Inspection on 02/04/09 for Three Corners Nursing Home

This inspection was carried out on 2nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Three Corners Nursing Home 12/04/07

Three Corners Nursing Home 27/04/06

Three Corners Nursing Home 26/10/05

Three Corners Nursing Home 10/05/05

Three Corners Nursing Home 03/08/04

Three Corners Nursing Home 18/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Three Corners Nursing Home 3 Greenway Road Churston Ferrers Brixham Devon TQ5 0LW     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: Clare Medlock     Date: 0 2 0 4 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: Three Corners Nursing Home 3 Greenway Road Churston Ferrers Brixham Devon TQ5 0LW 01803842349 01803846079 info@threecornersch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Golfhill Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 46. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home Three Corners Nursing Home is a 46-bedded care home providing personal and nursing care to older people who may have dementia type illnesses and physical illnesses. 0 46 Over 65 46 0 Care Homes for Older People Page 4 of 33 Brief description of the care home The home is located on the edge of a village of Galmpton close to the seaside towns of Brixham and Paignton. There is a car park in front of the home and access to the front of the home is through a modern porch. The accommodation is arranged over a two floors which can be accessed via stairs or passenger lift. Each room has a nurse call system and is equipped with furniture and adaptions for the needs of each person. A variety of equipment and adaptations are provided to meet the needs of people with access problems. There is at least one registered nurse on duty at all times supported by a team of care staff. Information about the home such as statement of purpose is given to each person at the home and also can be located within the entrance hall. The current fees range from three hundred and sixty two pounds to six hundred and fifty pounds. This price varies according to nursing needs and does not include costs of hairdressing, chiropody, personal items and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced. Prior to this inspection we received a well completed Annual Quality Assurance Assessment from the Registered Manager. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys to people who use the service, staff and health care professionals. This key inspection consisted of a visit to the home on Thursday 2nd April 2009. Care Homes for Older People Page 6 of 33 During this time we spoke to the Registered Manager and the administrator. We spoke at length to 2 visitors, and 5 staff members. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at five staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. During the inspection we watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Three Corners Nursing Home. What the care home does well: What has improved since the last inspection? The Statement of Purpose and Service User guide have been updated to include changes at the home and the information that is needed for people to decide whether the home is the right place for them to be.The pre admission assessment has improved since the last inspection. The AQAA told us that communication between families remains very good with then additional use of web sites as a way to communicate the services at the home. Large amounts of investment have occurred at the home. The home has been extended since the last inspection to provide a newer purpose built unit including bedrooms and lounge and dining room on the ground floor which is bright and well equipped. Various seating areas are arranged to provide private space and communal Care Homes for Older People Page 8 of 33 seating areas. The room has a large TV and virtual fish tank. The manager said further plans to introduce a real fish tank in other parts of the home are underway. Many areas of the home have been re decorated, new carpets and flooring have been provided and items of furniture have been replaced. Many beds have been replaced for fully adjustable beds for people who require nursing care. New vacuum cleaners and carpet washers have been purchased and new outside storage areas have been provided. Storage has improved and equipment replaced where necessary. People said that although the building work has been ongoing the transformation has been remarkable and has even raised the standard of care. Staff said it is a nicer place to work and the lounge area is a nice place to be. There have also been changes to the outside of the home. The front garden has been tidied, with trees being felled to allow extra light. An attractive herb garden and seating area has been introduced to the rear of the home which will be used in finer weather. A ramp around the edge of the home allows those people with mobility problems access all areas of the garden. Some double rooms have been changed to single rooms and many rooms now have fully adjustable beds which are appropriate for people who need nursing care. Changes to rotas and work practices have occurred at the home to improve the service provided. There is now a designated laundry person to co ordinate the laundry service and a new deputy manager has been appointed for the running of the home. What they could do better: The manager, provider and their team must ensure the records they keep reflect the care and work that is done at the home. Care Plans must reflect the knowledge of staff and accurately reflect the needs of each person so that care can be delivered in a safe way. Staff must take care to ensure care plans and records reflect the needs for the person and should write them in a person centered way. Kitchen staff should ensure their records are also kept up to date to show that the kitchen management is safe and should ensure they follow good practice guidelines on food storage. The manager and office manager must also ensure their records show that the recruitment process and process are followed to