Inspection on 03/06/09 for Yaxley House Residential Home

This inspection was carried out on 3rd June 2009.

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

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

Other inspections for this house

Yaxley House Residential Home 27/10/09

Yaxley House Residential Home 16/06/08

Yaxley House Residential Home 07/08/06

Yaxley House Residential Home 24/01/06

Yaxley House Residential Home 30/03/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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: Yaxley House Residential Home Church Lane Yaxley Eye Suffolk IP23 8BU     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: Deborah Kerr     Date: 0 3 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 33 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 33 Information about the care home Name of care home: Address: Yaxley House Residential Home Church Lane Yaxley Eye Suffolk IP23 8BU 01379783230 01379783743 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Providence Health Care Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 34 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The current owner, Mr Govinden Vythelingum purchased the home in December 2005. A new manager, Mrs Wilson - Godber was appointed at the same time and was registered by the Commission for Social Care Inspection (CSCI). In August 2008 a major variation to the homes conditions of registration was approved by CSCI to provide service users whose primary care needs on admission to the home are old age not falling within any other category and dementia. The maximum number of service users who can be accommodated is 34. Care Homes for Older People Page 4 of 33 34 0 Over 65 0 34 Brief description of the care home Providence Health Care have refurbished the home, dividing it into two units, the original part of the house Yaxley and a dementia unit called Peacehaven. The dementia unit provides accommodation for eighteen people, all rooms are on the ground floor, with en suite facilities. Peacehaven is built around a quadrangle garden facility where people can wander freely and safely. Yaxley has fourteen single bedrooms and one shared. Accommodation is on both the ground floor and the first floor. A shaft lift gives easy access to the upper floor for those unable to manage the stairs. The home is set in attractive gardens close to the church in the village of Yaxley. Ramps and handrails are provided at the front entrance. There is parking to the front of the house. Fees for this home range from £425 to £700.00 per week. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted nine hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in four residents and three staff Have Your Say surveys and the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with three people living in the home, four relatives and five staff. The manager was present during the inspection and fully contributed to the inspection process. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Four requirements were made at the previous inspection, which related to reporting of safeguarding matters, the building to be maintained to a safe standard during adaptations to the structure, all necessary documentation acquired prior to a member of staff being employed in the home and for accurate records of monies to be kept so that residents can be assured that their assets are safeguarded. Information provided in the AQAA and information obtained during the inspection confirmed the home has taken steps to address all of these requirements. The home has been refurbished and has been divided into two units, Yaxley and a dementia unit called Peacehaven. A considerable amount of decoration and refurbishment of bathrooms, toilets and shared rooms has taken place in the older part of the building to improve facilities for the people living there. New carpets have been laid throughout the home and new furniture and equipment has been provided, where required. One of the original shared bedrooms has been modified to create a communal lounge area, which connects to the dining room. The dining room has also been upgraded with an atrium installed to provide an airy and light environment. Two new bedrooms have been created to replace the shared bedroom, both of which are en-suite. The old dining room has been made into a new lounge and activities room. The newer eighteen bedded dementia unit has been purpose built, all rooms are on the ground floor, with en suite facilities and fitted with under floor heating. A new nurse call system has been installed, to ensure people have access to staff at all times. A new activities coordinator has been recruited, feedback from people using the service, their relatives and observation of activities in progress confirmed this has improved peoples quality of life. Care Homes for Older People Page 8 of 33 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service are provided with information and the opportunity to visit the home to help them choose if this service will meet their needs. Evidence: Copies of the statement of purpose and service users guide were provided at the inspection. These contain detailed information about the services provided, the facilities and also includes the complaints procedure. These will need to be updated to reflect the change of name and contact details of the Care Quality Commission (CQC). The AQAA reflects a professionally designed brochure is currently being designed using photographs of the