Inspection on 16/06/09 for Winterbourne Care Centre

This inspection was carried out on 16th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winterbourne Care Centre 09/10/09

Winterbourne Care Centre 05/05/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Winterbourne Winterbourne London Road Salisbury Wiltshire SP1 3YU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Winterbourne Winterbourne London Road Salisbury Wiltshire SP1 3YU 01722428210 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caring Homes Healthcare Group Limited Name of registered manager (if applicable) Ms Gillian Brinkley Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users whose primary care needs on admission to the home relate to their dementia may only be accommodated to receive personal care and not nursing care. The maximum number of services users who can be accommodated in 80. The registered person may provider the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category (Code OP) - maximum of 80 places Dementia (Code DE) maximum of 41 places Date of last inspection 0 0 Over 65 41 80 Care Homes for Older People Page 4 of 40 Brief description of the care home The Winterbourne Care Centre is registered to provide nursing and personal care for up to 80 people. It was purpose-built and first registered on 5th February 2009. Accommodation is provided over three floors. The home is divided into six units. At the time of this inspection, three units were opened. One unit on the ground floor to the right of the entrance area provided nursing care to people who were medically frail. The two units to the left of the entrance area on the ground and first floor provided dementia care for people who needed personal care only. The home is owned by Caring Homes Healthcare, a national provider of care. The registered manager for the home is Gillian Brinkley. The home is on the London Road, leading into the city of Salisbury. There is ample car parking on site, a bus stop close by and a train station about 10 minutes away by bus or car. Care Homes for Older People Page 5 of 40 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: two star good 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: As part of the inspection, 20 questionnaires were sent out and 4 were returned. Comments made by people in the questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the homes registration considered. We also received an Annual Quality Assurance Assessment (AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened since the home opened in February 2009. We performed a random inspection on 5th May 2009, following a complaint and a range of requirements and recommendations were made at that time. We looked at the AQAA, the surveys, the random inspection and reviewed all the other information that we have received about the home. This enabled us to decide what to focus on during the inspection. As the Winterbourne Care Centre is a larger registration and several issues were raised Care Homes for Older People Page 6 of 40 during our random inspection, three inspectors performed the site visit. One of the inspectors was a pharmacist inspector. These people are referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The visit took place on Tuesday 16th June 2009, between 9:00am and 5:50pm; it was unannounced. The acting manager was on duty during the site visit. The acting manager, a regional manager and the responsible individual were available for feedback at the end of the site visit. During the site visit, we met with ten residents and three relatives. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for five residents, across all parts of the home. As well as meeting with residents, we met with two registered nurses, five carers, the domestic performing the laundry, the receptionist/activities coordinator, the new chef, the regional catering manager and the training manager. We observed a lunchtime meal and two activities sessions. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, accident records, complaints records, the statement of purpose and service users guide. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? A random inspection was performed on 5th May 2009, following a complaint about service provision. As a result of this inspection, a range of requirements were identified. By this inspection all had either been addressed or showed much improvement. The acting manager has set up systems to ensure that all people have an assessment of their needs and can demonstrate that actions have been taken if a need or risk is identified. Where a person does have a need or risk identified, care plans have been put in place to direct staff on actions to take to meet need or to reduce risk. Where a person is not able to change their position or give themselves drinks or meals, improved monitoring documentation is in place. Where a person has not been given their medication, the reasons for this is documented. District nurses are called in promptly when indicated. Much work has been put into improving the meals service and a range of stocks of food-stuffs were evidenced during the inspection. The home have employed an experienced chef, who will be able to ensure that residents individual needs, likes and preferences are met. The home has made improvements in its systems for ensuring that the principals of infection control are upheld, including ensuring that infected and potentially infected laundry is correctly managed, hoist slings are not used communally and that there is a ready supply of disposable gloves and aprons. Equipment has been provided to support practice, such as disposable glove and apron dispensers and adequate numbers of rubbish bins. The home has set up systems to ensure that assessment of need for bed rails take Care Homes for Older People Page 8 of 40 place. Residents were generally left with access to their call bells. Accident records were much clearer, with full records maintained in accordance with guidlelines. We were pleased to note the major improvements made in service provision in this home in a short space of time. In order to ensure that this is maintained, we will perform a random inspection of the service during the next year, so as to be able to verify that the improvements have been sustained. 