ensure vulnerable people are cared for by staff who have had all the required recruitment checks performed. These checks include CRB and POVA checks and recent photograph. Records should be kept to show how the managers have reached decisions to employ staff when recruitment policies are not followed. Minor changes to recruitment records would also improve the information obtained by the provider and manager. People should also have their finances protected by ensuring the management of personal monies is fully auditable. The manager should ensure systems are in place to protect both the person and staff at the home. The manager should also look at privacy of the identified bedroom to ensure privacy for the person. Care Homes for Older People Page 9 of 33 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 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided means that people have accurate information about Three Corners Nursing Home, before they come to the home. The improved admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: The Statement of Purpose and Service User guide had been updated to include the increase in numbers the home are able to accommodate. Both documents were well written and contain the information that is needed for people to decide whether the home is the right place for them to be. Each document reflects the services that are provided and includes information on fees, staff, room sizes, services that are provided and information on how to make a complaint. Care Homes for Older People Page 12 of 33 Evidence: The surveys we received confirmed that people and their families were given enough information before and at the time of admission. The AQAA told us staff at the home gather information from the person their family and health care professionals. People told us that they had met the manager before they came to the home and were welcomed to the home. One person said I had heard about three corners before I came here and that is why I chose it. This person went on to say they had been in another home which was not a good experience and so far three corners is proving to be a good place to be. The same person said he had been given an information pack (statement of purpose) which was kept in his room. The AQAA told us that the pre admission assessment has improved since the last inspection. Each person is admitted following an assessment performed by nursing staff at the home. This assessment is used alongside assessments made by other health care professionals. Together this information is used to make an initial plan of care. Evidence was also seen of involvement of the person and their family. The AQAA stated that some people who have stayed at the home as respite or short term have asked to stay or return to the home. One relative confirmed that it was a good decision to chose Three Corners. On the day of inspection staff were receiving specialist training regarding the specific needs of a person recently admitted at the home. Staff said this was normal practice and that the manager ensured equipment and training was organised before people were admitted. Each person is given a contract when they move to the home. The majority had a contract through the NHS or social services. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is provided in a respectful way. Improvements to care plans are necessary to reflect the care that is actually provided and to prevent people from unnecessary risk. The management of medicines is good and helps protect people from risk. Evidence: People living at Three Corners Nursing Home said they felt well cared for. Surveys confirmed this and relatives said they always found their relative well cared for. Surveys from health care professionals confirmed these positive responses with one comment reading patients always report to me when they are well looked after. Another comment read Patients are always treated with dignity and privacy, always looking well kempt. People have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine Care Homes for Older People Page 14 of 33 Evidence: screening programmes. Each person has a GP who attends when staff request a visit. Specialist health care professionals are sought for advice and guidance. Progress of the person is recorded in notes made by the staff and also by health care professionals such as chiropodist and Doctors. One health care professional wrote When care plans are written by me they are always implemented whilst another comment read Whenever the patients have difficulties the home contact me directly for advice and guidance. During the inspection people looked cared with the finer details such as eye care, nail care and appropriate foot wear present. People being nursed in bed looked pain free, clean and comfortable with call bell and drink close by. Visiting health care professionals and relatives said they thought the standard of personal and nursing care was good at the home and had improved in recent months. One person who had recently moved to the home said the staff were wonderful. One person said he had improved since coming to the home-this was confirmed by staff. Each person has a set of notes, which contains assessments for such issues as falls, nutrition, moving and handling and more general risks. Risk assessments included Waterlow, nutrition, falls and mental health assessment. There is also a risk assessment completed when the use of bed guards (bed rails) has been considered. These assessments are generally reviewed each month or where a change occurs. The set of notes also contain care plans which are meant to highlighted the specific needs of people. Some of these plans were generically stored on a computer and adapted to the needs of each person, however, when this had been done staff had not ensured the plans had been completed sufficiently or in some cases incorrectly. One care plan seen contained a plan of care which potentially could place the person at high risk. This plan was shown to the manager and immediately taken out of action. Discussion was held