facilities. Consideration should also be given to providing this information in different formats to better meet the needs of people using or potentially using the service, to include large print and or Braille for people with a visual impairment. A copy of the service user guide is situated in each persons room, for people to peruse at their leisure. Care Homes for Older People Page 11 of 33 Evidence: Information provided in the AQAA and verified at the inspection confirmed Yaxley House has a comprehensive admissions policy and procedure to ensure that prospective users of the service are made aware of what the home has to offer. The AQAA states potential clients and their relatives have the opportunity to visit the home prior to admission. People are encouraged to spend a day at the home in order to facilitate their decision making and choice and all new residents are offered a trial period so they can take time to reflect on their decision. This was confirmed in discussion with residents and relatives. Comments included, it has a friendly feel at Yaxley House, that impressed us on our first visit, the manager was very welcoming and came in their day off to talk to us. They emphasised that this is the residents home and staff in the home work to that end in a relaxed way and we were given a good tour of all the rooms in the home before, our relative moved in, it is a very nice place and they are well cared for. As part of the inspection process the records and care pathways of three people living in the home were tracked to ascertain how well the home is meeting their individual needs. Two of the three people had had a detailed pre admission assessment completed, which covered all areas of their health, personal and social care needs. Where people had been referred through social services a copy of the social workers assessment had also been obtained. The third person had been admitted to the home as an emergency. The home had obtained assessments from the Local Authority, Suffolk Mental Health Partnership (SMHP) and the most recent Suffolk County Council (SCC) review. The assessments completed by social services and the homes own assessment provided all the information to complete the individuals care support plan. Each of the files contained a copy of Providence Health Care Ltd terms and conditions of residence at Yaxley House setting out the individuals fees, the roles and responsibilities of the provider and peoples rights and obligations whilst living in the home. Additionally, for people funded by the Local Authority a copy of the Individual Service Contract was held on their file. The home does not provide intermediate care. Care Homes for Older People Page 12 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. People who use this service receive health and personal care, which is based on their individual needs and are protected by the homes policies and procedures for dealing with medicines. Evidence: Three peoples care pathways and care plans were tracked as part of the inspection. Care plans had photographs in place of each individual to identify and personalise the care plan document, with the exception of one person who had recently moved into the home. The plans are well laid out and setting out the actions required by care staff to ensure that peoples health, personal and social care needs are met. Information provided in the AQAA states the service liaises closely with residents, relatives and multi disciplinary teams to ensure each person living in the home has an individualised care plan based on their specific needs. Whilst plans do achieve this statement, care plans are all formatted the same, using generic forms and assessments and amended to reflect the persons needs. Discussion was held with the Care Homes for Older People Page 13 of 33 Evidence: manager that more work could be done to make plans more person centered, focusing on life histories, wellbeing and feelings, which is the real meaning of person centered care. They confirmed they have approached the Primary Care Trust (PCT) requesting their input to develop Pablo Blue books, these are life books, which focus on the life of the individual and they are currently on a waiting list. At the front of each persons care plan is an index, which refers staff to individual support plans to meet the persons needs, such as washing, dressing, continence management, mobility, pressure area management, and dealing with confusion and death and dying. Each plan identifies the specific need, expected outcomes and goals, to enable the individual to retain their independence, where possible, and the care and staff intervention required, to achieve this. Evidence was seen that these are being reviewed monthly. The AQAA states the home has a very low level of pressure sore incidence, cross infection, falls, weight loss, skin injuries, dehydration, constipation and restraint. The home currently has one person on full bed rest due to a general deterioration in their health, reduced mobility and other complications due to their debilitated posture, following a stroke. The staff are proactive in managing their health care, health charts are being completed to monitor the individuals health and regular checks are taking place to ensure they are comfortable. The district nurses visit the home regularly providing advice and treatment where people have developed pressure sores and are prompt at providing equipment, such as adjustable beds, air mattresses and cushions, where required, to