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 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 40 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 40 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. Residents and their supporters will be informed about service provision, so that they can decide if the Winterbourne can meet their needs. Full assessments of need are carried out and the new manager ensures that the home can meet peoples individual needs. Evidence: The Winterbourne Care Centre has a Statement of Purpose and Service Users Guide available for all prospective new people to the service. Both documents are available in a large print format if required. The Statement of Purpose describes how the team support qualified nurses in providing appropriate care to those who need nursing intervention and in the day management of the residential unit. It also states that regular forums are to be set up to enable people to feedback on the operation of the home. Care Homes for Older People Page 11 of 40 Evidence: The Service Users Guide provides a further introduction to the home. This includes the name of the persons allocated key worker and services available to residents. We noted that some of the names of staff, such as the chefs were incorrect. The acting manager confirmed that as they had only recently come in post, the documents were being reviewed and updated regularly, until such time as all permanent staff were in post and the home was fully operational. When someone new is admitted to the service they are also provided with a My Life Book to complete on their own or with their families, if they wish to do so. It enables the home to gather further information about the persons life and likes and dislikes. This information may be particularly helpful for staff working with people with dementia. We performed a random inspection of the home on 5th May 2009. At that inspection, we found that there were clear assessments of need carried out for residents. No further residents have been admitted since the random inspection. During this inspection, we looked at different peoples assessments and again found that assessments had been carried out in detail. One persons assessment included detail of what parts of personal care they needed assistance with. The assessment was very individual in tone. The assessment also included the persons social needs and reflected what the resident told us. One persons assessment documented that they did not like certain dairy products and it was observed that staff were aware of this. A few of the assessments for residents admitted soon after the home opened were brief, however in these cases, assessments from the person who had been providing the person with a service were obtained and remained on file. In their AQAA, the home reported that Prospective service users are encouraged to look around the home prior to admission and invited to stay for a meal. One resident described to us how they and their family had looked at a number of other homes in the area, including periods of respite care at other homes, and had chosen this home. They reported that their family had described the home as the best place to go and reported Im pleased I did decide on here, that it was the little things that matter about this home. Another person reported that they had chosen the Winterbourne because it was very close to their family. We observed during the inspection that more than one of the residents admitted before the acting manager came in post, wished to smoke. Information provided by the home makes it clear that the Winterbourne is a no-smoking environment, therefore the home does not have facilities to meet the preferences of people who need to smoke. If that was the case, these two people should not have been admitted, Care Homes for Older People Page 12 of 40 Evidence: as the home does not have facilities to meet their needs. The staff were supporting residents who wished to smoke, but this was complex, as people have to be escorted to leave the home environment and has the potential to restrict the residents choice, as staff may not be available to support them at all times. It is appreciated that the decision to admit these two people does not relate to the current acting manager, however as these people are in the home, needs review to ensure the home can meet these peoples preferences, whilst they ensure their safety, the safety of other residents and staff. Care Homes for Older People Page 13 of 40 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. Peoples needs will generally be met by the improved systems put in place to meet peoples personal, nursing and health needs. Evidence: We performed a random inspection on 5th May 2009, following a complaint. The inspection raised issues about a range of matters, including care provision. At that time, there was a lack of on-going assessment of need and care planning, a lack of liaison with district nurses relating to people who needed residential care and a lack of documentation to show how frail peoples nursing and care needs were being met. There were also issues relating to ensuring that residents privacy and dignity were met and a need for improvements in documentation relating to the administration of medicines. The current acting manager had commenced their role on the day of the random inspection and they reported to us that since then, they had performed a full review of systems and documentation to ensure that peoples needs were met. In their AQAA, the home reported care file documentation has been reviewed. Medication administration procedures have been improved. This inspection provided Care Homes for Older People Page 14 of 40 Evidence: evidence of the amount of work put in by the acting manager and staff since the random inspection, to develop service provision. All of the requirements from the random inspection had either been addressed or showed progress. Some areas still need to be addressed, however it is appreciated that five weeks is a short period of time to fully to develop practice. Unlike the previous inspection, nearly all residents now had assessment of need, including assessment for risks such as risk of pressure ulceration, dietary risk and manual handling. Where a risk or need was identified, there was good progress towards developing plans to identify how such needs can be met. People commented on the service provided. One person reported that their relatives physical needs (i.e. washing, dressing etc.) are well covered, another that their relative is always treated with respect and dignity and another care is provided to high standards. A person reported I can ask them to do anything, another said staff are helpful to me and another Ive had a good bath this morning. One relative commented they are so good, you mention something to them and they try it out to see if it works, another relative commented that they had not been happy with certain aspects of the care but that now the new manager had come it was getting better. We met with a range of residents in all parts of the home which were open and observed care practice at different times of day, as well as reviewing records. Most records relating to provision of nursing and care were in place. All people had clear manual handling assessments and care plans, which staff were observed to follow. Where people had specific needs, this was documented. For example, one resident had complex behaviours, risk of these behaviours to them had been assessed and care plans drawn up. All documentation was written in a clear non-judgemental style. Some issues were identified in certain aspects of documentation. One person did not have a dietary risk assessment or social needs assessment completed. In two cases, care plans needed review. One persons care plan stated