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Inspection on 20/08/09 for The Squirrels Care Centre

Also see our care home review for The Squirrels Care Centre for more information

This inspection was carried out on 20th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents are happy living at The Squirrels. They speak positively about the staff team and the food provided. Comments include `the care staff are friendly and helpful`, `the staff do not rush my care and are always polite` and `the chef does his best to try and please`. The home has a stable staff team who are generally well trained and provide a good level of basic care to the residents. The activities officer is very resident led and is keen to do well for them and the residents are generally happy with the activities offered. Consultation with residents is good and any complaints are handled well by the manager, who the residents and staff speak highly of.

What has improved since the last inspection?

Since the last inspection the manager has addressed the shortfalls that were noted with the medication administration systems and has put monitoring tools in place to ensure that the standards are maintained. Staffing at the home has also improved with staff working less hours and receiving more support and supervision than before.

What the care home could do better:

There are two main areas for work in this home.The Squirrels Care CentreDS0000018113.V377768.R01.S.docVersion 5.2Whilst the staff team are quite well trained, stable and provide a good standard of basic care, there needs to be more attention to detail and a more developed person centred approach to care as there remain a few areas of concern where staff are not taking the trouble to attend to, for example, bed making, the approach of some staff and the care of residents clothes/personal belongings. It would also be of value for the manager to review how the shifts are set to ensure that, where expressed, residents have the ability to choose whether they have male or female carers. The premises require some care and investment to bring it up to an acceptable standard. Conditions are variable throughout the home but in particular more attention is needed to the decoration of communal areas, homeliness, cleanliness, odour control, safe access and the garden.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Squirrels Care Centre Warley Road Great Warley Brentwood Essex CM13 3HX Lead Inspector Diane Roberts Key Unannounced Inspection 20th August 2009 09:00 DS0000018113.V377768.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.2 Page 2 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 The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Squirrels Care Centre Address Warley Road Great Warley Brentwood Essex CM13 3HX 01277 224308 01277 261353 thesquirrels@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Roda Magwizi Care Home 58 Category(ies) of Old age, not falling within any other category registration, with number (58) of places The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided to no more than fifty eight service users over 65 years. Total number of service users for whom personal care is to be provided shall not exceed 58. 20th February 2009 Date of last inspection Brief Description of the Service: Ashbourne (Eton) Ltd., which is part of Southern Cross Ltd., owns the Squirrels Care Centre. The home provides personal care and accommodation for up to fifty-eight older people. The home is a large listed building and is situated in extensive grounds in a rural location some distance from shops and public transport. The home provides transport to both staff and visitors. There are car-parking facilities at the front of the property. The home provides single and double bedrooms and all rooms have en-suite WC facilities. There are two lounges and a large separate dining room. Passenger lifts provide access to all upper floors. As at 20th February 2009, we were advised that the fees for accommodation range from £465.00 to £750.00 per week. Extras to the fees include hairdressing, chiropody, personal toiletries, magazines and newspapers. Information about the services provided at the home is located within the homes main reception area. Inspection reports are available from the home and from the CSCI website www.csci.org.uk The Squirrels Care Centre DS0000018113.V377768.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 stars. This means the people who use this service experience good quality outcomes. We visited the home for a day and met with the manager, the regional manager and her team. Prior to this we reviewed all the information that we already had on the home. The manager was not asked to complete an Annual Quality Assurance Assessment, as she had already completed one in 2009 and residents and relatives were not surveyed as this was an unannounced key inspection. On the day of the inspection we spoke to 3 residents and 5 staff at the home. Whilst at the home we also reviewed records and undertook a tour of the premises. What the service does well: The residents are happy living at The Squirrels. They speak positively about the staff team and the food provided. Comments include ‘the care staff are friendly and helpful’, ‘the staff do not rush my care and are always polite’ and ‘the chef does his best to try and please’. The home has a stable staff team who are generally well trained and provide a good level of basic care to the residents. The activities officer is very resident led and is keen to do well for them and the residents are generally happy with the activities offered. Consultation with residents is good and any complaints are handled well by the manager, who the residents and staff speak highly of. What has improved since the last inspection? What they could do better: There are two main areas for work in this home. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.2 Page 6 Whilst the staff team are quite well trained, stable and provide a good standard of basic care, there needs to be more attention to detail and a more developed person centred approach to care as there remain a few areas of concern where staff are not taking the trouble to attend to, for example, bed making, the approach of some staff and the care of residents clothes/personal belongings. It would also be of value for the manager to review how the shifts are set to ensure that, where expressed, residents have the ability to choose whether they have male or female carers. The premises require some care and investment to bring it up to an acceptable standard. Conditions are variable throughout the home but in particular more attention is needed to the decoration of communal areas, homeliness, cleanliness, odour control, safe access and the garden. 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. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 7 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 Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 8 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be assessed properly, so they can be sure that the team at the home could meet their needs, but they may not always have all the information they need about the home made available. EVIDENCE: The service user’s guide was seen to be available where visitors signed into the home but they were not seen in any residents’ rooms. New residents spoken to said that they had not seen the guide. The manager has a system in place for the pre-admission of prospective new residents. Either the manager or the deputy undertake the assessments and two completed assessments were reviewed during our visit. The assessments were seen to be completed well and contained sufficient detail on the individual The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 9 on which to base a decision about whether admission to the home would be suitable for them. The assessments had a good level of person centred information and highlighted peoples’ choices and the level of support that they would need. Risk assessments, covering a range of subjects, such as manual handling, are also completed as part of the assessment. In addition to the assessment, information from the referring authority had also been obtained to support the information gathered. From the assessment a pre-admission draft care plan is developed and records showed that soon after admission a full care plan is put in place. Residents spoken to said that they had been shown around when they arrived at the home and told to ring and ask if there was anything that they wanted. Residents were satisfied with this. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive care that meets their needs, provided by staff that know them well. EVIDENCE: The manager has a care planning system in place. Three care plans were reviewed and two further care plans were used for cross referencing. Overall the care plans were good and contained sufficient detail to guide staff on the care and support needed. Throughout the care plans there was person centred information outlining, for example, residents’ preferences around food, daily routines and self image. This approach could be developed further with more person centred information being available in relation to the provision of personal care and for the care plans to identify residents abilities and strengths more, so that staff are encouraged to promote residents’ independence, the retention of skill and therefore self worth. This would also help to evidence that residents had been The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 11 involved in the development of their care plans. Residents generally had all the care plans in place that were linked to their assessed needs, however more could be developed to guide staff on supporting residents with mental health needs such as depression. For example, a resident who suffered with depression and openly discussed how it affected them did not have a care plan in place to guide staff. Social care plans were limited and these are discussed fully in section 3 of this report. Daily notes recorded by the care staff show that residents have been offered choices and their rights have been respected and they were sufficiently detailed to show the care and support that had been provided. Overall the care plans were up to date and show evidence of a regular review. Residents who commented on the care said the care staff do not rush my care and they are always polite and I would like more help to be independent. On speaking to the staff, they knew the residents well, including details of their individual preferences. Staff also knew very new residents quite well considering the amount of time that they had been in the home. Residents had a range of risk assessments in place and overall these were seen to be up to date and contained sufficient detail to identify the risk and any subsequent management. Where required, care plans had been generally been put in place, although staff were not always care planning for those residents who were at notable risk of falling. This should be addressed to ensure that the management of the risk is appropriate. Residents were assessed in relation to the risk of developing pressure sores and those with an identified risk had the required equipment in place, promptly supported by a care plan. For new residents, the majority of the risk assessments are completed at the time of the pre-admission assessments and staff should ensure that any key information is transferred over to the main care plan. For example, manual handling information was not easily available as it was hidden away in the preadmission assessment once the main care plan had been completed. Records showed that residents were being weighed regularly and nutritional risk assessments and specific care plans had been put in place, for example, with diabetes management. Additional information was also available in the plan for staff on diabetes and in some cases residents had a more detailed clinically based nutritional screening tool completed. Detailed care plans were also in place for those residents with specific medical conditions and these outlined the management and any support needed and again gave supporting information to staff on, for example, CVAs (cerebro-vascular accidents) and epilepsy. Records showed that residents were accessing their doctor in a timely manner and that they had input from district nurses, chiropodists and opticians etc. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 12 Residents’ bedrooms were visited and the role of the key worker considered in relation to the care of residents’ belongings. Residents’ clothes were seen to be on the floor of the wardrobes, not hung up and generally uncared for. On speaking to staff, they were clear as to the role of the key worker and that this entailed caring for residents’ personal items such as clothing. The manager needs to revisit this with care staff to ensure that residents’ dignity is respected. The medication system in the home was reviewed. The management of these systems had improved since our last visit and burglar bars have been fitted to the medication storage room. On the medication administration sheets, the prescriptions were clear, medication was correctly signed in and staff had signed correctly for the medication, including as a when medication, which may have a variable dose. Staff were using omission codes and detailing the reason for the omission on the back of the recording sheet. Medication packs were checked and these tallied with the administration sheets. Since the last inspection the manager has put a checking system in place to ensure that residents’ medications do not run out. Records were available that showed this system being used. It was good to see that new respite residents had a photo on file straight away to reduce the risk of medication errors. It was noted that one resident who was self medicating did not have a risk assessment in place and staff need to record the dates of opening on liquid medications so that they can be audited if need be. The medication system was last audited in July 2009 by the deputy manager and no major issues were noted. Training records showed that all staff who administered medication were trained at the end of 2008. Records within the care plans showed that residents had their medication reviewed on a regular basis. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can generally expect that their social care needs will be met and that they will receive a good meals service at the home. EVIDENCE: From discussion with residents, staff and from records, the routines of the day are generally resident led. Residents said that they had choice about how they spent their time although some said that they felt obliged to go to bed when more staff were around. Female residents expressed preferences of having female carers but said that they did not have a choice and really had to go with it if they wanted to get into bed. These preferences were not seen in the care plan. Staff speaking about the routines of the day gave variable responses, with some clearly showing that they gave residents choices and others spoke in a more institutional way about singles and doubles and that night staff get 12 residents up. The management of the home may need to revisit the daily routines with staff to ensue that they all have a person centred The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 14 approach to care that gives residents choices and the time to retain their skills and independence. Residents have a social profile in place; the standard of these was variable. Some contained more information than others on residents’ family and social interests and some were, on discussion with residents and staff, not reflective of the residents’ current needs and interests. A system should be considered whereby such documents are reviewed with the residents. For example, one profile had activities listed that the resident was no longer able to physically do. Social care plans were also variable in quality and often limited. Some contained no real assessment of need and just listed preferences and stated that staff should encourage x to join in activities. Occasionally staff had identified aims of social care such as to promote self esteem. More work is needed on the assessment of residents’ social care needs, in conjunction with the activities officer, to decide how social care may benefit residents as individuals in both a therapeutic and entertaining way. Residents who commented said I sometimes go in the lounge but there are not many people you can join in with and that depresses me, I would like more exercise to help me with my legs, the activities lady does her best but her time is limited, the activities lady comes to see me for a chat and that helps me a lot, I would like some-one to come and chat and play cards with me, I think we could do more exercises, the armchair aerobics is just throwing a ball. An activities programme was seen to be displayed in the main hallway along with posters for clothes parties and other events. Some residents had activities programmes displayed in there rooms, which is a good practice, but these were out of date, from June 2009, two months previously. Care staff spoken to said that they followed the activities programme and said that there were a lot of quizzes held. At the weekend they said that it was more one to one activities and they sat and chatted to the residents and did their nails. The manager employs an activities officer who works 25 hours a week. On discussion, she has not had any training for her role but has started to attend meetings with other activity officers for support and ideas. She confirmed that she completed a programme but said that she checks with residents on a daily basis whether they still want to do the set activity or whether they fancied doing something else. The activities officer had personal life histories in place that detailed social history and hobbies etc. and she said that she used these to help her plan the programme. When both lounges are in use there are two activities to choose from during the day. The