspection, to see if certain issues had been addressed. This meant we looked into their care in more detail by meeting with them, checking care records and other documentation relating to these residents (medication sheets, personal monies records, etc.), general observation of the care they received, and talking with staff. Staff files, kitchen documentation and other records relating to health and safety (such as accident and maintenance records) were seen. We ended the visit by discussing our findings with the manager. Information gained from all these sources and from communication about or with the service since the last inspection is included in this report. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 6 The Commission has not received any complaints about the home since the last inspection. What the service does well: The comments of one person who lived at the home included, “I should think it’s the best home in Seaton.” A relative felt, “Nursing medical care is quite good. By and large the staff show considerable patience and tolerance…” They also thought the ‘key worker’ system works well at the home. One said, “Very caring people. Always someone on hand, visitors made welcome, food excellent. My spouse is very happy at the Seaton.” When asked this question, another relative said, “Looks after all my mother’s needs very well.” They could not think of any improvements needed. A fourth reflected this: “Very well run – don’t think improvement needed.” Others were positive about the staff, and the ‘personal care and hygiene’. When answering this question, a professional thought staff were able to anticipate the needs of people they looked after, there was a homely environment, and good staffing levels. Another thought the home was good at providing social activities as well as care, and said the ‘care service is good’. A third thought staff were well organised, and caring. We found prospective residents’ needs are assessed well, helping ensure the home can care for people who decide to move into the home. People benefit from good health care, through input from a variety of relevant professionals. Medications are well managed, with practices used that promote peoples’ safety. Staffing arrangements are sufficient to meet peoples’ general needs. Catering arrangements meet their dietary preferences, as well as their social and health needs. People enjoy a generally good, safe, clean and homely environment, although they will benefit further from the ongoing refurbishment. People’ choice and control is promoted where possible, with respect for their privacy, and promotion of their dignity and rights. There are good links with their families, friends and the local area, so they benefit from supportive and interesting contact with the community surrounding the home. The home is generally run well and run in the best interests of people living there. Good practices protect peoples’ financial affairs. Their welfare and rights are safeguarded through a variety of policies and practices, including that The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 7 concerns and complaints are heard and used to improve the service provided, as well as the home’s recruitment practices. What has improved since the last inspection? What they could do better: Surveys from people living at the home suggested more trips, a stable staff team, and a bigger TV screen would improve the home. The larger screen was echoed by a relative, with others suggesting the laundry could be improved, a canopy at the entrance would be helpful, and more outings or volunteers ‘to chat’ would improve things. When answering this question, a community-based professional thought the home should ensure staff have good, clear communication skills, which was reflected by five other people. Two other professionals said they had no concerns about the home. One staff suggested they should have more meetings with the manager, and that staff levels could be improved so that they had more time with people without being in a hurry. They also suggested there might be more trips or activities for people, and more training for staff. Additional detail in some written care records may prevent inconsistencies in care given and ensure that everyone gets all the care they need. More training would help ensure the staff team has good basic knowledge and skills, to ensure peoples’ safety and meet their diverse or changing needs. The manager has applied to be registered with us. This is necessary even though she has relevant skills and experience, to confirm she is suitable to run the home in the longer term. There is attention to health and safety matters, but additional measures must be taken to further protect people at the home. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs are fully assessed, and they can get good information about the home. This helps to ensure it will be a suitable home for anyone who subsequently moves into the home. EVIDENCE: The home’s Statement of Purpose has much useful information, including a sample contract. It can be provided in large print on request. Minor changes were discussed with the manager, to clarify some points. We also discussed how information might be made more inclusive for people with diverse needs and to promote equality. People we spoke to who were new to the home said their families had looked around and chosen the home on their behalf. We saw pre-admission assessments of peoples’ needs, carried out by senior staff, were very detailed. They included aspects given in the National Minimum Standards, such as The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 11 individuals’ physical needs and spiritual beliefs. Previously identified needs were reviewed during the person’s first weeks at the home, with a note made of any difference to the original assessments. Information had been obtained from care managers or previous carers. We found the home sent a copy of the needs assessment to the individual or their representative, whenever practicably possible. This includes confirmation that the home can meet the individual’s needs, when offering a date for admission. Staff said they were given information about expected admissions before their arrival. New residents said they had settled in well. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home works with other professionals so people benefit from good health care. Staff have information about peoples’ various care needs, although lack of detail in some care records may lead to inconsistencies in care or a risk that some people may not receive all the care they need as an individual. Management of medication is good, with practices in place that promote peoples’ safety. Peoples’ privacy is respected, promoting their dignity and rights. EVIDENCE: Care plans and related documentation we saw gave staff good information about each person as an individual, using information obtained before their admission. One staff member said they would contact the person’s previous carers for more information, if they needed it once the person was admitted. People spoken with felt that they were consulted about the care planned for them. Their preferences and wishes, previous occupation, dietary likes/dislikes, The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 13 religious observances, final wishes, etc. were recorded. The care plans generally informed well about how staff should meet care needs. Appropriate person-centred support was suggested for one person who had dementia. However, no-one had a social care plan, about how they might spend their free time. A senior carer said the new manager was addressing this through senior carers, who were currently getting peoples’ social histories from individuals or their families so that a person-centred plan could be written. Staff we spoke with seemed to know people well, and confirmed the care plans were useful, although one thought they weren’t looked at as much as they might be. We noted care plans were now kept more securely than on our last inspection (to ensure confidentiality, etc.), but this meant they were less accessible to staff. People were weighed regularly. We saw from someone’s care notes that staff had noted they were losing weight and sought advice from a dietician. Since then, staff had recorded improvement in the person’s appetite, although no recent weight was shown. We saw some people were on fluid charts; all staff spoken with said they offered fluids hourly to such people, and that staff handovers included discussion of who needed more encouragement to take enough fluid. However, there was no record of fluid intakes target for individuals or what they actually took over a period of time. The care plan for one person with diabetes did not include their normal blood glucose range, to guide staff who monitored it. Risk assessments were evaluated usefully and regularly. They were crossreferenced to care plans, alerting staff to possible problems associated with care-giving. We saw someone’s care plan had been reviewed after they had had a fall. We discussed with the manager that risk assessment forms had occasionally not been fully completed, so the conclusion reached might not have been based on good information. This related to one assessment for bedrails, and to one assessment for risk of falls. She said she would monitor this. People said staff attended to their health needs well, and consulted GPs promptly. Records showed advice was sought, and followed, from GPs and specialist nurses such as Community psychiatric nurses. Four communitybased health and social care professionals were positive about the home. A visitor, who was otherwise happy with the home, felt the home could have communicated more about their relative’s recent health problems, however. People in bed looked comfortable and were attended to through the day. Pressure-relieving mattresses and cushions were in use around the home. The manager told us that organised activities helped alert staff to deterioration in peoples’ functioning (such as quizzes, which might show someone’s mental state was changing). The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 14 People we asked were satisfied with how the home managed their medications for them; none wished to self-medicate. We saw a nurse using good practices as she gave out medication during our visit. Handwritten entries on medication records had been signed by two people to verify the accuracy of what was written. Care notes showed nurses monitored the effects of new medication. We saw action had been taken when monitored storage temperatures were not at recommended levels. Medication received into the home was recorded, and appropriate systems were used to ensure prompt and safe administration or disposal of medication. This gave an auditable record of medication used by the home. Controlled drug stocks we checked correlated with records kept. People we spoke with felt staff were respectful and mindful of ensuring their privacy. We saw that staff entered peoples’ rooms only after knocking, calling out politely as they entered if they hadn’t heard a response. Care plans included consideration of maintaining peoples’ self-esteem and privacy in the various aspects of care giving. Communal toilets and bathrooms had privacy locks, as did bedrooms where requested by the occupant. Shared rooms had curtains between the two bed areas. When we asked if people were given a choice about sharing a room, the manager said people often accepted a bed in double rooms because it was the only bed available at the time. They would then be offered a single room when one became available. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recreational opportunities for people are being developed with individual preferences in mind, providing them with a better quality of life. Links are maintained with their families, friends and the community around the home, so they benefit from supportive and interesting relationships. There are practices that promote residents’ choice and control in their lives where possible. Catering arrangements meet peoples’ tastes, as well as their social and health needs. EVIDENCE: A photo album in the entrance hall showed people enjoying Christmas events and other recent activities. Two people were enjoying a game of dominoes in one lounge, with music playing quietly, when we looked around. Others were watching TV in another lounge area. A musical entertainer was well received in the afternoon. A relative said one person couldn’t do some activities because of their physical condition but they enjoyed the singing and flower arranging. One person said they enjoyed doing puzzles. Multi-denominational services are held regularly at the home. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 16 A notice board had information about local organisations and churches that might be of interest to people at the home, as well as details of advocacy groups. It also informed people about the home’s ‘Wii’ (a video game), which staff said was popular with certain people at the home. We saw from personal monies records that people were able to buy clothing from two companies that visit the home regularly. People said staff took a trolley round weekly, so people could buy sweets, cards, toiletries, etc. if they want them. A visitor felt activities provided by the home had improved in the last 18 months. Two people new to the home said there was not much to do; another said they got bored in the mornings. One said she would like to go out for walks, but then added that staff took people out into the home’s garden for a walk when the weather was better. When we asked one staff if they had enough time to spend socially with people who remained in their bedroom, one staff said they tried to make the most of the time they had to spend helping the person with care. The manager is already trying to recruit activity staff to spend 10 hours per week on one-to-one time with individuals. People said they could have visitors at any time, and those we met were happy with the home and how they were treated. One said they had been on outings organised by the home, with their relative who lived at the home. The Statement of Purpose also points out that people may decline to see callers, if they wish. Induction programmes for new staff included how to receive visitors, take phone calls, etc., and staff were heard welcoming visitors on answering the doorbell. A professional said matters had improved greatly at the home since they spoke to us last year about concerns that some staff did not greet or assist them properly when they visited the home. One person said they had their breakfast in bed because that’s what they wanted. People we asked said staff were flexible, helping them to follow a routine of their own choice. People had their own possessions in their rooms, reflecting their individual backgrounds, interests, etc. We were told that vacated rooms are being fitted out with new furniture which will have a lockable facility, so people will be able to keep valued or valuable items safely themselves. At present, the home holds valuables for people, limiting ease of access to their own property, or provides personal facilities if requested. People said they liked the food at the home. When we arrived, some people were still having breakfast, enjoying a cooked breakfast of different sorts, with their own pots of tea so they could help themselves when they were ready. The day’s lunch menu was written on a board in the dining area. The home is developing a catalogue of pictures of meals, etc., to help people with communication difficulties make their choice known more easily. People enjoyed the lunch served during our visit, with one commenting aloud on how nicely cooked the fresh vegetables were. We saw staff sitting assisting individuals at lunchtime. Some people chose to eat in their own rooms. Pureed The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 17 meals were attractively presented. Staff went round later, asking people what they wanted for tea that day. Staff could make snacks for people if they wanted something more to eat in the evening. Menus showed fresh fruit salad was available daily, with a hot homemade sweet also offered amongst other choices. The cook said menus were about to be revised to take into account seasonal changes, and people living at the home would be involved in this. We saw fresh herbs, olive oil, and cooking wine in the storerooms. One survey said the person missed the homemade cakes. When we asked about the cakes we saw offered with afternoon tea, the cook said cakes are always made daily, using a bought-in low sugar/salt/fat cake mix. A list of people requiring special diets was seen in the kitchen; the chef said staff also highlighted individuals’ special requests on menu sheets. He told us about current individuals’ preferences. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ welfare and rights are safeguarded through a variety of policies and practices, including that concerns and complaints are heard and used to improve the service provided. EVIDENCE: All people spoken with felt able to complain or raise concerns, as was reflected by surveys. Photos of staff were in the entrance hall, to help people identify who was in charge each shift, should they wish to speak to them. A relative said, “On the whole a good nursing home. We have had a few problems in the past but on the whole all things have been resolved.” A visitor told us they had been able to speak to the Responsible Individual representing the registered provider of the home when they had concerns. The complaints log showed a range of concerns was recorded, and action taken to try to prevent a recurrence of the issues noted. A senior carer said they were told the outcome of complaints made to the home. We have not received any complaints about the home since our last inspection. People we asked said they felt safe at the home. Staff confirmed they had had useful training on safeguarding; they knew they must report abuse, although they were not always aware of whom to contact outside of the organisation if they had certain concerns. The manager had told us that this issue had been The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 19 identified in the home’s own evaluation of safeguarding training, so the matter had been discussed again. However, she said she would repeat this point given our findings. Inventories were kept of peoples’ possessions, as a clear record of their property (as opposed to what had been provided by the home). Bedrails were seen on several beds. Staff were aware that bedrails are a potential form of restraint. We found people or their family had been consulted about their use, as well as their GP, helping to ensure peoples’ rights were upheld as well as their physical welfare. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a clean, safe and homely environment, although ongoing refurbishment will further improve the home. EVIDENCE: People were satisfied with their accommodation and facilities, including the lighting, hot water and heating. Bedrooms are being refurnished at a rate of 12 per month, including variable height beds. One person said there was “A nice garden to walk around.” A visitor suggested an awning outside over the front door would be helpful; the manager said this is in hand. The décor has been improved since our last inspection, with ongoing refurbishment planned. Some carpets in corridors were a bit worn, but new carpets have been laid in some lounges and bedrooms. Communal bathrooms and toilets have had minor repairs attended to, tiling done, etc. since we noted The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 21 these were in need of attention at our last inspection, improving appearances and hygiene. People said repairs are quickly attended to; one person said their room had been cold once but this was quickly seen to. Staff reported equipment was serviced regularly and rarely broke down. A visitor thought the main lift was problematic, although the manager thought it had only broken down once. We saw a list of servicing dates for equipment displayed in the home’s office, alongside the refurbishment programme for the next year. Raised toilet seats and frames were seen around the home, to help people use the facilities more safely and as independently as possible. One person noted the decking outside a lounge was slippery and therefore could not be used. The manager said a pressure washer was being obtained, to address this problem. People said they were very satisfied with the usual standards of cleanliness at the home. One survey from a relative said, ‘The home is exceptionally clean and smells fresh – they definitely get 10/10 here!’ There were no malodours and the home looked clean on the day of the inspection, with domestic staff on duty most of the day. Staff said there were always plenty of supplies such as disposable gloves and disinfecting hand rub. Those we asked described appropriate ways of ensuring their hands were clean. We saw lidded bins used for dirty laundry, with particular procedures used for transporting soiled laundry. Laundry washing machines had recommended programmes for disinfecting laundry. We saw care staff wore tabards over their uniform when handling food, serving meals, etc. Meals were taken to rooms on individual trays, with the plated meals covered during transit. The kitchen floor looked in need of a ‘deep clean’, but otherwise the kitchen area was well kept (with clean fridges and surfaces, freezers regularly defrosted, etc.). The cook said the floor had been steam-cleaned three months previously, and this would be re-done soon. We noted that clinical waste bins were not foot-pedal operated, which would help reduce cross-infection. Staff said that occasionally they had to share hoist slings between people, rather than each person having their own, especially since the increase in admissions. The manager said she would address these matters promptly. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements are sufficient to meet peoples’ general needs, although more training would help ensure the staff team has the knowledge and skills to ensure peoples’ safety and meet their diverse or changing needs. People are protected by the home’s recruitment policies and practices. EVIDENCE: People described staff as “Ever so nice”, “Very good – they really are”, “All very kind”, confirming they were gentle and polite. Those observed were cheerful, unhurried, and mature in manner. When we arrived, there were six care staff on duty, including one nurse, to look after the 31 people living at the home (26 of whom needed nursing care). An administrator (who has care experience), a cook, and cleaning staff were available to support them for much of the day. The manager also supported the nurse on duty, and answered peoples’ queries. People seemed very happy when we spoke with them, although three said there were a lot of staff changes when we asked them about this. They generally looked well cared for, including those in bed. We saw staff were patient and attentive to someone who was confused and needing reassurance. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 23 We heard staff talking with people as they helped them in their bedrooms. Six people commented on some communication difficulties with staff. One relative commented, however, that ‘Communication is usually quite good’. We saw one carer did not engage much with the person they were helping at lunchtime; in another case, one did not seem to appreciate a frail person might want to know what was in their pureed lunch. And we had some difficulties when speaking to some staff. People were generally positive about staff support and levels, saying staff were always available if they rang their bell. Staff levels in evenings have been increased since our last inspection. One staff member felt that, with several people needing help at mealtimes, the home could do with more staff then. Another said there had been several admissions recently, so the home was recruiting extra staff. Someone with more complex health needs said staff had no time to chat but they certainly couldn’t complain about the service they got from them, although they thought some staff knew their needs better than others. They added, “As for the sisters and Matron – you couldn’t wish for anyone better.” Someone in a lounge where there were few call bells to hand, said staff came round regularly; staff said that they checked hourly on people in lounges, because some were unable to use a call bell. Of 15 care assistants employed, four have a recognised care qualification, and five are undertaking one. If the latter achieve the qualification, the home will have met the recommended target that half of care staff are thus qualified. Those spoken with during the inspection had care qualifications or were on relevant courses, and had relevant experience. Rotas confirmed there is always a nurse on duty, to supervise care. Recruitment documentation was checked for three staff employed since the last inspection. Required information had been obtained before they commenced employment at the home, and all had relevant care experience. Senior carers we spoke with were responsible for induction of new care assistants. One said induction could take as long as it was reasonably necessary for an individual, to ensure they were competent and confident. They worked with the new staff and ensured they progressed through their induction programme. The completed induction record for one person showed they had been told about a range of topics including safeguarding, confidentiality, greeting visitors, mouth care, dementia and strokes. This induction was in addition to a 2-day company induction, on health and safety topics (provided by specialist external trainers), privacy and dignity, caring for people with confusion, and the role of the carer. Staff said although they hadn’t had regular formal one-to-one ‘supervision’, they had regular meetings with the manager or she was readily available to them, and any suggestions for improvements were listened to. We saw personal development plans for one staff member that included finding out The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 24 more about our reporting methods as well as improving aspects of recordkeeping. The manager said staff appraisals were used to identify training needs that informed the next year’s staff training programme. Each nurse’s clinical knowledge and skills were specifically assessed, with training arranged as necessary to ensure their clinical skills were maintained. The manager said she had also carried out a period of observation of staff practice recently, discussing her observations with the staff concerned. One staff member said they had attended some training relevant to the needs of people living at the home (on dementia), and thought their peers would benefit from this training. They also wanted more training about ‘strokes’ since there were more people at the home affected by this condition. The manager said training about sight problems is due to be given, by the home’s visiting optician, in March 2008. We saw records of short but regular training sessions given through each week by nurses, to the care staff on duty at the time. These covered current practice or issues - such as pressure area care and care plans. We saw photographs used for staff training – for example, to show staff how tables should be set for meals, with napkins, etc. However, it was difficult to see from records kept which staff were up-to-date with training, and some training staff told us they had had was not shown on records. The manager was sure that staff were either up-to-date or booked on relevant training. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally run well and run in the best interests of people living there, although the manager has yet to be registered with us to confirm she is suitable for this role in the longer term. Good practices used by the home protect peoples’ financial affairs. There is attention to health and safety matters, but additional measures must be taken to further protect people at the home. EVIDENCE: Katy Twidle is a Registered General Nurse with previous experience of managing similar care settings. She has managed The Seaton for some months, and in the process of applying to become the registered manager The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 26 through us. People living at the home and their relatives said they saw the manager/matron regularly, and that she was very nice. Staff said there were residents’ meeting three-monthly, although