help minimise and prevent pressure areas developing. Additionally, all staff have recently attended a prevention of falls seminar. Three staff have undertaken further training to become falls champions. As a result of this training from Suffolk PCT, the home has been able to provide prevention of falls equipment to people living in the home that are at risk of falls, which has dramatically reduced incidents of falls. Incident and accident reports seen confirmed this. The three care plans reviewed showed that two peoples nutritional needs are being monitored, with regular weight checks being undertaken. However, one of the three peoples nutritional assessment had no weight recorded since May 2007, when they were admitted to the home. The monthly review of their nutritional assessment notes they eat slowly, but there is no record to reflect how their weight is being monitored. People in the home are able to access health care services. The home has a positive relationship with the local General Practitioners (GP) and district nurses. Dates and details and outcomes of appointments had been clearly recorded in peoples care plans. Relatives spoken with told us staff are good at keeping them informed, and that Care Homes for Older People Page 14 of 33 Evidence: they are quick at calling GP, if their relative is unwell. Daily records and weekly key work reports are well written and provide a good overview of how each individual has spent their day, and give an indication of the individuals health and well being. Staff spoken with were able to give a verbal account of the needs and preferences of individual residents. Conversation with people living in the home confirmed that staff treat them with dignity and respect, however one individual commented, I was surprised when I first had a male carer, I am not accustomed to having male carers, I would prefer a female, not that the male staff are unpleasant, but I would prefer to have a female to attend to my personal care needs. This was discussed with the manager who agreed to ensure the individuals care plan reflects this and peoples choice should be determined through the pre admission paper work to ensure their preferences are respected when receiving intimate care. Observation of the interaction between staff, residents and visitors was appropriate, very easy going and friendly, residents and their relatives appear to have a lot of confidence in the staff. Time was spent with the senior discussing the process of ordering, storing, administering and disposal of medication. They had a good knowledge of medication. The home uses the Monitored Dosage System (MDS). Photographs of residents had been attached to the Medication Administration Records (MAR) charts folder to avoid mistakes with the persons identity. Policies and procedures are in place providing guidelines to staff for people who chose to self medicate. A risk assessment had been completed for one person being supported to self medicate, this had been signed, dated and agreed by individual. Lockable storage has been provided in their room to keep their medication secure. The practice of administering medication is being well managed. The MAR charts inspected were found to be completed correctly, with no gaps. Guidelines to remind staff of the procedure for administering medication and the homely remedies policy and protocols are included in the MAR folders for staff reference. Examination of the Controlled Drugs (CD) register confirmed the home currently has five people prescribed controlled drugs. Four people have been prescribed Temazepam and one person prescribed Buprenorphine Transdemol patches. The storage for controlled drugs does not comply with current legislation. This was discussed with the manager, during the inspection who agreed to look into purchasing a cabinet in line with requirements to ensure proper arrangements for the safe storage of CDs. However, it was noted that all medication was securely locked away and a check of the stock of each persons medication was found to be accurate and tallied with the amount of stock recorded in the CD register. Care Homes for Older People Page 15 of 33 Evidence: Fridge temperatures are being monitored, these are within the safe recommended temperature for storing medicines. However, the boiler for the home is sited in the medication room, which is making the room to warm for medicine storage. This was discussed with the manager, who agreed to look into purchasing an air conditioning unit to ensure the correct temperature is being maintained. Additionally, there was no daily record to show that the temperature of the room is being monitored. End of life care is an important part of the service being offered at the home. The Liverpool care pathway, which is a tool used to evaluate the well being of an individual at the end stages of life is being used. This paperwork was seen for an individual whose health recently deteriorated, all relevant health charts, had been fully completed, including a pain assessment. These were being checked, signed and completed daily to ensure the individual was receiving appropriate care. They also reflect liaison with the GP and district nurses. The paperwork reflects the individual made a good recovery and was observed at the inspection looking well and eating their meal. Care Homes for Older People Page 16 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 using this service are able to spend their time as they choose and are being provided with activities, however