activities officer has also started to complete social care plans for the residents and it may be of value for these to link into the care staffs social care plans to improve consistency, keep them up to date and avoid duplication. The care plans seen were detailed and generally of a good standard identifying residents’ needs more than those completed by the care The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 15 staff. Again a formal assessment of need may help with residents’ independence, the retention of skills and the promotion of self worth. The activities officer has a person centred approach and is aiming to bring a quality of life to residents living at the home. For example, she plans to organise wine for residents to have with some of their meals. One to one time is offered and from records consists of chatting, shopping, manicures and following specific interests etc. Records show that the activities officer does consult regularly with residents about activities and overall this is a positive service for residents that is developing well. Activity records show that residents have held parties, visited other care homes in the area, had Indian head massages, had owls visit the home, had quizzes, church service, visiting ice cream van, eating out at restaurants, poetry, entertainers, etc. The tables in the dining room were seen to be nicely laid with condiments and menus available. The menus were also pictorial to help residents with making a choice. Lunch was observed and residents were seen to be being helped in a sensitive way. The food looked appetising and residents were observed to be eating well. During the day juice was available in the lounges for residents to have a drink apart from at the drinks rounds but this was not used a great deal. Staff may need to be a little more proactive in offering this to residents rather than waiting for a request. Residents who commented on the food said the food is basic but good, the food is not too bad, proper mash potato would be nice not smash as it tastes funny, the food is sometimes too salty, I would like to put my own seasoning on, the food is excellent and you get a good choice, we get a choice of meals and I eat in my room and its always hot and We often have sandwiches for tea and I like x and the chef does that just for me and he does try to please. Records also showed that residents had also been consulted about whether they would like music on, when eating their meals. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their concerns and complaints would be listened to and that they would be protected from abuse or neglect as far as possible. EVIDENCE: The complaints procedure is displayed in the home and the manager holds surgeries for relatives and this was advertised in the reception area of the home. Residents spoken to who commented said that I do not have any complaints, the activities lady always asks me if I am alright and if there is anything I would like to raise and I would speak to the manager if I needed to say anything. Since the last inspection the manager has dealt with 3 complaints. These related to inadequate lighting and a lack of a mirror in a bedroom, standards of care at night and resident being left unattended. 2 complaints were upheld and one was not. The manager has a good and objective approach when investigating complaints and where required writes to residents to give a formal response. Records of investigations were good and showed that The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 17 thorough investigations are undertaken and where needed the appropriate action has been taken with staff. Staff spoken to confirmed that they had received training in adult protection but were unable to easily find the polices and procedures that the provider has in place. The staff showed a good understanding of the management of any suspect adult abuse and were able to describe the procedures that would have to be followed. The managers training matrix showed that all of the staff working at the home had up to date training in adult protection. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Variable standards around the home would mean that residents may not always experience living in a clean, well maintained and homely environment. EVIDENCE: A tour of the home was undertaken with the manager. All communal areas were seen along with bathrooms, the laundry and a number of bedrooms in all parts of the home. At the time of our visit, one of the lounges was cordoned off and not being used by residents as a small part of the ceiling cornice had come down due to water ingress and was awaiting repair. Due to the large size of the second lounge and the reduced occupancy, this was not seen to be adversely affecting residents quality of life. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 19 On touring the home water ingress and damp were seen in several parts of the home, for example, the stable block corridor. The paintwork in the home is in need of attention and reflects poorly on the overall decoration. Parts of the home require investment in order to bring it up to an overall acceptable standard, ensuring that residents have a pleasant and homely environment in which to live. The outside of the home is poorly maintained and access is limited to the veranda and courtyard, due to uneven surfaces and weeds etc. Off the rear veranda, staff have been working with residents to grow some vegetables, but again access poses a level of risk in relation to falls. It was also noted that staff use old wheelchairs for transporting rubbish to the wheelie bins and these are left in the courtyard with rubbish on. This gives again gives a poor impression of the home and does not make the courtyard a pleasant place to spend time. The home has two large lounges and a large dining room. One lounge and the dining room have and are in the process of being painted with colours that the residents have had input into choosing. This work is being completed by the maintenance man at the home who works full time and