Care Home: Alexandra Way EPH

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What the care home does well People are well cared for and experience some good outcomes with regard to personal care and healthcare. People are also well supported by healthcare professionals that visit the home. We spoke to several people and they told us that the staff were very kind and that they could not fault the care as everything was fine. Comments in the surveys told us; `when not well the care is very good`, `I am very happy at Alexandra Way`, `the staff are very helpful including shopping`, `the home looks after me well` and `I am happy here`. The two relatives surveys sent to us had the following comments; `there are friendly and approachable staff always willing to help`, `the service provides a happy caring environment, which gives reassurance and confidence to the elderly residents` and `the home has contacted me or my brother should a need arise and have been very approachable should any queries need to be raised, my mother settled in well and is very happy`. People have a varied menu where a choice of food is available and most people enjoy the food provided. The kitchen has achieved the highest award of 5 stars from Environmental Health this year. The home is well maintained and free from offensive odours and people told us it is always clean. The laundry was clean and well organised and the staff there have a comprehensive manual to include infection control. The homes recruitment procedures are thorough and staff complete a comprehensive induction, which helps to ensure that people are safeguarded. The staff training and development is excellent and staff told us that their training needs are well met, which helps to ensure that people are well cared for by competent staff. Nineteen staff had completed NVQ level 2 or above out of the twentyseven employed and eleven members of staff have been trained in basic nursing skills, at North Bristol Trust as part of the NVQ level 3 award. One care assistant we spoke to said the training was `second to none, it was excellent`. Some staff were completing a mentoring skills course linked to completing supervision and continuing professional development. The home is well managed by a qualified and competent registered manger and several duty managers. The completed staff surveys returned to us contained the following comments; `the home manager is exceptional and delivers what she says, she should be thanked for all the training we get`, `the home provides frequent and relevant training`, Alexandra Way is a very well run caring home, the managers are doing their job well`, `the managers work tirelessly to promote equality for people and care staff ensuring staff work above and beyond the national minimum standards` and `residents, families, doctors and district nurses all compliment us on our knowledge and care`. The home has a quality assurance programme where people and their relatives are surveyed twice a year to make sure that their views are known and changes are made to improve the service. What has improved since the last inspection? The person centred care plans have improved and there was a lot of detailed information, some of which was excellent, to help ensure that peoples needs are well met. The home has a new large screen television in the dining room where films and music can be played to entertain. A new information board has been put up in the corridor near the dining room. The information displayed tells everyone the date, which staff are working, what activities are scheduled and the menus for the day. There has been a lot of refurbishment to the home since the last inspection and it was well maintained and attractive. The dining room looked attractive with new flooring and decoration, to include additional communal seating. We looked at the homes annual improvement plan, most of which had been completed, this included the following; new profiling beds, new seating for lounges, new bedroom laminate flooring, refurbishment of bedrooms (only five left to complete), dining room refurbishment, new kitchen flooring and appliances, tarmac path to greenhouse, an additional tumble dryer,and bathrooms decorated and repaired. What the care home could do better: The staff should be more involved with pre-admission assessments to help ensure that people admitted can have all their needs met in the home. The level of care should be appropriate with regard to the dementia care provided, taking into consideration all people accommodated, as the home is not registered for this type of care. The statement of purpose should be updated to contain more information about the people admitted with regard to dementia care and there should be adequate fee information available before people move in. The manager, subsequently, informed us that there is appropriate fee information available. Risk assessments completed in peoples` care plans should be reviewed more regularly to help identify any changes. Medication administration and records could be improved to help ensure safe practice. People enjoy activities provided by the care staff and visiting entertainers, however, a dedicated activity person may help to co-ordinate and provide more structured activities. One staff survey comment told us; `the home could do better by providing a few more activities, and sometimes there is not enough time to do this`. One person would like more choice of food at supper time and we recommend that a variety of light meals are always available on the menu at any time for example; omelette, jacket potato and salad. Additional communal seating may be required to ensure that all people can enjoy the communal areas. The homes complaints procedure should be produced in a format that is appropriate for