there is more that could be done to enhance the activities provided to ensure these match peoples expectations and preferences, with particular consideration given to those with a dementia. Evidence: During our visit we spoke with three people living in the home. They told us what it is like for them living in Yaxley House. One person commented, the change of ownership and provision of dementia care, has changed the home, when I moved here it was a retirement home, some people have moved to other homes, for me it would be too much of an upheaval, however I am quite happy here. They also told us, the manager and the owner are very nice, easy to get on with and they pop in for a chat and I have a nice view of the garden from my window of the plants and shrubs. I prefer to spend my time in my room listening to the news. I like my own space and being quite, I am a quite person. The second person told us, I spend my time reading, especially the classics and watching television, the staff are very nice and I also get on well with some of the Care Homes for Older People Page 17 of 33 Evidence: other people living here. The third person commented, I am quite happy living here, staff look after me, I have choice of meals, we could do with more staff though, but activities are picking up, with the new activities person in post. We also received information in four residents Have Your Say surveys, which told us there is a good atmosphere in the home, staff are helpful and they receive good care and that staff are friendly and know the residents well. We also spoke with a number of relatives, who confirmed they were happy with the service being provided, they commented, staff are very helpful, but the home could do with more staff at certain times of the day. One relative told us, my relative is being well cared for, staff are very helpful, moving our relative into the home has been a positive experience for our family, however they commented, my relative appears to be wearing someone elses shoes today, and his jumper is missing. The AQAA reflects a new activities co-ordinator, has been appointed five days a week to ensure that residents receive comprehensive social activities centred around their individual capabilities and social needs. Positive feedback has been recivied from both residents and their relatives about improvements to peoples quality of life. Time was spent talking with the activities person, who confirmed they are now working full time in activities post. They have not had specific training, but commented the manager provides good support and advice. They spoke of forthcoming events they have planned, including a karaoke, cheese and wine and buffet tea event this afternoon and a summer fete. They intend to set up craft sessions, such as bead making so that these can be sold at the fete. The activities person was observed co-ordinating a game of carpet bowls. Residents were observed listening to music and singing whilst playing bowls, a visitor commented, how nice it was to see their relative playing bowls, as they used to be in a bowling club and regularly played in tournaments. Discussion with residents and their relatives confirmed the karaoke session had been well received. People were observed enjoying the occasion with families, singing old songs. Discussion with the manager identified that one of the residents had been crying as the song had brought back memories, but good ones, the managers response was to sit with the individual and let them cry, but offered reassurance at the same time by holding their hand. This was a very good example of person centered care. The cheese and wine event, was also a great success, visitors were observed engaging in the event and arriving with bottles of wine. Individual activity sheets were seen in the three care plans, reflecting activities they have taken part in. These included morning exercise, listening to music, and singing, watching television, bowls, hairdressing, facials and manicures. Now an activities co- Care Homes for Older People Page 18 of 33 Evidence: ordinator has been appointed, discussion was held with the manager that more could be done to provide activities to meet peoples expectations, preferences, hobbies and interests, by accessing appropriate training and resources. One person living in the home said, I would like to resume elements of a normal daily routine, of what I used to do before moving into residential care, such as preparing a meal and shopping. The AQAA reflects residents are encouraged to maintain contact with relatives and that some residents are supported to visit their families at home regularly, so that, where possible, they can continue their social circles. Entries seen in the visitors book, reflects relatives, friends and advocates visit the home on a regular basis. People told us they enjoy the food provided, comments included, staff ask me what I want, we are given choices and enough food, we have hot drinks when we want, but I generally wait for the trolley to come around. At the last inspection, it was noted that daily menus were available and displayed in the home, however there were no picture menus to assist those with dementia to make their choices. These were not seen on this occasion and will be followed up at the next inspection. People using the service told us they enjoyed the food, however one person said, food is OK, but I am not the right person to ask as I have a condition which makes swallowing and eating difficult, but I am provided with food that I can eat, I do not go hungry. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to express their concerns and have access to a robust and effective complaints procedure, and are protected from abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding people living in the home were provided at the inspection. A copy of the complaints procedure was seen on display in the home, however the print had started to run out and the type was very small, this was pointed out to the manager who was advised they need to ensure the procedure is available in a format, such as larger print for people with visual impairments. Information provided in the AQAA and verified at the inspection confirmed issues that arise, are addressed following Providence Health Cares complaints procedure. The manager and staff encourage an open system, where residents are able to express their concerns freely and without fear of reprisals. This was confirmed in discussion with residents and relatives, who told us, the manager and care staff are very approachable and I feel able to discuss any concerns openly with them and I am aware of the complaints procedure and I would talk to the manager, if I have any concerns. People told us they were confident that there concerns would be dealt with. Comments included, we visit on alternate days, if we have a problem we can discuss this with the manager in person or by phone, they listen to us and will take action on what we say, they are good at keeping us informed. Care Homes for Older People Page 20 of 33 Evidence: The complaints log showed the home has received two complaints since the last inspection in June 2008. Both had been fully investigated in line with the homes policies and procedures and a full written response provided to the complainant upholding the concerns and explaining measures to prevent re-occurrence of incidents happening again. Staff files show that all staff have received Safeguarding Of Vulnerable Adults (SOVA) training and that the service has robust recruitment procedures in place. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, prior to commencing employment. A requirement made at the previous inspection was for all staff to be aware of the local agreements for reporting safeguarding matters so that residents are fully protected from abuse. Staff spoken with were clear about their role and their duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse, including informing the manager, and local safeguarding team, through social services, customer first team. The AQAA reflected that action had been taken to use restraint on one individual. An incident report reflected that a lap belt had been used at meal times for a person who, due to changes in their behaviour was continuously on the move, falling regularly and not eating. By using the lap belt, staff were managing to keep the individual still long enough to eat some food. These measures had been discussed and agreed with the family, CPN and consultant, who visits the home regularly. The manager made a Deprivation of Liberty Safeguards (DOLS) referral with regards to restraining the individual. All the relevant paper work relating to the referral was seen at inspection. Following an assessment by the consultant, in accordance with DOLS legislation, a decision has been made in the individuals best interests, that the home could no longer meet the persons needs and an alternative placement has been found. A thank you card was seen from the family, expressing their gratitude for the excellent and tender loving care given to their relative. 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. Yaxley House provides people who live there with a safe, well maintained and homely environment. Evidence: The home is set in attractive gardens close to the church, in the village of Yaxley. Ramps and handrails are provided at the front entrance to provide easy access. There is parking to the front of the house. The home has recently been extended and refurbished and has been divided into two units. The original part of the house Yaxley and a dementia unit called Peacehaven. The refurbishment of the interior of home is near completion and work is in progress to improve the appearance of the exterior. The approach to the home is being tidied up, sowing new grass and laying out parking spaces. A person has been employed one day a week to plant and maintain the garden. Information provided in the AQAA and verified at the inspection confirmed the pre existing building Yaxley House has been refurbished. Yaxley has fourteen single bedrooms and one shared. Accommodation is on both the ground floor and the first floor. A shaft lift gives easy access to the upper floor for those unable to manage the stairs. Most of the bedrooms have been decorated, as have the hallways and new carpets have been laid throughout. New furniture has been provided and all bathroom and toilet facilities have been upgraded, including the creation of a disabled toilet. One Care Homes for Older People Page 22 of 33 Evidence: of the original shared bedrooms has been modified to create a communal lounge area, which connects to the dining room. The dining room has also been upgraded with an atrium installed to provide an airy and light environment. Two new bedrooms have been created to replace the shared bedroom, both of which are en-suite. The old dining room has been made into a new lounge and activities room. The dementia unit, Peacehaven provides accommodation for eighteen