Care Home: All Hallows Nursing Home

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What the care home does well Residents we spent time with during our visit, spoke positively of the staff and management of the home, and felt able to approach them to discuss any issues they may have. Prospective residents can benefit from getting to know the home, and the level of service they can provide by attending their Day Centre or staying at the home for a short break. As the All Hallows Health care Trust includes the services provided by All Hallows Hospital and Home Care Team, people living at the home and using their rehabilitation service (intermediate care), are able to access these facilities. The home employs the services of a Doctor as Medical Adviser, to regularly meet with residents, and have time to talk to relatives and staff to advise on any health issues. When we asked residents surveyed if they had anything else they would like to tell us about the home, their comments included; "clothing and bed linen are always very clean coupled with the care is compassionate", "I am happy and comfortable living at Adele house" and "I feel very well looked after and the Nurses and carers are friendly and kind; I feel very lucky to be here, in a place which has such a good feel to it". When we asked people surveyed `what does the care service do well`, comments from the following people included: Staff - "treats people with respect and dignity - caters well to individual needs". "staff work well as a team to provide good care, and organise each shift well". Health care professionals - "excellent work", "they always seem comfortable, clean and well cared for". Social care managers - "communication with families and other care professionals is excellent", "very good for placements - positive feedback from either the customer or their family", "home very good at supporting terminal cases and high nursing care needs". What has improved since the last inspection? This section is not applicable, due to the home being under new ownership `All Hallows Health Care Trust Limited`, the home is treated as a new service. What the care home could do better: Our inspection identified that the home is providing some stimulating activities, however this is an area that still needs to be developed, to make it more individualised, and support all residents` skill levels and abilities. Information in care plans on peoples interests, and the level of support staff will or are giving on a daily basis to support people in achieving this. Survey feedback from people living, working, and associated with the home, reflected our findings. Their comments included; "would like more outings" (resident), "mum says there are activities but she is often too weak to take part" (relative) "big efforts are now made to stimulate residents but there is always more that could be done, especially for the iller residents" (health care professional), "those that require less intervention could use more input on social side" (social care manager) and "provide more things for residents to do". The home needs to evidence that staff are receiving more in-depth training to support residents with their mental health needs (including memory loss and dementia), taking into account that the home has made an application with us, to look after people whose primary need is dementia. Key inspection report Care homes for older people Name: Address: All Hallows Nursing Home 26 St. Johns Road Suffolk NR35 1DL     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: Jill Clarke     Date: 2 2 1 0 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 36 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 36 Information about the care home Name of care home: Address: All Hallows Nursing Home 26 St. Johns Road Suffolk NR35 1DL 01986892643 01986893733 admin@allhallowsnursinghome.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): All Hallows Healthcare Trust Limited Name of registered manager (if applicable) Janet Dunning Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accomodated is: 51 The registered person may provide the following categories of service: Care Home with Nursing - Code N to service users of the folklowing gender: either whose primary care needs on admission are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home All Hallows Nursing Home, formerly known as Adele House, has been taken over by the All Hallows Health Care Trust Limited, who we registered in April 2009. The Registered Manager for the service is Janet Dunning. The home is situated on the south side of Bungay, a short distance from the town Care Homes for Older People Page 4 of 36 Over 65 51 0 0 51 Brief description of the care home centre. The home is registered to provide care with nursing for up to 51 people, in the categories of old age, and people who have a physical disability. Accommodation is located on 2 floors, and access between the floors is either by lift or stairs. The 50 bedrooms consist of 49 single and 1 double, 30 of which have ensuite toliet and washing facilities. There are additional toilets, shower and bathrooms which are wheelchair accessible located close to bedrooms and communal facilities. Communal areas consist of 3 day rooms, a dining room. There is also a chapel located on the ground floor that is accessible to residents. The landscape gardens can be accessed through a number of safe, level exits. The home also provides Day Care and short break services. Current fees (as given on the day of the inspection (22/10/09) range from £490 to £950 per week, depending on assessed needs. People can contact the home direct to request a copy of their Statement of Purpose and Residents Handbook, or access their website for further information. Care Homes for Older People Page 5 of 36 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: We (The Commission) visited the home unannounced, to carry out a key inspection, where we focused on assessing the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents view point, of what it is like living at the home, and feedback on the level of care they receive. The report has been written using accumulated evidence gathered prior to, and during the inspection. Earlier in the year we sent surveys to the home to give out. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they thought the home is run. At the time of writing this report 11 residents, 4 staff, 4 Health care professionals (Physiotherapist, Masseuse, GP, NHS Nurse Assessor), and 2 Social Care Managers surveys had been returned. Comments from which have been included in this report. Care Homes for Older People Page 6 of 36 We also looked at the homes Annual Quality Assurance Assessment (AQAA). This provides the CQC with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next 12 months. Comments from which have also been included in this report. The Registered Manager and the Matron were available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. During our visit, we spent time talking to 4 residents in the privacy of their bedrooms, and spent time talking to a visiting relative, to gain peoples views on the home. During the afternoon we joined residents sitting in the chapel, being entertained by Elvis. We also spent time with members of the care, nursing and maintenance staff. This supports us in identifying how well the home is being managed, and if staff are being supported, and receiving the training to be able to fulfill their role. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, minutes of meetings, action plans, questionnaire feedback, Statement of Purpose and medication records. This further evidenced the on going work being undertaken at the home. People living at the All Hallows Nursing Home prefer to be described as residents, rather than service users, therefore this report reflects their wishes. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Our inspection identified that the home is providing some stimulating activities, however this is an area that still needs to be developed, to make it more individualised, and support all residents skill levels and abilities. Information in care plans on peoples interests, and the level of support staff will or are giving on a daily basis to support people in achieving this. Survey feedback from people living, working, and associated with the home, reflected our findings. Their comments included; would like more outings (resident), mum says there are activities but she is often too weak to take part (relative) big efforts are now made to stimulate residents but there is always more that could be done, especially for the iller residents (health care professional), those that require less intervention could use more input on social side (social care manager) and provide more things for residents to do. The home needs to evidence that staff are receiving more in-depth training to support Care Homes for Older People Page 8 of 36 residents with their mental health needs (including memory loss and dementia), taking into account that the home has made an application with us, to look after people whose primary need is dementia. 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 36 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 36 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. Prospective residents are given sufficient information, in a format that meets their communication needs, to support them in identifying if the home is right for them. Evidence: Our last inspection report, undertaken prior to the change of provider, is available in the home for people to read. Discussions with a relative identified that they had read the version available on the CQC website, when they were looking at suitable homes. All Hallows Health Care Trust Limited also has their own website, which includes pictures of the home. The homes Statement of Purpose and Residents Handbook, gives prospective service users, a good level of information on all aspects of the home. We did find some of the information given on the environment, and our contact details needed to be updated/amended, which the management said they would do. The Manager confirmed that the information can be provided in different formats to suit peoples Care Homes for Older People Page 11 of 36 Evidence: individual communication needs. For example printing it in a larger font, or in another language. The AQAA informs us that under what we could do better that they could produce a video of a resident talking about the home, which would include their thoughts about moving in, and what their experience has been like since. This would be supportive both for a potential resident, but also as a training aid for staff to identify the different emotions people may have about moving into care. Residents completing our survey, when asked if they felt they had been given sufficient information on the home before they moved in, all had replied yes. Comments included had received good reports about the home and I spent four separate respite stays at All Hallows - so I was able to make up my mind in the light of actual experience. Besides respite (short break) care, people can also get a feeling of the home and what it has to offer, through attending Day Care, as they mix with residents during meal times and social activities. The AQAA also tells us under plans for improvement in the next 12 months, that they will continue to review the information held in their statement of purpose and resident handbook and will continue to identify views of staff, residents and families to identify what they do well, and any areas they feel could be improved. The minutes of the resident/relative meeting held on the 19 May 2009 evidences that this is happening, as the manager had asked people present if they felt they had received enough information before they, or their relative were admitted. The notes of the meeting go to say that the general consensus of those attending was that admissions had gone smoothly. The Manager also asked people at the meeting if everyone were happy with the contracts that were issued following admission, and they had replied that they were. When we asked people completing our survey if they had received a contract nine out of the eleven residents said they had. The AQAA informs us that the home has a comprehensive and robust preassessment, which enables them to gather all information required to meet individual needs and expectations. The two residents care records we looked at, held preadmission assessments which had been undertaken by a trained member of staff before they moved into the home. Besides gaining information on a persons physical, social, medical and nursing needs, it also includes information on the persons mental capacity and infection status. Prospective residents and their families are encouraged to visit the home prior to moving in. By doing this it gives people a further opportunity to ask staff any Care Homes for Older People Page 12 of 36 Evidence: questions, look at the environment, and meet other people living at the home. The AQAA tells us since we last visited they have started using a checklist. The list is used when showing people around, to ensure consistency in the information being given to people, and as a reminder of information required to be shared and communicated with others. When we asked two social care managers surveyed, if they