about the suitability of using generic care plans and the importance of staff writing care plans which are person specific. One person told us he was aware of the care plans that had been written about him but said he was not interested in reading them. Staff were able to verbally inform us about the specific needs of each person but this detailed knowlege was not included in the care plans. Staff surveys informed us that staff consider they are given sufficient information about each person. Staff at the inspection told us a detailed report is held at the beginning of each shift. People told us they felt very well cared for and were able to see the doctor when they needed. Relatives told us staff organised visits from the dentist and optician. Staff told Care Homes for Older People Page 15 of 33 Evidence: us district nurses have been to the home to work with staff using the new My health, my care, my record care plans. The management of medications is performed well at the home. We looked at the treatment rooms where medications are stored in either locked trolleys or locked cupboards. The Registered Nurses are responsible for management of the medication from receipt to disposal. Medicines are supplied mainly in a monitored dose system. The medication trolleys were clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. Fridge temperatures are recorded daily to ensure correct storage of medications. The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. Used medications that were to be disposed of were kept initially in a locked cupboard then placed in a returns container that securely held medication. All medications for disposal are recorded and signed for on collection as per the company and government policy. One minor recommendation was made regarding hand written entries onto the medication records. People were encouraged to move freely around areas of the home. Walking aids were present for those that required them. Grab rails were present throughout the home and ramps were available to reduce risk. We saw staff transfer people from wheelchair to chair using a hoist. This was done safely and sensitively with staff giving explanation and reassurance to the person being transferred. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and addressed using their chosen term of address. Screening is available in the rooms where people share a room. The home cares for people with dementia type illnesses. Some staff have been trained in the specialist ways of caring for people with these specialist needs. Appropriate use of diversionary tactics and orientation methods was also used throughout the inspection to calm anxiety and prevent escalation of some behaviours. Care of the dying is performed very well at the home. The manager attends a working group to improve and implement improvements into the end of life care in the Torbay area. Since the last inspection the home have developed a reputation for providing quality care to people at the end of their life with referrals being made from local Care Homes for Older People Page 16 of 33 Evidence: hospices and hospitals. Staff use the Liverpool Care Pathway effectively where all health care professionals work together and record together the care that is planned and given to ensure care is continuous and effective. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 a wholesome varied balanced diet and have access to activities but would benefit from more activities. Evidence: Visiting is open at the home. A visitors book in the entrance records visits for fire security reasons. Relatives told us that they are always made to feel welcome. People in the home are able to see their visitors in the privacy of their room or within the communal areas. People told us staff are very kind and respectful. One person said they had been made to feel very welcome and cared for by staff at the home and was particularly pleased with an invitation to bring personal items to the home to personalise their space. Property lists are performed on admission. Relatives, staff and people told us the food at the home was good. Some people told us they had a choice of breakfast foods and main meals, although some people were unaware of this fact and said staff just confirmed the main choice was OK. Surveys confirmed that people enjoy the food but one comment stated that a more individualised approach would be beneficial with regard to meals whilst one relative Care Homes for Older People Page 18 of 33 Evidence: wrote why does everyone have to have hot and cold drinks in a feeder mug. During the inspection a discussion was held regarding ensuring staff made sure everyone knew they had a choice of meals. It was also noted that not all people were using a feeder mug. Several people were using a cup and saucer. The food was very well presented, of good portions, and had a nice aroma. People spoken to said that they were very happy with the meal they had received. The pureed meal of the day was sampled. All samples were full of colour, texture and fresh flavour. The kitchen was organised and the chef had the Safer Food, Better Business records, although some food probe temperature records had not been completed although staff could recall what the temperatures had been. The last environmental health inspection had been performed in March and the recommendations made had been met. Staff told us new fridges and storage had been provided. Generally storage was well organised, but closer inspection confirmed that some foods that had been covered had not been labelled and showed an issue with the shelf life of some recently delivered produce. Staff told us that a record of likes and dislikes regarding food and a nutritional assessment is performed on admission and communicated to the chef who then produces each meal in a way that was palatable to the individual such as normal presentation or pureed. People at the home and their relatives said there was entertainment arranged at the home but more would be welcomed. One person said the musical entertainment was enjoyable whilst another person said they did have an entertainer the other day but I did not want to go. Staff said that more activities would improve the quality of life but that staff take opportunities to chat with people when they can. During the inspection we noted that staff shared a cup of tea with people and chatted about various issues. All interactions between staff and people at the home were positive and appropriate. The manager told us they were considering employing a designated activities coordinator to roll out a programme of activities, this was confirmed in the AQAA which stated we are aiming to increase our formal activities. At the time of writing this report we had been informed the recruitment process of an activities person was in progress. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge, procedures and training in place for the Protection of Vulnerable Adults help to protect people. However some recruitment practices have the potential to put people at risk Evidence: The Commission for Social Care Inspection received two complaints about Three Corners since the last inspection. earlier this year. One complaint is still on going and being dealt with by the provider. The other complaint was dealt with appropriately by the manager and was partially upheld. This resulted in changes to the admission process. The complaints procedure, is displayed around the home for the benefit of people who use the service, staff and visitors to the home and includes how to contact the Commission for Social Care Inspection/Care Quality Commission. The procedure is also displayed in the Statement of Purpose and Service Users Guide. The home are beginning to change the contact details for the CSCI. People at the home told us they would feel able to make a complaint to the manager or staff at the home. This was confirmed within the surveys. One person at the home Care Homes for Older People Page 20 of 33 Evidence: was asked if they knew how to complain and said I am not sure of the official way but I would certainly speak to the manager. Another person said he had not needed to complain as small things get sorted out straight away. Surveys from health care professionals stated that they had made two issues have been raised with the matron. She has responded appropriately and in a timely manner. Whilst another professional wrote I have never been involved in any of my patients making a complaint-they are all happy and content. Because of the mental illness of some people, it is difficult for them to clearly express their dissatisfaction with issues. However, during the inspection we saw staff anticipate behaviours and triggers for people to ease their discomfort and distress. All interactions seen on the day of inspection were appropriately affectionate, kind and professional. Staff we spoke to said they felt able to talk to the manager about any worries or concerns and staff surveys confirmed staff know how to report concerns. The home also operates a supervision and appraisal system in which staff raised concerns that are discussed, recorded and acted upon. Staff told us they would have no hesitation to complain if the situation arose and would certainly report poor practice. Staff also told us their Protection of Vulnerable adults (POVA) training occurred regularly and we were shown a training matrix which highlighted who had received POVA training. The training records also showed some staff have attended deprivation of liberty safeguard training. The manager is aware of the processes to follow if a safeguarding alert is received. The office manager explained that staff usually have a CRB (Criminal Records Bureaupolice check) and a POVA register performed by the home before their employment to ensure they are suitable to work with vulnerable adults. However shortfalls in this practice were highlighted at this inspection. Only two of the five staff files inspected contained a CRB check performed by the home. Two CRBs had been bought from previous employers despite guidance being that CRB checks are non transferable and one file did not contain any CRB check at all. Three files contained a POVA first check but two files contained no POVA first check. A risk assessment for the member of staff with no CRB or POVA check was performed but was inadequate. The office manager explained that the recruitment of these three new staff was done in recent months and staff were employed before checks were back because they did not want to loose the highly qualified staff applying for the post. One CRB had been performed which was returned with a conviction. There was no record to show how the manager had reached the decision to employ the member of staff. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Three Corners Nursing Home is a safe and pleasant place to live and work. Evidence: Three Corners Nursing Home is a large house set on a hill in a residential area of Galmpton, close to the seaside towns of Paignton and Brixham. The house has been recently extended to provide a newer purpose built unit including bedrooms and large bright communal lounge/dining area. All areas of the home are accessible by people who use the service. The older part of the home has been adapted with grab rails, ramps and passenger lifts for those with mobility problems. The new lounge and dining room on the ground floor is bright and well equipped. Various seating areas are arranged to provide private space and communal areas. The room has a large TV and virtual fish tank. The manager said further plans to introduce a real fish tank in other parts of the home are underway. Large financial investment has been taking place at the home. The extension to the home has been finished to a high standard. Many areas of the home have been re decorated, new carpets and flooring have been provided and items of furniture have been replaced. Many beds have been replaced for fully adjustable beds for people who require nursing care. New vacuum cleaners and carpet washers have been purchased and new outside storage areas have been provided. People