that they could feed themselves, however staff reported that the person had recently become more frail and needed assistance to do this. Their care plan had not been revised. Another person had had a fall and sustained a fracture. The person was now less able to perform personal care and may have been at a higher risk of pressure ulceration. Their care plan had not been up-dated. This person who had a history of falls. They had had a falls risk assessment and there was a care plan to reduce risk of falls. It was noted as good practice that the home did not as part of the persons care, seek to reduce their freedom by using physical or chemical means to reduce their risk of falling. As the person did fall, it would be useful if the home had an individualised monitoring record for when the person fell, as well as accident record, to identify if Care Homes for Older People Page 15 of 40 Evidence: there were any times of day or other factors which increased their risk of falling. Some of the frail people in the home were unable to change their own positions and needed supports to eat and drink. Where this was the case, the home had monitoring records to ensure that peoples positions were changed, to reduce risk of pressure ulceration and to ensure that they were regularly offered fluids and given meals. Improvements have been made in monitoring records since the last inspection, however this is an area where continued development is needed. Two people who were assessed as being at high risk of pressure ulceration did not have records to show that their position had been changed at the frequency stated in their care plans. Some people did not have fluid charts to show that if had been offered/given the fluids that they needed. Where fluid charts were in place, they were not totalled so as to assess how much a person had been able to drink in a 24 hour period. Most food charts were completed but a few had not been, so it was not possible to assess if a person had been given their meals, or had declined. Where a person had a urinary catheter, there were now records relating to the catheter. The home does not document the clinical reason for the catheter. This is indicated as catheters can be a source of infection and should only be used if they are in the best interest of the person. One persons record directed that their catheter needed changing in May 2009, however there were no records that this had taken place. This is needed as catheters need changing in accordance with guidelines, to ensure their patency is maintained and prevent risk of infection. Where a resident had a wound, there were clear records relating to this, including photographs. It is recommended that photographs include the date to support the evaluation process. To improve clarity of records, the home should also develop a singing off/archiving process relating to wounds which have healed. Staff we spoke with reported that they had good liaison with local GPs, district nurses and specialists, such as the tissue viability nurse. Now that the home has more permanent staff, people we spoke to had a much clearer knowledge of residents individual needs. With more permanent staff, and no further admissions, staff have been able to ensure that residents privacy and dignity is maintained. We observed that all personal care was performed behind closed doors. One resident reported to us on how the night staff were very conscious of their needs for privacy when going to the toilet and how they appreciated this. This good practice by staff was not included on the persons care plan and it should be, so as to ensure that all staff were aware of the persons needs in this respect and ensure consistency in practice. Our Pharmacist Inspector looked at medication handling in the home. Medicines were Care Homes for Older People Page 16 of 40 Evidence: stored appropriately, however specialist rag or rawl bolts are needed to secure the controlled drug cupboard to the wall in order to comply with current legislation. All the appropriate records were kept, including records for medication taken out with people when they went on social leave. People who wanted to manage some aspect of their own medication were supported to do so and we saw risk assessments for people who did this. Staff have training in the safe handling of medication and we saw them giving people medicines in an appropriate and sensitive manner. There is a procedure for staff to follow and information about medication is available to all staff. Some people were prescribed medicine to be give as required. Some of these instructions were backed up by guidelines which support staff when administering these medicines, but some needed to be clarified, so that all staff would know which medicine to use in which circumstance. The recording of these medicines was not always clear. Discussions with staff and the manager showed that the accurate recording of creams and lotions used was not always easy and sometimes missed, so a different system should be tried. Peoples records showed details of all the interventions by healthcare staff including GPs and specialists, and records of any medication changes. Changes to the medication administration records were not always signed, dated and checked by two members of staff. Care Homes for Older People Page 17 of 40 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 will now have their social needs met and meals are seen as a key area in providing of services to residents. Evidence: Good progress has been made with regard to social contact and the provision of activities, for the people living at the home. A person commented to us in their questionnaire that there had been a lack of activities for residents. They also commented on improvements since the change in management. The acting manager explained that they were currently employing someone for fifteen hours a week, to arrange activities. The member of staff works the remaining thirty hours a week in the role of receptionist. When we met with the member of staff they explained that working some hours on the reception is useful as it enable them to meet with relatives and obtain their views on events/activities, which have taken place. They reported that many relatives were volunteering to attend and help with events and planned activities. The home plans to hold regular activity/recreation meetings, which will involve relatives and the people using the service. On the day of our visit, we noticed that people were taking part in various activities such as colouring prints of the Mexican flag. Care staff were supporting residents with Care Homes for Older People Page 18 of 40 Evidence: this activity. The activities coordinator explained that they are holding a Mexican evening, when they will be providing Mexican food and dressing up in Mexican hats. Family and friends were invited. The event was advertised on the notice-board in the reception of the home. Another event advertised on the board was an Old Time Musical sing a long, followed by a buffet lunch. The activities