the home, and to comply with regulations. Currently there are sufficient staff to meet dependency needs, however, night staffing levels may need to be reviewed. The AQAA completed by the manager was comprehensive and gave us some good information about the home. However, the AQAA also identified that many of the policies and procedures had not been reviewed for several years, this should be completed as soon as possible to help ensure that the latest guidance is known and used. Key inspection report Care homes for older people Name: Address: Alexandra Way EPH 3 Alexandra Way Thornbury South Glos BS35 1LA     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: Kathryn Silvey     Date: 2 1 0 8 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 35 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 35 Information about the care home Name of care home: Address: Alexandra Way EPH 3 Alexandra Way Thornbury South Glos BS35 1LA 01454866172 01454866828 lynne.smith@southglos.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: South Gloucestershire Council care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 43. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary are needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP Date of last inspection Brief description of the care home Alexandra Way is a Local Authority home for older people. It is situated some distance away from the centre of Thornbury, an ancient market town. The home, whilst a good fifteen-minute walk from town, is well situated to access Bristol, Gloucester and the M4 and M5 motorways. The town offers all of the usual shopping, banking, sporting and spiritual amenities. Thornbury has its own festival and many amateur music and drama groups. The home is situated in well kept, extensive grounds and also has the advantage of being in a Cul-de-Sac. Care Homes for Older People Page 4 of 35 Over 65 43 0 Brief description of the care home The building is on one level and divided into wings leading to a central courtyard garden area. There is a large dining room that incorporates a small area where people can sit in armchairs to watch the new large screen television, this room is also where some activities take place. There are three meduim sized lounges and two small lounges. There is a reminiscence room where visitors can make a hot drink, and a separate hairdressing salon. Two bedrooms are dedicated for respite care, and the remaining fortyone bedrooms provide permanent care accommodation. The home also offers two places twice a week for people who benefit from day care. Alexandra Way accommmodation fees are currently £550. Additional fee information can be obtained from the home. Care Homes for Older People Page 5 of 35 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: The last key inspection was on 10 July 2007. We, The Care Quality Commission (CQC) completed this inspection over two days. The registered manager was on annual leave, however, we had direct contact with three duty managers, care assistants, the chef, the laundry person, a domestic, a visiting district nurse and people living in the home. we also spoke briefly to everyone living in the home when we looked at the environment to help ensure that people knew we were completing an inspection. We received eight completed surveys from people living in the home, five from the staff and two from relatives. We looked at care records to include medication and some policies and procedures. The manager had completed an Annual Quality Assessment Audit (AQAA) providing us with information about the home and what has changed in the previous twelve months. Care Homes for Older People Page 6 of 35 Care Homes for Older People Page 7 of 35 What the care home does well: People are well cared for and experience some good outcomes with regard to personal care and healthcare. People are also well supported by healthcare professionals that visit the home. We spoke to several people and they told us that the staff were very kind and that they could not fault the care as everything was fine. Comments in the surveys told us; when not well the care is very good, I am very happy at Alexandra Way, the staff are very helpful including shopping, the home looks after me well and I am happy here. The two relatives surveys sent to us had the following comments; there are friendly and approachable staff always willing to help, the service provides a happy caring environment, which gives reassurance and confidence to the elderly residents and the home has contacted me or my brother should a need arise and have been very approachable should any queries need to be raised, my mother settled in well and is very happy. People have a varied menu where a choice of food is available and most people enjoy the food provided. The kitchen has achieved the highest award of 5 stars from Environmental Health this year. The home is well maintained and free from offensive odours and people told us it is always clean. The laundry was clean and well organised and the staff there have a comprehensive manual to include infection control. The homes recruitment procedures are thorough and staff complete a comprehensive induction, which helps to ensure that people are safeguarded. The staff training and development is excellent and staff told us that their training needs are well met, which helps to ensure that people are well cared for by competent staff. Nineteen staff had completed NVQ level 2 or above out of the twentyseven employed and eleven members of staff have been trained in basic nursing skills, at North Bristol Trust as part of the NVQ level 3 award. One care assistant we spoke to said the training was second to none, it was excellent. Some staff were completing a mentoring skills course linked to completing supervision