Inspection on 28/01/09 for Thornfield Care Home [Seaton]

This inspection was carried out on 28th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thornfield Care Home [Seaton] 04/03/08

Thornfield Care Home [Seaton] 03/10/07

Thornfield Care Home [Seaton] 03/04/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thornfield Care Home [Seaton] Thornfield 87 Scalwell Lane Seaton Devon EX12 2ST     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teresa Anderson     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Thornfield Care Home [Seaton] 87 Scalwell Lane Thornfield Seaton Devon EX12 2ST 0129720039 01297625979 thornfieldcare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cannon Care Homes Limited care home 38 Number of places (if applicable): Under 65 Over 65 38 38 38 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 3 0 0 This home last had a key inspection in March 2008. A random inspection to monitor progress and in response to a complaint was undertaken in July 2008.Thornfield is a care home that provides care and accommodation for up to 38 residents with needs relating to old age and/or dementia. It is situated on the outskirts of Seaton, in a quiet residential area within driving distance of the town and seafront. The home is a large older style house, which has been converted and extended over the years.There are currently two areas within the building where people are cared for. One area includes a lounge and part of a conservatory. The other area has two linked sitting areas and a dining room. On occasion residents who spend their days in this second area have their access to other parts of the home restricted by a keypad system. Bedrooms are situated on the ground and first floors. The majority are for single use and some have ensuite facilities. A staircase and a small passenger lift link floors. Outside the home Care Homes for Older People Page 4 of 33 Brief description of the care home there is parking on the road outside and a small garden to the rear. The current fees range from 385.00 to 700.00 pounds. Fees do not include items such as taxi fares and the cost of newspapers or toiletries. Those people who wish to use incontinence aids and are not assessed as needing them by the district nursing service pay for their own. Further information about this home is available direct from the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was undertaken as part of the normal programme of inspection. The visit to the home was undertaken by two inspectors. One inspector arrived at 09.30 and a second, Louise Delacroix, arrived at 11.00am. The inspection finished at 7.00pm. Prior to this visit the commission had carried out a random inspection in July 2008 in response to a complaint made about the quality of the food, staffing and the provision of hot water. This complaint was partially upheld. Information about these issues can be found in the section entitled Complaints and Protection. During our visit, we (the commission) wanted to speak with people living here to gain Care Homes for Older People Page 6 of 33 their views on the service they receive. However, as the majority of people living here have communication difficulties associated with dementia we could not do this by speaking directly with them. We spoke with those we could speak with and observed others. We did this using a method partly devised and fully accredited by Bradford University. This method is called a Short Observational Framework for Inspection (SOFI). This gives us information about peoples well being, their interactions with other people and staff and about how they are engaged over a period of time. We looked closely at the care and accommodation offered to two people who had been observed and two other people who have different types of needs. We did this to help us understand the experiences of people who have different needs who use this service. This is called case tracking. We looked at peoples written assessments and plans of care, the environment in relation to their needs and at how their health, personal and social care needs are met. We spoke with the manager, with three members of staff, with the administrator and with the cook. We visited the communal and service areas in the home and saw approximately ten bedrooms. Other records including those relating to medication, peoples personal allowances and recruitment were inspected. Prior to the visit to the home the manager provided information about the service in their Annual Quality Assurance Assessment (AQAA). In addition questionnaires, asking for feedback and comments about the home, were sent to people living at the home and six were received; to staff working here and four were received and to health and social care staff and none were received. Feedback and comments given are included in this report. What the care home does well: What has improved since the last inspection? Since the last inspection the management of medication has significantly improved. The ongoing upgrading and redecoration has resulted in the home being more homely and there is now a space for people to see their visitors in private. The home has complied with the requirements made by the fire service and general hygiene practice Care Homes for Older People Page 8 of 33 has improved. Procedures in relation to safeguarding have also improved. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before moving in, so can be sure that the home can meet those needs. However, further improvements are needed in the assessment of mental health needs to ensure these can be met. Evidence: We looked at care records which show that each person who comes to live here has their needs assessed by a senior member of staff. A standard format is used to help staff to explore important areas. In the main this assessment focuses on physical needs and forms the basis for a care plan about how to meet those needs identified. Information relating to peoples mental health needs is minimal, naming the persons mental health diagnosis but giving no information about how this translates into needs. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medicines are well managed meaning that people receive the medicines they need safely. Improvements to the way care is planned and delivered would ensure that all people living here have their physical and mental health needs met. Some improvements in how staff protect peoples dignity would help to enhance the experiences for some people living here. Evidence: We looked closely at four care plans and we also looked at some other records in other care plans. We found that each person living here has a plan of care and these are easy to access and well organised. We found that the documents used help staff to determine what peoples needs are. We found that this home cares for people with a wide breadth of needs. Some have physical needs, some are very able, some are very frail and some have mental health needs. We found that none of the care plans looked at addressed all of these needs in a way that was person centred. For example, some people have been identified as being at risk of developing pressure sores. A recognised assessment tool has been used. However, the recommendations which accompany the Care Homes for Older People Page 12 of 33 Evidence: assessment have not been followed. This has resulted in a number of people not being cared for on pressure relieving equipment to help prevent pressure damage. In addition, one persons records show that they had been identified as being at risk of pressure damage and needing the application of a cream to help prevent this. Records do not show if this action were carried out on eleven out of twenty seven days. Two people living here have recently developed pressure sores which have healed. These people are now being cared for on appropriate pressure relieving equipment. Some people have been identified as being at risk of becoming malnourished. The assessment tool used, as far as we could tell, is not accredited, and the scoring system is not complete. In addition, recommendations resulting after identifying that people are at risk are not always made. This means that staff are using their own judgment about what to do in individual cases. However, we observed people being well supported to eat during meal times. People who need full assistance receive this. People are weighed regularly and records in care plans show that people are maintaining or increasing their weight. We looked at two care plans to see what guidance staff are given to support people who have difficulties expressing their needs verbally. One person was assessed as needing help with personal care from two carers. The plan includes the comment that the person could become aggressive during this form of assistance but did not provide staff with guidance as to how to respond and did not provide a review of what might trigger this persons aggression. Care plans should help promote peoples independence, but in this case there was no individualised guidance about how the person liked their care to be given i.e. did they prefer a flannel and soap to wash their face, could they wash their face themselves etc. Care plans are not always written in a personalised way, meaning that staff may not know what to do to meet individuals needs to help staff meet peoples individual needs. We saw in many care plans that the aim of care is to ensure that people remain as independent as possible for as long as possible. However, peoples abilities had not been recorded and instructions in care plans do not include how to help people to maintain their skills or independence. For example, a high number of people living here experience double incontinence. We observed during this inspection that staff did not (in general) offer to take people to the toilet. We did see some exceptions to this. For example, one person living here began to walk around the room. A carer approached this person and discreetly asked if they could help him to find the toilet. This shows that this carer understood there was a purpose to this person wandering and that they had thought about what that purpose might be. Another person was supported to use the toilet, however this person had initiated staff support by requesting help. Care Homes for Older People Page 13 of 33 Evidence: A care plan stated that a person should be supported to use the toilet on a regular basis to promote continence. This was not seen during our observation, and we saw in their care plan that they will become very loud and start to shout when wet, which we later heard after lunch. There was no timescale guidance to staff as to what regular meant and the care plan did not record how often this support was happening. We observed one person coughing a great deal whilst being assisted to eat. The care plan did not contain a risk assessment relating to this coughing and potential choking. The member of staff helping this person to eat waited for each coughing bout to stop before continuing. However at one point this person appeared to be on the verge of choking. We saw in care plans that reviews take place each month. However, the care plans we looked at did not contain thorough oversights of how each persons needs are being met. Each plan remained unchanged even though evidence in the care plans indicated that some plans of care needed amending. This included people who were unwell through colds and flu and a person who had developed a pressure sore, has fallen twice and who says their legs are not as strong as they were. Care plans also showed us that referrals are made to specialist health care professionals. For examples, staff are quick to contact GPs, to refer to psychiatric nurses or doctors, to follow up and collect prescriptions and medications and to ensure people are seen by opticians and chiropodists. People who could, told us that they get the care they need. One visitor told us that their very frail relative is well cared for by very caring staff. We looked to see how peoples dignity is maintained by staff. During our two hour observation interactions between staff and people living here were normally limited to tasks e.g. assisting with a meal or moving around the home, and during the two hours there was minimal interaction with staff for some people. Meaningful contact from staff helps people with dementia to maintain their identity and to feel valued. We