coordinator reported that they had attended a course on Dementia awareness, which they had really enjoyed and found very useful in the planning of activities. In their AQAA, the home reported on how they are planning to develop activities for people with dementia care needs, including liaising with an expert who will be assisting them in devising activities around such needs. We asked how they would ensure that the people who like or may be confined to their rooms, through ill health are also offered opportunities for social interaction. They confirmed that they were hoping to spend one-to-one time with these people, exploring what particular needs or interests they may have. This may simply be spending quality time with them just chatting, so that they do not feel isolated. Staff were also observed to regard activities as an area where they had a role. A carer was observed in an upstairs sitting room engaging two residents in conversation about their past lives. The carer clearly knew about both residents interests and was using their knowledge as an opportunity to support the people in both memory retention and conversation abilities. One resident told this carer youre brilliant. One person had a care plan relating to their communication difficulties, which set out clearly how staff were to support them in their social care needs in the light of the communication difficulties. We discussed the need to consider the specific needs of people, such as when a person has a visual impairment. The activities co-ordinator explained that they had made contact with an organisation called Living Paintings, which may provide interest for people with limited sight as they use raised images and tapes. There are plans to use an area within the reception as a resource centre for relatives and the people living at the home. This will include feedback cards on recent events. There is currently a photograph album located there, which has photos of people making cakes and gardening. The home is in the process of drawing up social assessments and care plans, together with individual profiles. Considering that this was an area which was totally lacking at the random inspection, in only five weeks, they have made good progress. For example, one persons plan detailed how they were till mourning the loss of a spouse and how this affected them. Records are maintained of activities participated in, but Care Homes for Older People Page 19 of 40 Evidence: many had not been completed since late May 2009. We suggested that it would be good practice to develop a method of evaluating how successful or not activities may have been. This may be through observation of reactions, interactions and engagement. The manager reported that one relative of a person being supported at the home, is working with them to provide information on how the person may communicate their needs, by gestures, body language and facial expression. The home has a minibus, which enables people to access the local and wider community. Weekly trips are arranged for people to attend Salisbury market if they wish to do so on a Tuesday. Trips are also arranged to local garden centres. The activities coordinator explained that outings depend on staffing and if a driver was available. They added that they also have to consider access to buildings when they plan trips for people who may use a wheelchair or have limited mobility. One resident reported to us that they enjoyed the trips out and had been on three during the past month. Another person reported that due it the homes position, they were able to go out of the home most days to visit their family It was reported that the home have good links with the nearby St Marks church. They had recently attended summer fete there and they is also plans for the church to visit the home and provide a cream tea for everyone. Future plans for the home include arranging for Pet therapy and a beauty therapist to visit the home regularly. The activities coordinator told us that they had a meeting arranged with the local Girl Guide and brownie pack to explore how they might be involved with the home in the future. Residents reported that they were able to chose how they spent their lives. One person reported that they did not want to come out of their room for meals and this was respected. A person in the nursing wing reported that they liked to go to one of the residential wings for lunch and this was observed to take place. One resident wished to support the home by brushing the patio, as they had used to do in their own home and had been given a brush so that they could do this. One person who remained most of their time in their own room had been supported in bring in a range of their own items, which gave their room a highly personal appearance. A relative commented staff take good care of [the residents] appearance - helping [the resident] choose what to wear, apply make-up etc. A visitor commented that visitors are always made welcome. They appreciated how visits could take place in the communal lounge, a small lounge or the persons bedroom. At our previous visit to the home on 5th May 2009, we were very concerned that there were insufficient food supplies to meet residents nutritional needs. When discussed Care Homes for Older People Page 20 of 40 Evidence: during feedback with the two managers on duty at the time, they undertook to rectify the situation by the end of the day and confirmed this in writing to Care Quality Commission. The home have now appointed a new and very experienced chef to take on catering management. On the day of our inspection, this person was working their first shift on duty. As part of our inspection process, we met with the chef and discussed their plans for the future. They reported that they were hoping to make the menus seasonal and continue with a four week rolling menu. We checked the food supplies and found that there was plenty of fresh salad and vegetables available. There was also a large bowl of fresh fruit. We noted that all opened food stored in the fridges had been covered and dated; this included fresh fruit salad and a smoothie drink. The chef reported that as the weather was particularly nice on the day of our visit, the menu had been changed to allow for a picnic to take place in the gardens. The picnic consisted on chicken breasts, salmon fillets, jacket potato wedges and vegetables. A choice of dessert was available. The chef told us that care staff hand out the menu choices for the next day and that people living at the home can choose their meal preference for the next day. They added that they were planning to attend weekly meetings to enable them to obtain peoples views on the food provision. The manager reported that a recent survey had been sent out to residents and their relatives for feedback on the meals provided. At the time of our visit to the service the chef confirmed that no one living at the home had specific dietary needs. We talked to people about the meals. One person reported Id give it 50 out of 100 about the meals, another person