people, all rooms are on the ground floor, with en suite facilities and fitted with under floor heating. Communal rooms and corridors are light, spacious and airy which enables residents to value their own sense of personal space. All the corridors in Peacehaven have grab bars to assist walking or standing. Peacehaven is built around a quadrangle garden facility, with raised planters for residents to take part in gardening and where people can wander freely and safely. Peacehaven has a large bathroom, shower room and wet room, especially designed for residents with dementia, and a smaller, more personal bathroom. Where the bathrooms throughout both units have been built and refurbished, these have been nicely done, with new tiles, flooring and furniture, however they would provide a more welcoming environment if the decor was more personalised and colorful. People living in the home are encouraged to personalise their rooms, and to add finishing touches of their own to make their living space more homely. These were nicely decorated with peoples personal effects to reflect their individual personalities, hobbies and interests. The manager is currently looking to install memory boxes outside peoples rooms to help them identify their own rooms, and trigger memories. Some residents choose to have the key to their room to lock the bedroom door, others are being locked by the manager at relatives request, to prevent other residents having access to peoples rooms and removing personal objects. However this was discussed with the manager, who needs to consider an alternative way of preventing this, as people with out a key or unable to operate a key are unable to access their own room with out staff assistance. To ensure the safety of people living in the home, radiator covers are in situ throughout both units, which prevent the risk of people falling against them and sustaining burns and scolds and all windows are fitted with restrictors. A new nurse call system has been installed, to ensure people have access to staff at all times. Fire exits have been connected to an alarm system to let staff know if residents leave the building via the fire exits. Doors separating corridors are in two parts, the main door and a separate smaller section, which can be opened to make the corridor wider. It was noted in two corridors, the smaller sections had been hooked open. In the event of the fire alarm sounding, the automatic door releases would shut the main doors, Care Homes for Older People Page 23 of 33 Evidence: however the smaller sections would remain open, which would render the fire door ineffective. This was drawn to the attention of the manager, who closed the doors immediately and stated they would be reminding staff these must be kept closed. A new laundry area has been created providing clean and dirty facilities for health and safety purposes. The laundry was clean and tidy, and appropriate washing machines, tumble dryers and a sluice function have been provided. To reduce the risk of spreading infection, sinks with knee operated taps have been fitted, however water staining in the sluice sink shows this is being used to deal with soiled linen. The laundry does have a washing machine with a sluice function included. The use of dissolvable red bags used for containing soiled linen, which can be put directly into the washing machine on a sluice cycle was discussed with the manager. Using these would reduce staff contact with foul linen, and further minimise the risk of spreading infection. The manager agreed to look into purchasing these. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in all bathrooms, en suite and toilet facilities, where staff may be required to provide assistance with personal care. Peacehaven and Yaxley are connected via a corridor, all parts of the home are accessible to the people living there by using push buttons to release the doors in corridors. These ensure people are able to have access, but deter people from leaving the building unescorted or unknown. The entrance and reception area has been moved to the side of the new extension. The front door is also operated by a push button, which is causing problems as this is not connected to the nurse call or alarm system. Residents have on a number of occasions been able to leave the building unnoticed. The manager is intending to fit a key pad to the front door for better security, they were advised that they need to risk assess this to ensure people living in the home, without a dementia, have access to the code so that they can leave the building when they choose. The home is generally equipped with aids and equipment to promote mobility and maximise peoples independence, including grab rails and other aids, which are available in corridors, bathrooms, and toilets and where required, and in residents own rooms. Three new commodes, a stand aid and bath hoist have recently been purchased. Additionally, the home uses assisted technology, to minimise people falling, such as pressure pads, under mattress and cushions, which alert staff when an individual is moving in room. 