heard people being called by their preferred names as stated in their care plans, and we saw staff trying to assist people with managing their heavy colds to maintain their dignity. However, we also saw after lunch one person being brought back to the lounge by staff with food still around their face. Another person we met, had sticky eyes and food down their clothes. We were told that staff sometimes have to be prompted to clean peoples teeth. A visitor told us that they ensure that their relatives dignity is maintained by checking that they have their own clothes in their wardrobe, Care Homes for Older People Page 14 of 33 Evidence: which sometimes is not the case. We did also see two people being taken by staff to their bedrooms to change their clothes during the day. These examples show that there is an inconsistent approach to supporting people with their appearance to maintain their dignity. Some people living at the home would benefit from some staff giving them more eye contact when they spoke to them. Some staff interaction was not positive and did not leave people feeling valued. For example, some staff spoke to people but did not really listen to them. For example, a staff member asked a person if they were alright, the person said no, not really, the staff said oh dear and then walked off leaving the person standing on their own. The person looked unhappy. Previously this person had been trying to get out of a locked door and had been told by a staff member its locked, alright. This person was unsettled during our observation, although one member of staff had taken them out in the garden earlier to try and ease this. Unfortunately, a lack of positive staff interactions can have a detrimental effect on peoples well-being and sense of personhood. We looked at the way medicines are managed generally and for some of the people we casetracked. We found that there are good systems in place for ordering, receiving, administering and returning medicines. Staff receive training in managing medicines and when we observed staff administering and recording medicines this was done safely. All records seen were up to date and accurate. Although records which detail the temperature of the medicines fridge show that this is running at a temperature that is too high, meaning that these medicines might not be bing stored safely. All other medicines are stored securely and safely. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people living here are engaged and active and many are helped to make choices in their daily lives. Others would benefit from increased engagement and more flexible routines suited to their needs and abilities. Improvements to the way food is managed mean that people enjoy a nutritious diet. Evidence: In surveys people told us that they can do what they like when they like. Four out of seven say that they can always make decisions about what they do and others say they usually or sometimes can. Care plans provide information about each persons life history and their social interests. They also contain information about a persons preferred daily routine, such as what time they get up and what time they go to bed. This home has activities coordinators who works on six days of the week. Activities offered include flower arranging, movement to music, ball throwing, hand massages, prize bingo and dominoes. In addition the home has the use of a minibus on two afternoons per week which can take seven relatively mobile people and one person Care Homes for Older People Page 16 of 33 Evidence: who uses a wheelchair. Feedback from people living here, relatives and staff show that these outings are very popular. However, some people living here who are frail cannot take part in these activities. The activities records shows that these people sometimes have hand massages and are greeted by the activities co-ordinator every day. However, their care plans do not include instructions for staff or a plan of care on how their needs, other than physical needs, might be met. In addition, some people living here have very short attention spans and for that reason cannot join in with activities. The home have not yet explored options available which might help these people to engage with their surroundings. Staff told us about an intervention that had been successful in engaging someone in a positive way and which demonstrates that more work could be done to make the environment more stimulating. When the maintenance man was carrying out a painting job one day, one of the people living here who has dementia showed an interest. This person was given a clean paintbrush which he used for a long period of time. Staff commented he was absorbed by this task and shows that he was being stimulated to engage with his surroundings. This successful engagement has not be used as part of this persons on going plan of care to help meet this persons need for engagement and stimulus. On the day of this inspection this person was observed moving furniture around, which disturbed other people and which one member of staff commented this person does when bored. Discussions with staff show that they understand that this person had been occupied because he was doing something that related to his past. We spent time in the communal areas of the home to help us make a judgment about peoples sense of well-being. Throughout the day music was played, which some people seemed to enjoy i.e nodded in time, with one person dancing with staff. At various times a television was on, although it was rare to see anyone actively watching it. We saw one member of staff encouraging someone to play the organ, and this person responded well to the staff member. Another person went outside with a staff member, and two other people walked around re-arranging the furniture or looking at people, which resulted in some other people living at the home becoming annoyed with them. The majority of people dozed in armchairs. We saw that the lounge had a fish tank and birds in a cage. However, there was little that people could interact with or look at e.g. newspapers. We talked to staff about considering how the environment could be improved for people who spend large amounts