and continuing professional development. The home is well managed by a qualified and competent registered manger and several duty managers. The completed staff surveys returned to us contained the following comments; the home manager is exceptional and delivers what she says, she should be thanked for all the training we get, the home provides frequent and relevant training, Alexandra Way is a very well run caring home, the managers are doing their job well, the managers work tirelessly to promote equality for people and care staff ensuring staff work above and beyond the national minimum standards and residents, families, doctors and district nurses all compliment us on our knowledge and care. The home has a quality assurance programme where people and their relatives are surveyed twice a year to make sure that their views are known and changes are made to improve the service. Care Homes for Older People Page 8 of 35 What has improved since the last inspection? What they could do better: The staff should be more involved with pre-admission assessments to help ensure that people admitted can have all their needs met in the home. The level of care should be appropriate with regard to the dementia care provided, taking into consideration all people accommodated, as the home is not registered for this type of care. The statement of purpose should be updated to contain more information about the people admitted with regard to dementia care and there should be adequate fee information available before people move in. The manager, subsequently, informed us that there is appropriate fee information available. Risk assessments completed in peoples care plans should be reviewed more regularly to help identify any changes. Medication administration and records could be improved to help ensure safe practice. People enjoy activities provided by the care staff and visiting entertainers, however, a dedicated activity person may help to co-ordinate and provide more structured activities. One staff survey comment told us; the home could do better by providing a few more activities, and sometimes there is not enough time to do this. One person would like more choice of food at supper time and we recommend that a variety of light meals are always available on the menu at any time for example; omelette, jacket potato and salad. Additional communal seating may be required to ensure that all people can enjoy the communal areas. The homes complaints procedure should be produced in a format that is appropriate for the home, and to comply with regulations. Care Homes for Older People Page 9 of 35 Currently there are sufficient staff to meet dependency needs, however, night staffing levels may need to be reviewed. The AQAA completed by the manager was comprehensive and gave us some good information about the home. However, the AQAA also identified that many of the policies and procedures had not been reviewed for several years, this should be completed as soon as possible to help ensure that the latest guidance is known and used. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose was detailed, however, there should be more information about the people accommodated, and people should have access to the homes terms and conditions before they move in. People are not always assessed by staff from the home before they move in ,which is not good practice. Suitably qualified staff from the home should assess people to help ensure that all their needs can be appropriately met. Evidence: A social worker completes peoples initial pre-admission assessment, however, we were told that if a person is admitted from a hospital the manager of the home would usually complete the assessment. The manager identifies, from the social workers assessment, whether the home requires further information from a healthcare professional, for example a Community Psychiatric Nurse (CPN). People usually visit the home before they move in, and the duty manager told us that Care Homes for Older People Page 12 of 35 Evidence: informal notes about their care needs are completed. We looked at some preadmission assessments by the social worker, and recommend that suitably qualified staff from the home complete a more formal pre-admission assessment. The assessment should include all the areas in Standard 3 of the National Minimum Standards to help ensure that the home can meet peoples needs before they move in. People are admitted on a four week trial and the AQAA told us that during this time the staff work with the person to compile a Provider Support Plan, which is outcome focused. Five of the eight people that completed our survey told us that they had enough information to help them decide if this was the right home before they moved in, two told us they did not have enough information, and one person didnt know. We looked at the homes statement of purpose and the staff were unable to locate a service users guide. It was assumed that the statement included most of the information required in the guide, with the exception of the sample contract and last inspection report. The last inspection report was available for people to see in the home. There was no information seen about how fees are calculated and when increases occur. The home is registered to accommodate older people, not falling within any other category, however, fees were quoted for people who may be elderly mentally infirm (EMI), a term not generally used any more. There is insufficient information provided about the people accommodated, and the manager must be the only person to decide that a persons mental health needs can be met at the home, as it is not registered for dementia care. The specific needs of people with dementia, the staffing levels required and the suitability of the accommodation may not be appropriate in all cases. The home does not provide intermediate care. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are detailed and provide staff with some good individual actions to help meet peoples needs. Risk assessments are recorded, however, they should be reviewed more often to help ensure that people are safe. Community healthcare professionals provide support, and there are good outcomes for people. Medication administration and records could be improved to help ensure safe practice. Evidence: We looked at several care plans, one of which was a new format that was explained by a carer. The information was clear and easily accessible. The new plans included information about peoples lives, and we looked at two examples of social histories. There were monthly wishes recorded by people living in the home and descriptions of what a good or bad day would be like for them. There were were fourteen areas identified in the care plans that provided very good information about how the persons individual needs were being met. We were informed that nutritional assessments were beginning to be completed and that people Care Homes for Older People Page 14 of 35 Evidence: are weighed every three months. We looked at a record of the weights, and we concluded that the frequency may not be sufficient for a person at risk from malnutrition. Individual risk assessments are recorded annually and included some good information. We looked at examples for wheelchair use, pressure area care and insulin administration. We also looked at a lack of capacity risk assessment, completed this year. We recommend that risk assessments are reviewed more often and are included in the monthly care plan reviews. Some assessments were not dated so reviews were not easy to plan. Care plans were not individually reviewed, instead there was an overall review for the month. Any changes must be included in the individual care plan. The staff told us there was little time to complete the reviews. Manual handling information was detailed and included the lifting sling sizes used, however, in one plan there had been no review recorded since 2007. We recommend that reviews are completed monthly. Another manual handling plan seen had very good pictures of the staff using the hoist. Social services complete an annual review with each person, which may include relatives. Healthcare professionals support people in the home and the district nurse is responsible for any clinical tasks completed by the carers that have the new clinical training award. The home has access to community health services to include; chiropody, dental and optical, which are provided where necessary. There was an excellent daily podiatry check form completed by the care staff for a person with high risk diabetes. The home has good links with the community nurse service. We spoke to a community nurse visiting the home, she told us that the care in the home was very good, particularly end of life care, and that communication was excellent. The nurse also told us that the care staff followed instructions to help make sure that any pressure ulcer care was progressing well and healing. The community nurse agreed to provide training for care staff with regard to insulin preparation. Each person has a healthcare plan completed by the doctor and all healthcare professional visits were recorded in a separate folder to include any letters from hospital consultants. People are allocated a keyworker which is a care assistant that records a monthly review centred on making sure their clothing and bedrooms are organised and clean. Daily records were informative and well completed by the day and night staff. The medication administration records were complete, however, care staff were seen Care Homes for Older People Page 15 of 35 Evidence: administering medication not in the original container or dosette and without the administration record. This is unsafe practice and we explained to staff that mistakes can be made and medication given to the wrong person, should staff become distracted, travelling from the medication cupboard around the home. Generally the medication trolley is used to administer medication and the records are taken to each person and signed after each administration. Warfarin tablets were not well recorded as different strengths need to be recorded separately and signed when given so that an audit can be completed. Information regarding Warfarin administration practice can be found in the National Patient Safety Agency Guidance about anticoagulants. The web site address is www.nspa.nhs.uk/patientsafety/alerts-and-directive/alerts/anticoagulants. There was no protocol for as required Diazepam, there should be a protocol to make sure that for all medicines prescribed with a direction as required or with a variable dose there is always clear, up to date and detailed written guidance for staff. The guidance should provide information on how to reach decisions to administer the medicine, and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. There was excellent information about each persons medication and the potential side effects. A March 2008 British National Formulary was in use, we recommend that the home has a more up to date version. The medication is administered by dosette provided weekly by the pharmacist and all returns to the pharmacy are recorded and signed for. The medication policy was a 2006 procedure provided by The Commission for Social Care Inspection. We recommend that the home has its own policy and procedure, and that there is also a copy of the Royal Pharmaceutical Societys medication guidance for care homes available for reference. The controlled drug medication was correct, however, the controlled drugs cupboard should have rag and rawl