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. People using this service are supported by a staff team that are trained, skilled and competent to do their jobs, however people living and working in the home tell us there are not always sufficient numbers of staff at certain times of the day, to meet peoples needs. Evidence: We, CQC recivied mixed information about staffing levels in the home. The AQAA reflects the home has adequate staffing ratios in order to meet the needs of the people living there, however discuison with staff, residents and realtivies commented that there are certain times of the day when their could be more staff availble. Comments included, I visit regularly and cannot always find a member of staff, and often see the same staff, they appear to work long hours and staffing is ok, we have three staff allocated to Peacehaven, and two in Yaxley, however we could do with one more person on shift at busy times. Staff told us in the surveys the home is understaffed, staff are overworked and at times there are not enough staff on duty, an example given was when medication is being given out, making it very difficult to concentrate and when staff need to support an individual in pairs, this can take a long time, leaving no staff on the floor. However, a member of staff told us, there has been significant improvement in staffing and communication in the home. They commented, people are not working so many hours, and with more staff people are doing a good job, the atmosphere is a lot better, it is a nice home. Care Homes for Older People Page 25 of 33 Evidence: The duty rosters for the two weeks prior to the inspection and two weeks folowing, were provided at the inspection. These reflect the normal staffing ratio of five staff, including a senior are on duty during the waking hours and three staff including one senior at night between the hours of 10pm and 8am is being maintained. Staff confirmed they do work flexibly to cover any staff sickness. Support staff consist of a handyman, a cook, two kitchen assistants and two part time housekeepers. One housekeeper has set hours, which cover three days, during the week, however the rota does not reflect how the other four days are covered, to ensure the home is kept clean and hygienic. Care staff confirmed they are expected to take care of the laundry and night staff do the ironing. Surveys and discussions with staff confirmed they felt they had been recruited fairly and received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. The training file confirmed staff have completed all mandatory training, including infection control, fire safety awareness, food hygiene, moving and handling, protection of vulnerable adults and administration and handling of medicines. The AQAA states, all staff are already trained to administer medication and are embarking on a further course through Great Yarmouth College. Additional training to meet the specific needs of people using the service, has included, managing challenging behaviours and dementia awareness. The manager and two senior carers have become falls champions after training, to all staff in osteoporosis and falls prevention provided by Suffolk Primary care Trust (PCT). Discussions with staff reflected there is a disparity in there understanding of dementia and person centred dementia care. Most of the staff spoken with demonstrated a reasonable understanding of dementia, however this is an area, where additional training is needed to further develop dementia care in the service. Information provided in the AQAA states the home employs a total of twenty two care staff. Eight of whom have achieved a National Vocational Qualification (NVQ) level 2 or above, with one senior care assistant currently undertaking NVQ 4 and four staff working towards NVQ, level 2 qualification. These figures reflect the home is working towards achieving 50 percent of staff to hold a recognised qualification, in line with the National Minimum Standard NMS. The AQAA states Providence Health Care Ltd have implemented a strict recruitment regime. Examination of three recently recruited staff files confirmed all relevant documents and recruitment checks, required by regulations, to determine the fitness Care Homes for Older People Page 26 of 33 Evidence: of the worker had been obtained prior to them commencing. However, one of the application forms had limited information about the employees previous employment, there was no information about their employment prior to 2008. Where there are gaps in a persons employment history these need to be explored to ensure the protection of people living in the home. Providence Healthcare Ltd have produced their own induction booklets for care staff, which meet the Skills for Care, Common Induction Standards (CIS). Staff spoken with and port folios confirmed new staff had or are in the process of completing their induction training. Staff told us they had received a good induction, which included an orientation tour of the home, and what they needed to know to support the people living in the home. Care Homes for Older People Page 27 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 management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. Evidence: Mrs Carole Wilson - Godber is the registered manager for this service. They have a range of experience, which spans twenty years working with people in care settings, and people with a dementia. They hold the Registered Mangers Award (RMA) and has completed a range of training to ensure they have the right qualifications and experience to carry out their role as manager of the service. Most recently training has included person centred dementia care, a three day foundation course at Bradford University, which will be followed up next year with the next level of training on this subject. Additionally, they have completed train the trainer training, which enables them