of time in one position and therefore may have the same view each day. Care Homes for Older People Page 17 of 33 Evidence: As we have commented earlier, the majority of staff interactions were mainly task orientated. However, we saw that one person received more positive attention from different members of staff than other people, which could leave other people not feeling as valued. Other people were given support by staff to help complete tasks, such as walking to the dining room, but we did not see staff spending any meaningful time with them. We looked at the activities records for two people, one person appeared to have had minimal contact in a period of twenty three days, despite a mental health professional promoting the importance of mental stimulation in a letter to the home. Another person had been involved in a ball exercise, had received a hand massage, which was listed as something they enjoyed in their care plan, and listened to several short story over a similar period of time. However, it was difficult to judge if these activities met the persons social needs as there was no record of their response to them. Some people living here like to walk around in different areas of the home. Changes to the way access has been managed means that people are able to do this safely and to their satisfaction. Some areas of the home are not accessible. However, these are service areas which might pose risks to someones safety. People are not able to open the outside door without a code number for the same reason. Care plans record peoples religion, and communion is offered in the home by a visiting minister. It is not clear if the current arrangements for meeting peoples religious needs are successful. Since the last inspection the cook has been replaced and the new cook has extended responsibility as the kitchen manager. This person is in the process of reviewing the current menus and working towards offering a choice of foods which does not result in a lot of waste. At the present time the main meal is cooked a lunch time and a choice is not routinely offered, as is good practice. Instead, if the cook says she knows if someone does not like something and will prepare something different for that person. If someone refuses something when it is served to them, she prepares something different such as an omelet. We talked with the cook who told us that she was fairly newly appointed. She has received training in food hygiene but has not received training in the provision of specialist diets or in how to encourage people with dementia to eat. She told us that she does have some reading material relating to the latter which she uses. We spoke with some people about the food served and they told us they enjoy it. One person told us they had put on weight since coming to live here and another said the food is always good. This person also told us that they do not like to wear their false Care Homes for Older People Page 18 of 33 Evidence: teeth and the staff make sure the meal is softened for them. We observed staff assisting people to eat. They did this by sitting with each person, attending to them and by supporting them at a pace that suited each person in an unrushed manner. The manager told us that lunch used to be served at two sittings because this had helped to maintain an atmosphere of calm. However, this had also resulted in some people having to be prevented from eating when they wanted to. The manager says that other changes to the environment of the dining room and to where people with differing needs eat have achieved a calm atmosphere without limiting peoples choice. Changes to the dining room include the addition of table cloths, place mats, serviettes, pictures and dining room furniture making this a very homely area. The information sent to us by the manager said that hot drinks are available whenever requested and at regular times throughout the day, indicating that people are able to make choices. However, we heard one person asking for hot drinks who was told they would have to wait and could have one at the regular time. This person had a heavy cold and might have benefited from extra drinks or the comfort of additional hot drinks. Another person was helped to sit in the lounge at around 2pm. This person asked staff what they were supposed to do and was told to relax. When asked how long for they were told until five oclock. When the person said no, they were told to wait until tea and the staff member then walked away. Visitors to the home told us that they are free to come and go as they please and that they are kept up to date with changes and developments. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and are kept safe. Evidence: Two complaints have been made about this service. The commission received one which stated that the food combinations were not always appropriate, that not all bedrooms had hot water and that staffing had been reduced. We carried out a random inspection and found that food combinations were not always appropriate and that some bedrooms did not have hot water. We also found that staffing had been reviewed in line with a decrease in occupancy and changing needs and that the level was adequate to meet peoples needs. The second complaint was received by the service. This was dealt with within the timescales set by the home. The manager reports that this complaint related to how the lunchtime meals were being managed. He reports this was dealt with quickly and that the changes made as a result have benefited the people living here. In surveys people say they know who to make a complaint to and that they are listened to. One visitor said they can usually find a senior member of staff to speak with if they need to, that staff listen to them, but also that they sometimes had to chase concerns to get a response. Care Homes for Older People Page 20 of 33 Evidence: Records show that staff receive training in the protection of vulnerable adults. We talked to members of staff about their understanding of what abuse is and what they would do if they suspected or saw abuse. Their responses demonstrate that they have a good understanding of what abuse is and how to ensure that people are safeguarded. Information around the home tells staff that there is the zero tolerance to abuse. The manager has had cause to employ the locally agreed procedures relating to protecting people and did this effectively. We observed that people living here have relaxed and comfortable relationships with people caring for them. One person told us how safe they felt. Another was heard asserting themselves appropriately which shows they are confident in their setting. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe environment where the homeliness and ambiance has much improved. Evidence: In surveys people told us that the home is always or usually clean and hygeinic. People told us the cleaner works hard and has a lot to cope with. We saw staff preventing the spread of infection by for example using gloves and washing their hands with liquid soap and drying them with paper towels. In addition all staff carry alcohol gel rub as an extra precaution against the spread of infection. We did note that a number of people living here have colds and that some staff after giving assistance to these people, for example helping them to blow their noses, did not always wash their hands or use the alcohol gel. Staff cleaned tables and ensured that empty drinking glasses were collected and washed, as a way of further maintaining standards of cleanliness and preventing the spread of infection. The entrance to this home has recently been redecorated and refurbished. It has been wallpapered, painted and carpeted. Furniture, pictures, plants, flowers and new chairs have been added. This area is very homely and welcoming. Other areas of the home are also very homely. This includes the dining room where Care Homes for Older People Page 22 of 33 Evidence: the tables are laid with tablecloths, placemats, serviettes and flowers. This room has been made more homely with the addition of colours and pictures. Additional furniture, such as a sideboard and shelving with ornaments on, have been added to this room. These not only make the room more homely but also give visual clues to people with communication problems as to what the room is used for. As we walked around the home we could see that work is ongoing to ensure that all areas of the home are homely and welcoming. We also noticed that an area of the home which was a communal area is now being used as an office. The manager reports this is temporary until the extension is built, which will incorporate extra office space. We are aware that the home had some problems with the provision of hot water in some bedrooms. The manager reports this is now been resolved. We turned on hot water taps in the number of bedrooms and bathrooms and found that water is hot. We noted that windows in the upstairs rooms are restricted to prevent people from hurting themselves by falling. We noticed equipment around the home which would help people with mobility problems. This includes hoists, bath hoists, handrails and wheelchairs. We looked in the kitchen. This is clean and tidy and there is a cleaning rota in place. We looked in the fridge and saw that all food is covered and that any unused food is marked with the day and date it is opened/left there. We looked in the laundry and found this to be quite tidy, and to be clean. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by a staff group who are employed in sufficient numbers, recruited using robust methods and who are continuing to develop the skills needed to care for them. Evidence: We looked at the duty rota and found that in the morning there are five carers on duty (there were 31 people living here on the day of this inspection). In addition, there is a care officer, the deputy manager, the manager, an administrator, cleaner, laundress, cook and kitchen assistant. In the afternoon there are four carers and a care officer and at night there are three carers on duty. In surveys and during conversations people told us they always or usually have their care needs met. Comments about staff include they are lovely, very kind and some have real patience. Records show that staff who come to work here receive induction training that is based on the Skills for Care training course as is recommended. Staff also have an introduction to the home during which they learn about what to do if there were a fire and about the layout of the home. We talked to staff about this induction and they say that it equips them to do their job. In addition the manager reports that over half of the staff working here have achieved a National Vocational Qualification in Care to level 2 or above. Care Homes for Older People Page 24 of 33 Evidence: We looked at three staff files to check if robust recruitment checks had been carried out. We found that they had. This includes obtaining written references from previous employers and getting enhanced police checks prior to the person starting to work in the home. As shown in the section Health and Personal Care some staff are more practiced in providing person centred care and in ensuring that peoples needs are understood and met. Other staff are more orientated to carrying out tasks. For example, when helping to move people using equipment, some staff explained what was happening and what they were doing and others didnt. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there have been many changes to the management of this service, people are benefiting from changes which continue to ensure that the home is run in their best interests and where improvements are ongoing. Evidence: This home has had a number of management changes over the past year. The current manager has achieved the Registered Managers Award and has many years experience of working in and managing in the care sector. He has made his application to the Commission to become the Registered Manager. Staff working here say they feel well supported by the management arrangements. People living here say they know who to talk to and have confidence in the manager. The manager has ensured that mandatory training for staff is ongoing. Records show this includes moving and handling, fire training, first aid and health and safety and we Care Homes for Older People Page 26 of 33 Evidence: noted