bolts to the wall to comply with Misuse of Drugs (Safe Custody) Regulations 1973. Liquid medication was dated when opened to help ensure that out of date medication is discarded. We recommended that a regular recorded medication audit is completed with regard Care Homes for Older People Page 16 of 35 Evidence: to storage, administration and compliance to identify any unsafe practice. Spot check tablet counts should also be completed, particularly for medication not in the dosette system, to help ensure safe administration. All care staff have medication training, however, the duty managers complete all medicine administration during the day until 22:00 hrs. People were treated with dignity and respect, however, there were insufficient armchairs in the communal areas to accommodate everyone. We spoke to several people and they told us that the staff were very kind and they could not fault the care as everything was fine. Comments in the surveys told us; when not well the care is very good, I am very happy at Alexandra Way, the staff are very helpful including shopping, the girls have a very good sense of humour, the home looks after me well, when care is being provided staff talk about what they did last night and I dont have their full attention and I am happy here. Six of the eight surveys completed for us told us that people always received the care and support they needed and two indicated they usually did. The two relatives surveys sent to us had the following comments; there are friendly and approachable staff always willing to help, the service provides a happy caring environment, which gives reassurance and confidence to the elderly residents and the home has contacted me or my brother should a need arise and have been very approachable should any queries need to be raised, my mother settled in well and is very happy. Care Homes for Older People Page 17 of 35 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 enjoy activities provided by the care staff and visiting entertainers, however, a dedicated activity person may help to co-ordinate and provide more structured activities. There is a choice of food provided and generally most people were satisfied with the quality, additional choice may be required at supper time. Evidence: The care staff are responsible for ensuring activities are completed and there was a rota for this, however, on one day of the inspection the dedicated staff were unavailable and activities were not being completed. We did see staff dancing with people in one small lounge but there was little room for manoeuvre. We were told that the dining room was used for group activities, which includes exercise classes and watching films on DVD on a new large screen television, that can also play music compact discs. The staff told us they complete individual activities to include reading and talking to people. Activities completed by people were recorded individually and included the following; board games. flexicise exercises, sing along, nostalgic times, sherry night, films, planting busy Lizzy flowers, quizzes and trips out. One person had been Care Homes for Older People Page 18 of 35 Evidence: swimming with the stroke club and had managed to rekindle her love of swimming. A new information board has been put up in the corridor near the dining room. The information displayed told everyone the date, which staff were working, what activities were scheduled and the menus for the day. In the eight surveys returned to us five people told us there are always activities they can take part in and two told us usually and one indicated sometimes. Comments in the surveys included; I would like more trips out, I would like a room designated for activities alone, and maybe a life appreciation society. People told us they would like more to do, one person wanted to start knitting. One staff survey commented; the home could do better by providing a few more activities, and sometimes there is not enough time to do this. We looked at the homes July newsletter that told us people were going to Westonsuper-Mare and a garden centre in August and that some people enjoyed a day at Thornbury carnival in July. Photographs of the days out were displayed on the notice board. The newsletters also mentioned the new one to one evaluations completed by staff, to replace residents meetings, where people have a chance to air their views and offer suggestions about how the home is run. Changes were made to lunchtime after the previous evaluation and staff were to ensure that people were aware of the choice of food available each day. The duty manager told us that people can go to the local Baptist church, and that holy communion is held regularly in the home to help meet peoples spiritual needs. The July newsletter also contained some interesting cultural information about one of the staff who has moved here from Jamaica. We recommend that the daily menu also contains a list of light meals that are always available, for example; omelette, jacket potato and salad. The chef told us that special diets are catered for, to include diabetic diets. A comment in the surveys told us; the home could do better food at tea time and better choice, We also spoke to several people and three people told us they liked the food provided. Two people told us in the surveys they always liked the meals, five told us they usually did and one said sometimes. One person originally from the Caribbean was spoken to about the food provided and she told us she liked the food. Care staff also told us that this person had relatives that visited the home regularly, and that Caribbean food was addressed, however, it was not requested. Care Homes for Older People Page 19 of 35 Evidence: We observed an unhurried and congenial atmosphere during lunch in