to cascade training to staff. Care Homes for Older People Page 28 of 33 Evidence: The manager completed and sent us their AQAA when we asked for it. It was clear and gave us all the information we asked for. They told us they run the service with an open door culture for residents, their relatives and staff, with the aim of promoting good communication amongst the staff team, providing a positive and productive role model to all and to be available to all who enter the home. Other information provided in the AQAA states staff feel less apprehensive to approach management, which has boosted morale and created a happy team. Discussion with people using the service their relatives and staff and comments seen in the most recent quality assurance surveys confirmed this. Six residents and thirteen relatives had returned the homes quality assurance questionnaires, which covered topics, such as admission to the home, care provided, activities and food. These provided positive responses and comments included, we were given a good tour of all the rooms in the home before, our relative moved into the home, it is a very nice place, the people are well cared for and we are pleased with our relatives daily care, they always look nice and clean and staff are most helpful and are a pleasure to talk to. Other people commented, we appreciate the phone calls, when our relative is unwell or had a fall, we feel confident that the staff always consider our relatives best interests and Yaxley House was supposed to be a temporary placement for our relative until we could find somewhere nearer home, however they have settled well, we feel that our relative is being cared for so well, we will not move them. Less positive comments referred to, the occasional disappearance of relatives belongings, shoes and a calendar have gone missing, from our relatives room and we are unhappy about other people entering their room. Comments obtained in three staff Have Your Say surveys and discussions with five staff during the inspection told us, that generally staff are happy working in the home. Comments included, I enjoy working here very much, I have received training and I am kept informed about changes in peoples needs and the manager is good, they are very hard working and supportive and the manager is very supportive, I am very happy here, however one member of staff was less positive, they felt they were not provided with the support and supervision, they needed to do their job and that there was not a happy staff team working in the home. Comments received in the surveys included, the owner and manager are doing a very good job at keeping the staff and residents happy and the manager is good, very hard working and supportive and I feel well informed about the anything that happens in the home and issues about the health and well being of residents, there is good communication in the home and among staff. Care Homes for Older People Page 29 of 33 Evidence: Where able, people are supported to manage their own finances, the home does hold small amounts of money for residents at their request. All other financial arrangements are handled by families or through the court of protection. Records and receipts are kept of all transactions. Records of two people tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. Staff files confirmed that regular supervision takes place. The documentation reflects that these sessions include discussion about their work, the individuals approach to job, resident issues and areas of development and training needs. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. The installation safety record was seen for the gas (LPG) cooker and the most recent electrical safety certificates, including Portable Appliance Testing (PAT). Certificates were seen confirming the passenger and hoisting equipment have been serviced in line with the Lifting Operations and Lifting Equipment Regulations (LOLER). The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly. However, the fire log book showed two fire risk assessments are in place, it was unclear which of the risk assessments, was in use and met the most recent fire safety legislation. Care Homes for Older People Page 30 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 31 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 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 1 Consideration should be given to providing information about the service in different formats, including large print and/or Braille for people with a visual impairment. Further work could be done to make care plans more person centered, focusing on life histories, wellbeing and feelings, which is the real meaning of person centered care. The complaints procedure needs to be reprinted to ensure it is ledgible, and in a format so that people with a visual impairment can access this information. Doors to service users private rooms should be fitted with appropriate locks suited to the individuals capabilities or an alternative way needs to be established to prevent other residents having access to peoples rooms and removing personal objects. The use of dissolvable red bags used in washing machines on a sluice cycle would reduce staff contact with foul linen, and further minimise the risk of spreading infection. Gaps in a persons employment history should be explored to ensure the protection of people living in the home. 2 7 3 16 4 24 5 26 6 29 Care Homes for Older People Page 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!