commented that the meals tended to be dried up and that this was particularly the case with the macaroni. Another person commented the food is not wonderful but its reasonable. We observed a mealtime and noted that nearly all residents were sitting out on the patio, under umbrellas, enjoying the warm summers day. People appeared to enjoy the meal. One resident described the meal as absolutely beautiful and another said to us after the meal was finished everybodys had a nice meal. Staff were available to support residents who needed assistance. They showed a good knowledge of residents likes and preference and were able to support the new chef in this area. The meal was well managed for the more able residents, however attention needed to be paid to the management of meals for frailer people. The home had some people who were too frail to go to the dining rooms and needed assistance to eat their meals. We observed that it took some time to settle people to eat their picnic lunch on the Care Homes for Older People Page 21 of 40 Evidence: patio, but they were given their meal first. This meant that frail people were given their meals afterwards, so some people did not have their meal until after 1:30pm and one person did not have their meal until 2:00pm. The acting manager explained that the meal had been less well organised than usual, as they had decided on the spur of the moment as it was a nice day, to organise a picnic. It was also less well organised as it was the chefs first day on duty and that staff were supporting the catering service in ensuring that residents could enjoy an outside activity. Staff confirmed that practice seen on this day was unusual. This was confirmed by the residents who were not able to get up to go for the picnic. Care Homes for Older People Page 22 of 40 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 will now be able to raise concerns and complaints, knowing that they will be fully investigated and acted upon where relevant. People will feel safeguarded by the homes systems. Evidence: In their AQAA, the home reported that communication with relatives and stakeholders needs to be improved through structured processes of meetings, feedback forms and open access to the newly appointed management team. We looked at the procedure for raising concerns and making complaints. Guidance on making a complaint and the organisations procedures and policies are available within the Service User Guide and the Statement of Purpose. In the event of a concern being made, it is recorded within the complaints log. We observed that the complaints log before the acting manager took over indicated that not all complaints had been logged or responded to. We noted that since the acting manager came in post, any concerns raised have been recorded correctly, with clear actions, outcomes and timescales. The acting manager has responded in person to the complainant and a record has been kept of the actions taken. It was noted that some complaints received related to staffing levels, laundry facilities and some care issues. Records demonstrated that the manager has responded appropriately to concerns raised and records have been kept. Care Homes for Older People Page 23 of 40 Evidence: One relative reported in their questionnaire that they had felt able to approach the regional manager with concerns. We asked people how they raised complaint or matters of concern to them. One person reported Id talk to someone in a blue dress - theyre pretty good at sorting out something and another Ive explained to [a senior member of staff], [the person] does try to get things right for me. A relative reported to us that they had had concerns in the past but that the acting manager was working with them to improve the service to their relative. A member of staff reported you can say anything to [the acting manager] and [the person]ll sort it and another that the acting manager was so easy to talk to if you have any concerns. Policies and procedures are in place to ensure that people using the service are safeguarded from abuse. Staff training records show that all staff attend training in abuse awareness and are aware of the local protocols they need to follow. On the day of our visit safeguarding training was taking place at the home. The training officer confirmed that there is an expectation for all staff to attend a four hour training session on the subject of safeguarding. We talked with staff, who showed an understanding of this area. One carer described how important it was to ensure that peoples individual rights and preferences were maintained. They reported that one resident under their care had laddered stockings, they had tried to persuade the person to change them, but that the person had insisted that they wanted to wear that pair of stockings that day. More than one residents records indicated that they could be aggressive at times, including physical violence. Records of such occasions were clear and written in a factual manner. Staff reported that they felt fully supported by the acting manager on each occasion when this had happened. The acting manager reported that they were aware that if a resident did exhibit violence towards staff, to enable them to feel safe and ensure the safety of the resident and other residents, that staff needed full support from management promptly after the event, and were able to show by their records how staff had been supported. Staff spoken with were fully aware of how to prevent risks to other residents when people had complex behaviours, including use of distraction techniques. No aggressive behaviours were observed during the inspection. At the random inspection, we observed that more than one resident had not been left with access to their call bell and so would not have been able to summon assistance in an emergency. During the inspection, we observed that one person used their bell and that a carer promptly attended to them. By the time the carer attended - a few seconds after the person had used their bell - the resident was not able to remember why they had used their bell. The carer was observed to be very kindly in approach to Care Homes for Older People Page 24 of 40 Evidence: this person and said that they would be happy to come back if the resident needed them again. At this inspection, all apart from one resident had been left with access to their call bell. This person was not fully aware of how to use their bell, although they reported that they had used it at times. Where a person has specific needs to behaviours in relation to use of the call bell, full documentary systems need to be in place so that staff are aware of actions to take to ensure their safety (see also health and personal care). Care Homes for Older People Page 25 of 40 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 will be supported by a well designed environment which can meet peoples needs. Some areas relating to prevention of spread of infection need further emphasis, to fully reduce risk to people. Evidence: The Winterbourne Care Centre was