the dining room. The kitchen has achieved the highest award of 5 stars from Environmental Health this year. Care Homes for Older People Page 20 of 35 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. The complaints procedure for the home did not comply with the regulations and could be improved to simplify the homes role when a complaint is made. However, people felt able to share their concerns with the staff. Safeguarding procedures should be reviewed to ensure that The Care Quality Commission is aware of any issues that effect people in the home. Evidence: The complaints procedure supplied to people living in the home was the South Gloucestershire Council complaints procedure and did not contain the name, address and telephone number of The Care Quality Commission, as required in the regulations. The home could have its own complaints procedure, in addition to the councils being used, where resolution and a reply to the complainant is required within 28days. We looked at the procedure provided to people and it was unclear that the home can deal directly with a complaint using its own procedure and without involving the councils complaints department. A simple procedure to include the Commission where necessary and the local council as the provider may be more appropriate. Three of the eight surveys completed by people living in the home told us they did not know how to make a complaint. The duty manager told us that there had not been any complaints recently, we looked at the complaints book and any action taken after a complaint was recorded. We also looked at a compliment received. The people we Care Homes for Older People Page 21 of 35 Evidence: spoke to during the inspection told us they would speak to the care staff or the manager if they were concerned about anything, and we observed that staff had a good rapport with the care staff. We also looked at the June 2009 Regulation 26 visit, that a dedicated person records for the provider during monthly visits, to help ensure that people experience good outcomes. More detail could have been recorded to include the comments four people made. A recommendation made during the visit had been completed, this was that drinking water be made available in the lounges. During the inspection we were informed about a safeguarding event, that had not been reported to us, involving a person with dementia care needs where the person did not have capacity to consent. A strategy meeting had been held, however, no record of the meeting could be located. We must be informed under Regulation 37 about any issues that affect people living in the home. The AQAA told us that the last review of the homes safeguarding procedure was completed in March 2007. Another policy regarding sexuality and relationships, which may have been useful in the recent safeguarding event, had not been reviewed since December 2005. The AQAA also told us that all staff have received training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. All staff are to update their safeguarding training by completing the new training for safeguarding adults. Care Homes for Older People Page 22 of 35 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 live in a well maintained and clean home. To meet the peoples needs additional communal seating may be required. Evidence: When we looked around the home, there were no offensive odours and the home was clean and well maintained. The home has three medium sized lounges that accommodate approximately eight people, two small lounges and several easy chairs in the large dining room where the large screen television is. We noted that one lounge had been converted to a large office and we recommend that there are sufficient communal easy chairs around the home for all people to have access to communal space, as daycare people also visit on two days each week. There is also a reminiscence room, that relatives can use to make hot drinks, a separate hairdressing room, and the dining room is sometimes used for activities such as crafts and exercises. An inner courtyard provides access to a secure garden area and there are various places in the gardens where people can sit. One person commented in the surveys that the home needs a gardener to trim back so the place looks better, and to water the plants more often, which may have been a reference to the inner courtyard. Another person told us the home is clean and tidy. All eight surveys told us the home Care Homes for Older People Page 23 of 35 Evidence: is always fresh and clean. We looked at the homes annual improvement plan, most of which had been completed, that included the following; new profiling beds, new seating for lounges, new bedroom laminate flooring, refurbishment of bedrooms (only five left to complete),dining room refurbishment, new kitchen flooring and appliances, tarmac path to greenhouse, an additional tumble dryer, and bathrooms decorated and repaired. There were a few other improvements the manager had identified that were still being considered, however South Gloucestershire Council were consulting people about future changes to care provision. The AQAA told us that the home has an infection control policy based on the Dept of Health (DoH) Essential Steps to Safe Clean Care Guide. We looked in the laundry and it was clean and well organised, and the staff there had a comprehensive manual to include infection control. Care Homes for Older People Page 24 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good recruitment practices that help protect people, and staff are well trained to meet their needs. Currently there are sufficient staff to meet dependency needs, however, night staffing levels may need to be reviewed. Evidence: The AQAA told us that the home has a stable staff team, that will help