said that although the Care Homes for Older People Page 22 of 33 Evidence: building work has been ongoing the transformation has been remarkable and has even raised the standard of care. Staff said it is a nicer place to work and the lounge area is a nice place to be. A discussion was held regarding one existing bedroom which now overlooks the communal lounge/dining area. Although net curtains were present, it was possible to see into the persons room. Staff said they are very careful to close curtains when personal care is being provided, but a discussion was held regarding the importance of ensuring privacy of people in that room. The arrangements for the maintenance of the home remain good despite continual building work. The home was clean, tidy and free from offensive odours on the day of inspection. One person said since the building work, new flooring and new lounge area the smell in the home has gone. There have also been changes to the outside of the home. The front garden has been tidied, with trees being felled to allow extra light. An attractive herb garden and seating area has been introduced to the rear of the home which will be used in finer weather. A ramp around the edge of the home allows those people with mobility problems access all areas of the garden. The home has suitable numbers of toilets with disabled access for people to use and these are well placed around the building. The bathrooms provide modern bathing facilities with hoists. There are also portable hoists, stand aids and a shaft lift to access all floors of the home. People are mainly provided with their own single bedroom with some double rooms now being made into single accommodation. A small number of rooms are left for people who chose to share, these have screening curtains. Rooms contained items, furniture, photos and small ornaments that people had bought to the home to personalise them. Many rooms have new and fully adjustable beds which are appropriate for people who need nursing care. A small number of people have bed rails that are only used after a risk assessment is done and the outcome agreed with the person in the room and their relative. Bed rails that had been fitted to beds were being used after a detailed risk assessment. Staff use protective equipment when providing personal and nursing care. Gloves, aprons and hand washing are available for staff use. Staff told us the infection control Care Homes for Older People Page 23 of 33 Evidence: team from the health protection agency have visited the home to use their light box to educate staff about effective hand washing. Staff also told us that infection control training is done. The home has its own laundry that is large and well equipped with industrial type washing machines with sluicing cycles and large dryers. The laundry has washable walls and impermeable floors. There are dedicated staff who operate the service. Staff told us a member of staff has a designated role to work in the laundry which is improving the service provided. People told us they wear their own clothes which are laundered in the home and this has not been an issue. Care Homes for Older People Page 24 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. Although people who use the service are cared for by a stable group of staff, minor improvements to the recruitment procedure would show they have had all the pre employment checks. Evidence: People told us they liked staff at the home. We were told staff were wonderful, very good and the best. Relatives said staff were welcoming at professional. People said they did not have to wait long for someone to answer their call bell. We were told that for the 36 people currently in the home staffing levels are generally maintained at 6 care staff and 2 registered nurses in the morning, reducing to four care staff in the afternoon with two registered nurses and at night 2 care staff with one registered nurses. We were told in addition to care staff there are additional administration, domestic, kitchen and laundry staff employed. Staff said training opportunities were excellent at the home. During the inspection a health care professional was visiting to teach staff how to care for the specific needs of a new person at the home. Surveys from health care professionals said staff attend specialist training days. Examples of training seen included equality and diversity, palliative care, dementia awareness, nutrition and health, infection control, continence care, speech and language and wound care. Care Homes for Older People Page 25 of 33 Evidence: Many care staff have NVQ (National vocational qualification) qualifications in care. Some staff are doing leadership NVQs. Staff said the manager is very supportive with training and always have support in the work place. The manager explained that incentives for low staff sickness have been introduced at the discretion of the manager and provider, and an employee of the month has been introduced. Staff files were inspected. Initially three files were requested and provided for inspection. Major shortfalls regarding CRB and POVA checks in these files prompted discussion about the usual system and process followed by the manager and administrator when employing a person. A further two files were sampled and showed rigorous recruitment procedure. The shortfalls are reported upon in a later section of this report. All files contained an application form, and employment history, although dates on some applications were vague and made looking for gaps difficult. Details of next of kin for the majority of staff were stored elsewhere. All staff had two written references and proof of identity present in files. All staff had received a contract and a record o interview was recorded on the majority of files to show the interview process is consistent. A system is in place to check the Nursing and Midwifery Council PIN numbers each year. These details were up to date. There were no recent photographs on file apart from proof of identity pictures which in some case were not recent. Discussion