the manager said sometimes people didn’t want to meet so she spoke to them individually instead. One relative said the home had carried out surveys for quality assurance purposes, although they hadn’t had any feedback on the outcome yet. The manager said a written report is put in the entrance hall initially and later kept on another notice board. The Responsible Individual or their representative has carried out monthly unannounced inspections of the home, as required after our last inspection, to ensure the home is developed safely and appropriately. They repeat a full audit of the home every three months, and a staff member spoke about action taken as a result of findings from these. We found senior staff were aware of matters we raised, with evidence that there were plans to address most of them already. Staff do not act as appointee for anyone living at the home, so people can chose who manages their financial affairs for them. The manager was trying to arrange Court of Protection involvement for one person, however. We saw the administrator provides receipts for money given to her to be held by the home on behalf of any resident. There is a bank account used solely for personal monies belonging to people living at the home, since the home does not keep large amounts. Individual, computerised money records were seen. The administrator told us printed copies are kept in case of any queries, or are given on request and when someone’s balance is low. Receipts were seen for transactions checked on these records, with two signatures obtained to verify each transaction. Staff we asked said they felt they had a safe working environment, although one thought, with a recent sudden increase in admissions, they could do with more hoists for assisting people to move. Those we spoke with said they had had recent updates on health and safety topics. A newer staff member said they had fire safety training on their induction, repeated a month later. Although a company responsible for the home’s fire risk assessment had visited in November 2007, when it was due for review, the risk assessment itself had not been re-dated to confirm it had been reviewed. The manager said she would follow this up. We also discussed that there were no fire safety risk assessments for individuals, which the home should consider for inclusion in care plans. Risk assessments had been undertaken where bed rails were used for people we case-tracked, with monthly safety checks carried out. A professional had raised concerns with us about wheelchairs being used without footrests, which affects peoples’ comfort and safety - something we had raised at our last inspection. However, the professional has since said things have now improved, and we did not note any such issues during this visit. Regular The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 27 checks of wheelchairs, to ensure standards were maintained, were not evidenced. The home’s AQAA stated that electrical circuits had been serviced in November 2007, as had the heating systems and lifts at the home; gas appliances has been serviced in December 2007. Legionella checks had been done in April 2007, according to information we saw. The programme of fitting radiator guards was due to be completed by September 2006. We saw some bathroom radiators were still unguarded. The manager said the programme was ongoing, guided by risk assessments, and we saw a written programme for this displayed in the office. The manager said room risk assessments were to be introduced, and these would include checks for window restrictors. One en suite bath had hot water that was at least 50°C. Although the person could not use the bath unaided, such temperatures should be monitored and regulated in case someone else tried to use the bath. The cook on duty had achieved an intermediate food hygiene certificate, and was using current food safety guidance. Fridge, freezer, and cooked food temperatures were recorded, and these were at appropriate levels. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(4)(c) Requirement You must ensure that unnecessary risks to the health and safety of people living at the home are identified and as far as possible eliminated. This relates to safety checks on wheelchairs, window restrictors, water temperatures, etc., so that people have as safe a home as possible. Previous timescale of 31/10/06 not fully met. Timescale for action 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that care plan reviews and evaluations should include sufficient detail, to show whether identified care needs are being met or not. DS0000061080.V358655.R01.S.doc Version 5.2 Page 30 The Seaton 2. 3. OP28 OP30 4. OP31 5. OP38 It is recommended that 50 of care assistants have NVQ level 2 (or equivalent) in care, so that people are in safe hands at all times. It is recommended that a) The staff training & development programme ensures staff are trained & competent to meet peoples’ individual or more diverse needs; b) That it includes various communication skills; and c) Clear records of training undertaken by staff are available, in part to show staff are up-to-date with health and safety training. It is recommended that the manager is registered to run the home as soon as possible, to confirm her fitness for this role, and because any person managing an establishment without being registered is guilty of an offence. It is recommended that work to cover all radiators at the home should continue until completion, to reduce the risk of burns. The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Seaton DS0000061080.V358655.R01.S.doc Version 5.2 Page 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. 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