has help from a driver also linked to the home. Due to the large sizes of the rooms this work is taking time to complete leaving the rooms looking unfinished/tired. One lounge in particular and the dining room lack a homely feel overall and would benefit from some furniture, other than chairs and more pictures on the wall. A small lounge in the stable block contains a drinks machine for staff. The siting of such a machine should be considered as drinks machines are not seen as lounge furniture. Curtains around the home were seen to be dirty, especially net curtains in the corridor to the stable block. Housekeeping staff should have this task as part of the cleaning schedule. Residents had personalised their bedrooms where they wished or were able. Some bedrooms were noted to have unacceptable odours but these were restricted to the rooms and did not affect the home as a whole. The standard of decor in the bedrooms was variable with some being good and some looking tired and in need of redecoration. Again the maintenance man was due to redecorate some of the bedrooms. Some of the vanity units in the bedrooms need some attention or replacing. Overall the beds were noted to be poorly made by staff and the bed linen had not been changed where it was seen and felt to need doing. The quality of the bed linen and pillows was poor overall, and several rooms were checked. The manager said that no new bed linen had been purchased in the recent past and on seeing clean linen in the laundry, sheets were seen to be thin and marked. This standard would affect the quality of life for residents in the The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 20 home. Residents who commented said the duvets are lumpy and I think my bed is changed often enough, its always clean. Minutes of a relatives meeting in June also showed that they were dissatisfied with the bed making at the home along with residents at their meeting the same month. It is disappointing to note that this issue has not been addressed by both the management and the care staff team. The bathrooms were seen to be satisfactory although some communal toilets required repair with broken toilet seats - putting residents at risk of falls. Residents who commented about the home and facilities said the accommodation is basic, my room has been cleaned only once in 3 days and the bin is overflowing, there is no attention to detail from the cleaning staff and they have kindly supplied a television but the remote control does not belong to the TV so I cannot change channels as I cannot move. The manager told us that with a grant from the local authority, they planned to ensure that every bedroom had its own television in the near future. The maintenance man works at the home full time. Records show that staff raised items for attention with him and he signs them off when completed. The maintenance man also has a lot of premises checks to undertake as well as decorating the home. A review of the time allocated to this post should be undertaken in order to ensure that there is sufficient time to complete the decorating in such a large home. Since our last inspection the top floor of the home has had a new fire alarm system installed. Records show that the manager reviews the fire system safety records on a regular basis and these include, alarm tests, staff fire drills and emergency lighting checks. All these were seen to be in good order and the manager also had a fire safety risk assessment in place which was up to date. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable and generally well trained staff team to care for them. EVIDENCE: At the time of the inspection the home was fully staffed, the manager had no vacancies and no agency staff were being used. The current staffing levels, based upon the dependency of residents and the layout of the home are, for 29 residents, 6 staff in the morning, 5 in the afternoon and evening and 4 at night. The manager says that she keeps the staffing levels under review. The staffing of the home has improved since our last visit with staff working more acceptable hours and the levels are maintained if not exceeded at times. Residents spoken to, who commented on the staff team, said that the care staff are very good, helpful, I am not too enamoured with the night staff they do not respond to you as a person and are reluctant to help, the staff do their best, they are a nice bunch of people, but there are not enough women carers to see to our needs and sometimes the call bell is answered promptly and The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 22 sometimes it is not, depends on how short staffed they are. Residents who were in their rooms were observed to have the call bell system to hand. The interaction between staff and residents was seen and heard to be friendly and caring. It was noted that staff whose first language is not English were interacting less with the residents. This has been noted as a concern in previous inspection reports. Staff spoken to confirmed that they had been undertaking NVQ qualifications. At the current time, records showed that only 9 out the 24 staff had achieved an NVQ qualification. The manager has records to show that 13 more care staff would be commencing training in September and October 2009. Two staff files were reviewed to check the recruitment process at the home. Records showed that the files were generally in good order with all the required checks and documentation in place at the appropriate times. More care should be taken to ensure that new staff supply a reference from the most recent employer and that any gaps in employment are explored with the applicant. Training records showed that compliance with training in the home is very good. Nearly all staff were up to date with fire safety and infection control and all staff were up to date with manual handling, food hygiene and health and safety. In addition to this the majority of staff had undergone training in the last year on nutrition, pressure area care, customer care, challenging behaviour, dementia awareness and bed rail safety. Consideration should be given to providing key staff with training on conditions associated with old age, for example Parkinson’s disease to increase the knowledge base further and possibly extend the care planning training to more care staff so their skills and appreciation of person centred care are developed. Staff spoken to confirmed that they were undertaking Skill for Care induction following an initial induction to the home and the records seen on staff files concurred with this. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be consulted about issues that may affect them whilst living at the home and be assured that the home is managed with their best interests in mind. EVIDENCE: The manager has been working at the home just over a year and has made steady progress towards improving standards in the home. More work could be done by the manager and her senior team to monitor standards in the home, for example, with bed making and domestic cleaning. Records show that the manager has an NVQ level 4 qualification in management and also has trained to be a trainer in mandatory courses that The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 24 staff in the home need to have such as manual handling. She has also completed a course in the care of people with dementia and one on effective staff management. Residents who commented said that the manager was very nice and helpful and the staff team respond to her and occasionally I see the manager and my relatives see her, shes a very nice person. Staff spoke positively about the manager and minutes of meetings showed that she meets every couple of months with them. The minutes also show a good open dialogue between the manager and the staff about care standards and issues that may affect the smooth running of the home. The manager has a quality assurance system in place that includes obtaining feedback on the home and service offered, from residents. The questionnaire is good, covers all areas and is in a primarily pictorial format, making it easy to use. The questionnaires had recently been sent out and were in the process of being collated. The most recent feedback from residents showed that results were variable and in some areas there was still room for improvement. For example, 85 of residents who returned a questionnaire said that they got the help that they needed with personal care but 23 said they could not choose who helped them and 31 said that staff did not respect their choices. However 69 said that staff treated them with dignity and respect. 92 of residents who responded said that they were happy with the activities programme and 69 said that the staff were friendly and helpful. The activities officer holds meetings with relatives on a regular basis and the minutes show that residents are happy to give their views on a range of services in the home. It may be of value for the manager to attend occasionally as some residents are raising issues which the manager may need to hear for herself and comment upon or follow up, for example, staff attitude and bed making. The manager also meets with relatives on a regular basis and minutes are taken. It is clear that the manager is encouraging relatives to give their opinions and comment on changes in the home. Relatives are also being encouraged to form committees to aid with the development of the social side of care in the home. In addition to this the manager completes a monthly outcome audit tool and develops an action plan where required. This checks many systems in the home including staff records, care planning etc. Records show that the manager is completing these and addressing any shortfalls noted. The regional manager covering the home also visits and undertakes the sane audit to ensure an objective approach. Records in staff files and the supervision matrix, showed that the staff were receiving regular supervision and staff spoken to confirmed this. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 25 Accident records were reviewed and found to be completed clearly. One resident was noted to be falling 2 or three times every month. Records showed that the GP was aware as was the social worker at a review earlier in the year but no referral had been made to the falls prevention team. The team at the home should explore all avenues on the resident’s behalf to see if the risk can be reduced in any way. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 26 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP 10 Regulation 12 Requirement Timescale for action 30/10/09 2. OP9 13 3. OP19 23 Respect residents’ dignity by caring for their personal items and in the way they are cared for so they experience a good quality of life. Undertake risk assessments for 14/09/09 those residents self medicating and kept it under review to ensure that it remains safe for them to continue to do so. Keep all parts of the home clean 30/11/09 and in good repair so that residents have a pleasant environment in which to live. 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. OP1 2. OP7 The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 28 Refer to Standard Good Practice Recommendations Make the service user guide freely available to residents Where required put mental health care plans in place. 3. OP9 4. OP12 5. OP12 6. 7. OP29 OP27 Record dates of opening on liquid medications so they can be audited. Review the routines of the day with staff to ensure that a person centred approach is being taken by care staff. In conjunction with the activities officer, assess residents social care needs and plan a programme of activities accordingly. Review how the rota is set with regard to the male and female care staff ratio, to ensure that where residents express a choice, this can be respected. When recruiting new staff always request a reference from the last employer and explore any gaps in employment. The Squirrels Care Centre DS0000018113.V377768.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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