provide continuity of care. New staff complete the Skills for Care induction standards and all staff receive regular supervision, Personal Development Performance Review, and attend planned meetings where equality and diversity are discussed. We looked at an example of a comprehensive induction record and several well completed supervision records. All five surveys completed by the care staff told us that the manager gives them support, and that all their training needs were met. We were provided with a two week staff rota on the day of the inspection, these included care assistants and ancillary staff. There was a separate rota for duty managers and the registered manager. There are usually five care staff in the morning and four in the afternoon and evenings, and a duty managers on all day shifts. A kitchen domestic is available every day from 16:45 until 20:45 to prepare supper and help the care staff serve the meal, Care Homes for Older People Page 25 of 35 Evidence: and the evening drinks and snacks. The duty manager told us that there were sufficient staff to meet peoples needs and that dependency levels were not high at present. One care assistant told us that additional staff would enable people to have access to the local community more frequently. A member of staff also told us that two staff on duty at night is insufficient for fortythree people, some of which have dementia care needs. We recommend that the manager records a night staffing levels assessment as the AQAA told us that five people require two staff to met their needs in the night, and ten people have dementia care needs. Should there be a fire the need for adequate staff is essential at night, and this must be taken into consideration in the fire risk assessment. We were informed that nineteen staff had completed NVQ level 2 or above out of the twentyseven employed and that eleven members of staff have been trained in basic nursing skills, at North Bristol Trust, as part of the NVQ level 3 award. The statement of purpose contained good information about the staff qualifications, which may need updating to reflect additional training provided, and the induction awards that are completed by Skills for Care not TOPPS as stated. We were unable to locate the training matrix for all staff as the registered manager was on leave, however, the duty manager told us that all mandatory training had been completed. We looked at the training records for two staff recruited and it included the following completed training; safeguarding, manual handling, dementia care, first aid. medication, food hygiene, mental health awareness and depression in older people. The AQAA told us that thirtythree staff had completed prevention and control of infection training, and twentyfive had received training in malnutrition care and assistance with eating. One care assistant we spoke to said the training was second to none, it was excellent. Some staff were completing a mentoring skills course linked to completing supervision and continuing professional development. We looked at two recruitment records that had been correctly completed, which included interview notes. The administrator told us that staff do not start work until a Criminal Records Bureau check has been completed. Care Homes for Older People Page 26 of 35 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 people living in the home and their families have opportunities to influence how the home is run to benefit them, and their financial interests are safeguarded by correct procedures. Health and safety issues are well addressed, however, some policies and procedures may benefit from a review to help ensure best practice. Evidence: The homes registered manager has the required qualifications and experience and is also an National Vocational Qualification (NVQ) assessor. The four duty managers are well qualified, three have the NVQ level 2 in care, one has NVQ level 4 in care management, and the other three are working towards achieving NVQ level 3 in management. They each have different responsibilities in the home for example; manual handling training and medication management, and three are NVQ assessors. During the inspection several duty managers were available and were individually Care Homes for Older People Page 27 of 35 Evidence: knowledgeable about the aspects of the home they were most familiar with. As the manager was on leave the benefit of having a deputy manager to be in overall day to day control should be considered. The completed staff surveys returned to us contained the following comments; the home manager is exceptional and delivers what she says, she should be thanked for all the training we get, the home provides frequent and relevant training, Alexandra Way is a very well run caring home, the managers are doing their job well, the managers work tirelessly to promote equality for people and care staff, ensuring staff work above and beyond the national minimum standards and residents, families, doctors and district nurses all compliment us on our knowledge and care. The AQAA told us that South Gloucestershire Council has an Investors in People Profile and the management team actively support staff to develop and improve care services and performance. All staff receive annual health and safety training that includes Control Of Substances Hazardous to Health (COSHH), risk assessment, safeguarding adults, infection control, moving and handling and first aid. We were told that the Council provides fire safety training for all staff twice a year and that the homes fire risk assessment is up to date. Fire drills also take place and the maintenance person tests the fire alarms weekly. We looked at a record of falls in the home and one person had three in one day, and the Regulation 26 visit