purpose-built as a care home. Accommodation is provided over three floors and is divided into two wings on each floor, making a total of six different units. There are passenger lifts in-between each floor. The home has been designed to meet the needs of people with dementia care needs as well as people who are physically frail and there is a secure door entry system to the dementia care units. Separate patio areas are provided to both the units. At the time of the inspection, landscape gardeners were in the home, planting and improving these areas. External seating, tables and umbrellas were provided. In their AQAA, the home reported the current home environment is to a very high standard. We will strive to ensure that the facilities are fully utilised by all residents as often as possible. One person reported that the home presents itself well, another person said its lovely, its very posh, another the home is new, very well furnished and comfortable and another that the smaller units work well so that their relative did not get lost as they had done in their previous home. A relative commented Theyve put a lot of thought into how it is laid out so that its less confusing. Care Homes for Older People Page 26 of 40 Evidence: The home offers a wide range of communal ares. Each wing has its own sitting dining area and additionally there are a range of different communal rooms on the ground floor near the entrance area. The entrance hall is nicely laid out and has been furnished, so that visitors can sit there if they wish. All communal areas have been furnished to high standards, giving the appearance of a good standard hotel. Although the home is on a corner plot between a main road and a railway, these do not predominate, as there is full sound-proofing to windows. The windows are large, letting in light and air to rooms, in a safe manner for mentally frail persons. A wide range of equipment is provided for people, particularly for people with disability needs. All beds for nursing care are profiling. A wide range of hoists are available for manual handling and relevant equipment to prevent risks of pressure ulceration. We performed a random inspection on 5th May 2009 because a complaint had been raised in relation to a range of areas, including practice and equipment to prevent risks of spread of infection. Much has improved since that inspection. The acting manager reported that he had ensured that systems have been put in place to regularly order disposables. Disposable gloves and aprons were now readily available and this was also confirmed to be the case by staff. We observed that glove and apron dispensers were in the process of being installed in toilets, bathrooms and sluice rooms. All rooms now had rubbish bins. Improvements had been made in the naming of topical creams, but work is still needed in this area, as some topical creams continue not to be labelled with the persons name. If creams are not named, there is a risk that they may be used for other people and present a risk of cross infection. One of the areas raised by people was the management of the laundry. People reported that the quality of the service was not to the standard they expected. Improvements have been made in the laundry since we visited the home, however some areas remain to be addressed. We were informed by the person performing the laundry that all staff now put potentially infected and infected items in appropriate bags and that they no longer have to open them to re-sort laundry. When we visited the laundry, we observed that used laundry was spilling out of a container on to the floor. This had been addressed by the end of the inspection but is not good practice, as to prevent risk of cross infection, used laundry must not be left in contact with the floor. We observed that, like the previous inspection, that there were no gloves or aprons in the laundry. The person performing the laundry knew where they could get such disposables, however such disposables need to be in the laundry, to prevent the person performing the laundry from having to leave the room when performing their role. There was a rubbish bin in the laundry, but it was very small and by 9:15am was full to overflowing, when we visited the laundry later on, it had been emptied but was Care Homes for Older People Page 27 of 40 Evidence: again full of different items. We observed that there was a pile of un-named clothes, including un-named net underwear and some un-named pop socks and tights in the laundry. We discussed this with a carer who reported that only one person in the home currently used net underwear and another carer reported that as they had so few people on their wing, they were able to know which socks and tights belonged to which people. One relative described to us how their relative has lost clothes and that at times they had seen their relative wearing other peoples clothes. The acting manager reported that they knew that this was an issue and that they were in the process of investing in marking systems for clothing. The acting manager also reported that they had recruited a person to work in the laundry, who would be able to take on responsibility for the area, rather than a range of staff performing the role and that this would improve practice. Care Homes for Older People Page 28 of 40 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. Residents will be supported by a staff team which is being developed in their roles, has been safely recruited and where turnover is now reducing Evidence: When we visited the home on 5th May 2009, we observed that there had been a high turnover in staff and that there were high numbers of agency staff being used. A person commented in their questionnaire on the teething problems when the home opened, that staff had been leaving to work elsewhere and that staff were still overstretched. One person described to us during the inspection how the home were not serviced with a figure of staff, another that you hear the call bell a lot, another staff keep changing, keep seeing new faces, however people also noted that improvements had happened since the acting manager came into post. One person reported much better here recently about staff turnover, another about some of the very good girls who had remained in post and a member of staff reported that since the acting manager came in post that they had had very few agency. On the day of the inspection, all apart from one person on duty was employed by the home and the one agency person had worked in the home previously. A review of the off-duty showed that usage of agency had decreased and that on average there was one agency person on duty per shift. In their AQAA, the home reported E Learning has been widely utilised to ensure Care Homes for Older People Page 29 of 40 Evidence: compliance. Additionally a significant and robust recruitment process has dramatically reduced the use of agency staff. We discussed staffing with the acting manager. They reported that, following the random inspection, they had stopped admissions