was held regarding improvements to the application form and recruitment process. Care Homes for Older People Page 26 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. The home is well run but improvements to record keeping are required to show that systems are in place to protect people from unnecessary risk. Evidence: The AQAA states that Three Corners have an experienced first level nurse as a registered manager. Together with the Provider and office manager they are available to the staff, residents and visitors. The AQAA also states that the Provider has created a new post for a deputy matron which has been filled by an experienced nurse. Staff told us leadership was very good at the home and they felt supported and were able to see their manager when necessary. Staff were complimentary about the manager saying it is good she works with us on the floor so she knows what it is like. Staff also said they were asked their opinion and were able to share ideas. Staff also told us they received regular supervision where staff are offered support and training needs were identified. Care Homes for Older People Page 27 of 33 Evidence: Financial viability was not inspected in detail on this occasion, however the building work and re furbishment was a sign that the providers were keen to improve the home. The AQAA stated that the providers still use a program for wages and continue to source better tariffs for supplies and have worked together to improve the financial stability of the business. The home appeared to be a safe place to live and work. No risks to health and safety were identified. The AQAA gave details of maintenance records and training records showed that staff mandatory training was either up to date or booked. People at the home are encouraged to manage their own finances where possible or encourage family members or power of attorneys to hold this responsibility. One person said he was able to manage his own finances and looked forward to staff taking him to the local bank. Some people have a small amount of cash held at the home for services such as hairdressing, chiropody and other services. On inspection balances were found to be correct but there was no clear audit trail to show receipts for two transactions. One was due to no date on an invoice and a receipt for another transaction was not located. Some receipts were loose and not securely stored. The Provider checks balances on a regular basis but other transactions are signed for by one member of staff. Discussions were held about how staff could improve the system to protect themselves as well as the person. Other records in the home for the protection of people, such as inadequate pre employment checks and inadequate care plans were also not always well maintained to reflect the service provided. These shortfalls are reported upon in an earlier sections of this report. The manager told us quality assurance occurred in various ways at the home. Surveys are sent out to people who have an interest in the service and the results collated to monitor trends. Complaints are also treated as a way of improving the service and the daily presence of the manager is useful in picking up issues before they become a complaint. Staff said the Providers visit the home on a regular basis and are always looking at how the service is running. The manager said she has a good relationship with the provider and feels supported when making decisions. When asked what the service does well, health care professional surveys read Communication is excellent and they are always willing to accept advice. Shortly after the inspection we were contacted by the Providers who explained what action had already been taken in the time between the inspection and the report being Care Homes for Older People Page 28 of 33 Evidence: written and were keen to emphasis they will address the issues raised at the inspection. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 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 13 The manager must ensure staff write appropriate care plans that do not place people at risk This will mean that staff have accurate information to refer to when caring for a person. 14/08/2009 2 17 13 The Provider must ensure 07/07/2009 staff are only employed after they have performed a CRB and POVA check This will show that staff are suitable to work with vulnerable people 3 35 13 The Provider must ensure 07/07/2009 systems are in place to show that money belonging to people in the home is safely managed and accountable. This will protect people from financial abuse but will also protect staff by ensuring Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action systems are robust and transparent 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 4 5 6 7 9 12 15 15 18 Staff should ensure care plans are person centered and reflect the care that is provided Staff should use two signatures when copying a prescription on to the MAR sheet Staff should consult people about their interests and ensure people have access to meaningful activities Staff should ensure people know they have a choice about food Staff should enquire whether people are happy with the meals provided The manager should maintain records to show what safeguards are in place t protect people who present with a positive CRB check showing they have been fair to the member of staff whilst protecting the vulnerable people in the home. The manager should look at ways to further protect the privacy of people who have a room overlooking the lounge. The kitchen staff must be reminded to keep accurate records to show the kitchen is well maintained and must be reminded to adhere to good practice regarding food storage. The manager should obtain a recent legible photograph for all staff Systems must be in place to obtain the next of kin details of all staff More specific questions are recommended to obtain employment dates on the application form 7 8 19 26 9 10 11 29 29 29 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. 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