that infection control training is due to be updated. Staff report there are frequent staff meetings which are held approximately every 6 weeks. The manager reports that these are well attended and that staff are paid for the time they attend. The manager also says that residents or relatives meetings have not been held recently. He feels there is work to do to create a relationship between management and visitors. A visitor said they had attended one meeting, the only one called in over a year. At Christmas time a party was held which was very social which he believes gave staff, management and visitors the opportunity to meet and talk. The manager reports that the last quality assurance survey was carried out in May 2008. A new quality assurance system has since been developed which the manager intends to use annually to compare year on year. One visitor said they had never been asked to complete a quality assurance survey. We looked at how peoples monies are managed. This is monies kept and spent on their behalf. Access to these monies is restricted and monies are kept securely and safely. We looked at two accounts and found that receipts are kept, that the total amount of money recorded in records matched that being held, and that frequent audits are carried out by the manager. We noticed when looking at care plans that these are not kept securely. Although they are kept in a cupboard and which can be locked, this cupboard is in a communal area for use by people living and visiting here and which was not locked throughout our visit to the home. Whilst walking around the home we noticed that all substances which might be hazardous to health are stored safely and securely, that upstairs windows have limited openings to prevent people falling or climbing out and that water temperatures are not so hot as to be scalding. We checked in the kitchen and found that fridge and freezer temperatures are recorded to ensure that food is stored at the correct temperature, and that foods opened and kept in the fridge were labeled to say when they had been opened to ensure that the food is not used past its use by date. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) Each person living at the 31/08/2008 care home must have a plan of care that identifies all their individual needs and which offers instructions for staff on how these needs should be met in an appropriate and consistent way. The care plan must include how to meet the needs of people with dementia and should be person centred. Care plans must also help to ensure that people maintain the abilities they have for as long as possible. Each plan must be reviewed in a way that identifies changing needs, the effects of the care plan and which ensures that appropriate actions are taken. Previous timescale of 30/06/07 not met. Timescale of 31/01/08 partially met. 2 12 16 (2) (m) (n) Each person living here must 31/07/2008 have their social needs and interests identified and you must make arrangements to enable these needs to be met. This is particularly Page 28 of 33 Care Homes for Older People important for those people with dementia. This should include helping people to exercise choice in relation to religious practice. Previous timescale of 31/01/08 partially met. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Each person should have a plan of care that identifies their specific needs, which provides a plan on how these needs are to be met and which is reviewed in a way that provides an overview of the care given and its success in meeting the identified need. This will help to ensure that each person has their personal needs identified and met in a way that suits them and which is appropriate. 22/05/2009 2 8 12 Each person living here 22/05/2009 should have all their health and welfare needs met. This must include taking actions to prevent pressure damage, help people to remain continent or manage their incontinence and ensuring that peoples mental health needs are identified and met. Care Homes for Older People Page 30 of 33 This will help to ensure that each person has all of their health care needs met and that actions are taken to prevent ill health or deterioration. 3 12 16 People living here must be 26/06/2009 engaged with activities which meet their needs. This is particularly relates to people with dementia. This will help people to experience feelings of well being and activity which will help to promote their health and well being. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 10 Each person who comes to live here should have their mental state, cognition and needs identified. People living here should all have their dignity protected, especially when they have dementia and cannot always do this for themselves Monthly reviews of peoples needs and care plans should include peoples social needs. This should be done in a way that provides an holistic overview of their care. Records should show peoples responses to activities so that they can be reviewed in relation to the level of enjoyment and success of that activity. People should be able to exercise choice in relation to their daily lives. This includes such things as having drinks when they want them. The food available and menu on offer should be kept under review to ensure that people have enough choice about what they eat and that it is suitable. The use of communal space as office space should be kept Page 31 of 33 3 12 4 14 5 15 6 19 Care Homes for Older People under review to ensure that people have the communal space they need. 7 30 Staff training needs in relation to planning, reviewing and providing person centred care should be kept under review and actions taken to meet learning needs when identified. The manager should continue with his application to become the Registered Manager of this home. The procedures for assessing the quality of the services provided should be kept under review to help ensure the home is run in the best interests of the people who live here. All records should be kept securely and confidentially. The infection control training needs of staff should be reviewed and training updated where necessary. 8 9 31 33 10 11 37 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!