to the home and concentrated on recruitment of staff. The acting manager reported that, as well as recruiting a new chef and a person for the laundry, they had also recruited care and registered nursing staff and were waiting for a range of people to come into post, following employment checks, including a deputy manager and maintenance man. The home are to be congratulated for all the work they have put in to retaining the staff that they do have and for recruitment further permanent staff. We discussed how the home was progressing with staff training to National Vocational Qualification (NVQ) levels. The training officer explained that their main focus at the present was to ensure that all newly appointed staff had received their basic mandatory training. They added that they will be looking at the development of NVQs as soon as possible and that some staff had already expressed an interest in obtaining the award. As part of our inspection process we sampled the recruitment files of six members of staff. Four of these being the most recently appointed to the service. We found all recruitment files to be in order. Correct safeguarding checks had been completed prior to the staff member being appointed. Records show that at least two satisfactory references had been sought. We noted that one staff member person had one professional reference and one personal reference on their file. We discussed this with the manager who provided us with a satisfactory explanation as to why there was not two professional references obtained. There was also evidence of the staff members identity and a recent photograph on file. New staff were provided with a contract and a job description. Records for agency staff detailed their qualifications and confirmed receipt of a check with the Criminal Records Bureau (CRB). As mentioned previously in this report, the training officer was delivering safeguarding training on the day of our visit. This enabled us to spend some time with them and obtain information on the training programme offered by the home. We firstly discussed the induction process for both permanent staff and agency staff. New carers, who do not hold an NVQ complete a course of E learning (computer based), which covers the required skills for care in line with the Common Induction Standards. There is an expectation that this will be completed within the 12 week probationary period. The induction period for registered nurses consists of completing a checklist of basics such as fire procedure, care plans, policies and procedures and other records and documentation. Agency staff work through a checklist during their induction and a record is kept on file. We suggested that all agency staff sign the record to confirm Care Homes for Older People Page 30 of 40 Evidence: that they have completed an induction period and had been provided with relevant information. The training officer showed us the homes training matrix and explained that training is separated into four main pathways. Pathway one covers all mandatory training such as fire awareness, safeguarding, manual handling, basic food hygiene, infection control, COSHH, medication, reporting and customer service. All kitchen staff receive training relevant to their role. Pathway two covers specifics such as dementia care, elderly care and sensory awareness. The trainer confirmed that if they admit someone with specific health care needs such as Parkinsons disease, appropriate training would then be provided to staff. Pathway two (clinical) covers continence, blood glucose, pressure damage and other areas relating to residents clinical needs. Pathway three covers NVQs. The trainer reported that they are currently aiming to visit the home and provide training at least once every two weeks. There appeared to be a good system in place for tracking of training, which ensured that courses are regularly in place for newly appointed staff to attend. A carer reported to us on the providers approach to training reporting that they know our needs for training and that they had been supported in their development. Care Homes for Older People Page 31 of 40 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. People will be protected by the homes effective management systems. Evidence: On the day of the random inspection, the current acting manager was working their first day in the home. It has been reported to us that the registered manager for the home has resigned their post and they had not been on duty in the home for a period of time. The acting manager is an experienced manager, who has worked for some years in the care sector, including working as a manager for a large corporate provider. The person reported to us that since they took up their role, they have reviewed the services provided by the home and put in a range of interventions to improve and develop service provision. During the inspection, we were able to review actions taken by the acting manager, particularly in relation to the meals service, care provision, staffing and ensuring that principals of infection control are up-held. People commented on the changes made by this manager. One person reported that the home was much better recently, we had a meeting upstairs not long ago, Care Homes for Older People Page 32 of 40 Evidence: another person reported that the home was on the up now and another that they could raise issues with the acting manager and that they would look into what they had said and work towards addressing matters of concern. Staff reported that they felt much more supported in their roles. One person commented on how the home felt more settled since the end of May. As well as meeting with the acting manager, a regional manager was attending the home as part of their regular supports to the home. This person was reviewing systems for administration and management of medication. They were observed to review these systems in detail and spend time with the people administering medication, to ensure that the person was fully aware of their role and the importance of following guidelines in administration of medication. The responsible individual also visited the home during the inspection. She was able to feed-back to us on how they reviewed service provision in the home and steps they had taken since the random inspection to improve performance. This senior management team were highly professional and fully honest in their reports to us. This is to be commended and provides evidence that the management team are prepared to take action where deficits in service provision are identified. In their AQAA, the home reported the home is very well supported via a head-office team of peripatetic managers and clinicians, whose primary role is to support the home manager and home staff in implementing robust procedures and building teams capable of delivering care to the the highest professional standards. Records demonstrated that monthly audits were completed by a senior manager. We noted that the last audit was completed on 21/5/09 between the hours of 8am and 