highlighted that there were seven fall in one month. We recommend that accidents are audited monthly to identify the possible preventable causes. The time of an accident should be included in the audit as it may highlight the need for a staffing level review. The AQAA told us that that people are referred to a Falls Advisor after a fall and risk assessments are completed. The Intermedicate Care Team also support people with variable mobility. All equipment had been maintained, serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA told us that the home has a quality assurance programme that includes people and their relatives by completion of an agreed bi-annual survey. The surveys cover the environment, external Primary Care, food, laundry, entertainment/activities, religion and culture, personal care, staff listening to needs and wishes of people, and delivery of care. The results of the surveys are distributed to people in the home and their relatives. Following comments received from a relative the home has revised work routines to ensure continuity of care to all people. Care Homes for Older People Page 28 of 35 Evidence: We looked at three records for peoples personal monies and all were correct, including how the hairdressing and lottery monies are collected. The AQAA completed by the manager was comprehensive and gave us some good information about the home. The AQAA identified that many of the homes policies and procedures had not been reviewed for several years this should be completed as soon as possible to help ensure that the latest guidance is known and used. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 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 9 13 Medicines should be administered from the original container with the persons administration record and the person present. This is to avoid errors and promote correct practice. 16/12/2009 2 9 13 Warfarin tablets were not well recorded as different strengths need to be recorded separately and signed when given. This is to ensure safe practice and allows for clear audit trails to be completed. All medicines in the home must be kept safely so as to prevent unauthorised access. The controlled drugs cupboard should have rag and rawl bolts to the wall to comply with Misuse of Drugs 16/12/2009 3 9 13 31/12/2009 Care Homes for Older People Page 31 of 35 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 (Safe Custody) Regulations 1973. 4 9 13 The registered person must 16/12/2009 review medicine records and care plans for people living in the home to make sure that for all medicines prescribed with a direction as required or with a variable dose there is always clear, up to date and detailed written guidance for staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. The registered person must 16/12/2009 inform the Commission about any event that affects peoples well being or safety. This is to ensure that we know about any events that may be a safeguarding issue, to be looked into further to protect people. 5 31 37 Care Homes for Older People Page 32 of 35 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 A copy of the homes terms and condition should be availabe, to include fee information, before people decide to move in. The client group admitted to the home should be identified more clearly in the statement of purpose and be within the current regulations. We recommend that suitably qualified staff from the home complete a more formal pre-admission assessment to include all the areas in Standard 3 of the National Minimum Standards, to help ensure that the home can meet peoples needs before they move, in particularly with reference to dementia care needs. We recommend that risk assessments are reviewed more often and are included in the monthly care plan reviews. The community nurse should complete necessary training for staff with regard to insulin preparation. We recommended that a regular recorded medication audit is completed with regard to storage, administration and compliance, to identify any unsafe practice. Spot check tablet counts should also be completed, particularly for medication not in the dosette system, to help ensure safe administration. There was a March 2008 British National Formulary in use, we recommend that the home has an up to date version. We recommend that there is a dedicated activity person, which may help to co-ordinate and provide more structured activities. We recommend that the daily menu also contains a list of light meals that are always available, for example; omelette, jacket potato and salad. A simple complaints procedure for the home could be used and should include information required legally and The Care Quality Commissions details. We recommend that there are sufficient communal easy chairs around the home for all people to have access to communal space, as day care people also visit two days each week. We recommend that the manager records a night staffing 2 1 3 3 4 5 6 7 8 9 7 8 9 12 9 15 10 16 11 19 12 27 Care Homes for Older People Page 33 of 35 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 level assessment as the AQAA told us that five people require two staff to met their needs in the night and ten people have dementia care needs. 13 38 Some of the homes policies and procedures had not been reviewed for several years, this should be completed as soon as possible to help ensure that the latest guidance is known and used. We recommend that accidents are audited monthly to identify any preventable causes. The time of an accident should be included in the audit as it may highlight the need for a staffing level review. 14 38 Care Homes for Older People Page 34 of 35 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). 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