4pm. Issues raised from our last visit to the service had been followed up and action taken to address them. The audits covered all aspects of the service provision, including percentages of staff compliance relating to all areas of training. Any complaints received and any accidents, which may have occurred, are explored further to monitor for any trends or patterns. Since our last visit, the home have ensured that we have been notified of any incidents, illnesses and other events which may affect the well-being or safety of any person living at the home. We reviewed a range of records and, as noted in Health and Personal Care above, observed that not all records were completed in full or at the time care was provided. We observed one record in a persons daily record about an accident, which indicated that it had been written some time after the accident had occurred. The acting manager reported that this related to a member of staff who had forgotten to make a Care Homes for Older People Page 33 of 40 Evidence: record before they went off duty and had made the record when they returned for the next shift. They were aware of this matter and were supporting staff in developing skills in record-keeping. We observed that some residents daily record included gaps. Good practice guidelines state that gaps should be avoided in what is a legal record and a line be drawn through any gap. We noted from a list on the notice-board that the home has 10 named fire marshals. We sampled the fire log book and noted that they schedule for six monthly evacuation tests. Records showed that these had been completed on 15/5/09, 21/5/09 and 3/6/09. The first two tests record that they had not been satisfactory, however the last one records that everyone had responded well. Fire drills were completed for on the 14th and 21st May 2009 and a drill for night staff took place on 21st May 2009. Records stated that monthly extinguisher inspections were satisfactory. The home has a clear fire action plan in place, which explains the evacuation procedure. All staff sign up to the action plan. Environmental risk assessments were in place including a fire risk assessment. However, this document may not currently contain sufficient information to conform to the Regulatory Reform (Fire Safety) Order 2005. Therefore we suggest further information be added to this document. We sampled the accident books and noted that they had been recorded appropriately. The acting manager reported that they were currently setting up a system for 24 and 48 hour written reviews of accidents. We discussed that where people were being cared for in bed, that safety rails were uniformly used, rather than lowering the bed to its lowest levels and using crash mats, which is regarded as good practice. The responsible individual reported that this was an area for development and that they were seeking to train staff in ensuring good practice in this area. The environmental health officer has visited the home since our random inspection and has reported that the home now complies with its requirements. Care Homes for Older People Page 34 of 40 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 35 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 12 As the home has admitted 31/08/2009 people who wish to smoke, they must ensure that such persons are able to do so, in a safe manner. Residents rights to chose to smoke need to be up-held. However as this is a care home which aims to meet the needs of frail elderly people, including those with dementia, facilities must be provided, so that residents can continue to smoke in a way that ensures that their safety, the safety of other residents and staff is maintained. 2 7 12 Where a person is unable to 31/07/2009 change their position or give themselves fluids or meals, monitoring records must show that care has been given in accordance with care plans. Monitoring records must be fully Page 36 of 40 Care Homes for Older People 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 completed at the time care was given. Monitoring records are needed, so that staff can assess if a persons needs have been met and managers can monitor effectiveness of care plans. 3 7 12 All residents must have assessment of need, including assessments when their care needs change. Following assessment, all people must have a care plan drawn up to direct staff on how the persons needs are to be met. Assessments of all of a persons needs is indicated so that care plans can be developed to ensure that peoples needs can be met, in a consistent manner 4 8 12 Where a person has a urinary catheter, there must always be records to show that it has been changed as directed. Urinary catheters need to be changed in accordance with guidelines to ensure their functionality and prevent risk of infection. 10/07/2009 31/07/2009 Care Homes for Older People Page 37 of 40 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 5 9 13 The administration of medication which has been prescribed as required must be clearly recorded including the time and dose given, and supported by suitable guidelines. This will ensure that people are given their medicines safely. 31/07/2009 6 9 13 The controlled drug cupboard must be secured to a solid wall with rag or rawl bolts. This will ensure that it complies with current legislation for the storage of controlled drugs. 31/08/2009 7 26 13 The home must ensure safe practice in the laundry, including the correct handling of items for laundering, the availability of disposable gloves, aprons and rubbish bins and the marking of residents own items. If there are not safe systems in the laundry, there will be a risk of cross infection. 31/07/2009 Care Homes for Older People Page 38 of 40 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 7 7 8 8 Where a person is having their fluid intake measured, the amount taken in should be totalled in 24 hours. Where a person falls frequently, a falls monitoring chart should be used. Where a person has a urinary catheter in place, the clinical indicator for the catheter should be documented Where a person has a wound photographed, the date should be included on the photograph and a singing off/archiving system be developed for healed wounds. Records for the use of creams and lotions should be made by the staff applying those products. Written additions to the medication administration record should be signed, dated and checked by two members of staff. All activities participated in by residents should be documented and the home should develop systems so that they can review and document how successful or not activities have been for people. All topical creams should be named and dated on opening Agency staff should sign to confirm that they have received an induction into the service. Gaps should be avoided in residents daily records and a line be drawn through any space. The fire risk assessment should be further developed. 5 6 9 9 7 12 8 9 10 11 26 30 37 38 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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