felt the homes current assessment arrangements enables accurate information to be gathered about the prospective resident, one had replied always the other usually. Comments included yes, each time I have visited the care home I have not had any concerns in this area. Residents we surveyed, in response to being asked do you receive the care and support you need, nine replied always, and two usually. Comments included all services been very good and exemplary. During our visit when we asked a resident if they would recommend the home to others they replied yes - I have recommended it to others and they have moved in. Visiting health care professionals, when asked if they felt the residents individuals health care needs are being met by the home, three replied always and one usually. To support people who after an illness or operation, and are not quite ready to return to their own home, and need a period of rehabilitation, the home offers intermediate care. At the time of our inspection the Manager informed us that they had three people using this service. Although the AQAA did not mention or provide information on providing intermediate care, the Manager was able to answer our questions on the rehabilitation work being undertaken. People using this service are assessed by a Physiotherapist and Occupational Therapist, who will also carry out a home visit and liaise with the person relatives, where applicable. The home is able to accesses the day services at All Hallows Hospital to support people with their rehabilitation, and can also use their own Domiciliary Care Service (All Hallows Home Care Team) to support them, if required when they return home. Care Homes for Older People Page 13 of 36 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. Residents can expect to be treated with dignity and respect, and asked how they wish to be cared for, whilst having their health and nursing care needs monitored by trained staff. Evidence: The AQAA informs us that they maintain detailed individualise care plans, using the Roper Model of assessment, for all residents. They go on to say that their care plans also include a daily summary, clinical risk assessments, person centred care which maintains privacy and dignity. We spent time tracking three residents care, which included gaining the residents views on the home, looking at their care plans and nursing notes. We also spent time talking with staff to gain an insight into the level of a care and support the people were receiving, to see if it reflected the information given in their care plan. The residents whose care we tracked had been given their care plan to keep in their bedroom, which enables them to look at it at any time. The care plan consists of a set of care records, which gives guidance to staff on the level of assistance the person Care Homes for Older People Page 14 of 36 Evidence: requires, to meet their assessed needs. Information taken from the pre-assessment, external health and social care professionals, from the person receiving the care, and if applicable their family, is used to produce the care plan. A statement on the front of the care plan this information is confidential and belongs to the service user and is only to be read with the service users permission, reminds people that they do not have an automatic right to read the confidential information. Care plans contained care plan agreement form, signed by the resident, or if not able to, their relative, which informs people who they allow information about their care needs to be shared with. For example, they gave permission to share the information with health care professionals, if they needed to be admitted to hospital. The care plans provided information on who the persons named nurse and key worker are. These are nominated memebers of staff who are responsible for monitoring the persons care, and ensuring care records are being kept up to date. We asked the staff we surveyed, if they are being given up to date information about the needs of the people they care for, One replied always, two usually and one told us sometimes. Comments included the majority of the time care plans are relevant, accurate and up to date, there are only a few occasions when new information hasnt been added yet and needs updating. Through discussions with the people whose care we tracked, or if unable to answer our questions, through observation of their needs, we found the information held in the care plans reflected the level of support they are currently receiving. In addition to the care plan, each resident has a file containing nursing progress notes which is kept in the Nurses office. From the information we read, we could see that peoples care and nursing needs are being met. This includes monitoring the condition of their skin, and where there are signs of redness, or skin breaking down taking appropriate action to treat the area and promote healing. One of the care plans gave information on the break in the persons skin, and how it was being treated, which included staff using photographs to help them in monitoring the healing process. One resident told us nurses are very good when it comes to doing dressings, as they showed us the area they are currently having treated. When we asked a resident if they are receiving the medical care and support they needed, they replied yes just next door (referring to the GP surgery located next to the home). They also told us that the doctor is very good and undertakes routine visits twice a week, and also if needed outside these times, saying I can only praise the staff, for their kindness and prompt attention to any of my needs. Care Homes for Older People Page 15 of 36 Evidence: The persons feedback reflected the feedback we had received from other residents surveyed, who in response to being asked if they receive the medical support they needed, one person had replied usually and ten always. We also asked do you receive the care and support you need three residents replied usually, and eight always. A resident we met during our visit also commented on the level of care and support they receive. They told us that they have been lucky in only needing occasional medical help, however when they did have problems with their mobility, staff had acted appropriately to support them, which included being seen by a physiotherapist within two days. Our visit coincided with the Doctor, who is employed as the homes medical advisor, regular Thursday visit. A diary held in the office showed the list that had been complied by the nursing staff, of people needed to be seen or have thier care reviewed. The AQAA informs us (under what we do well), that medication competence is undertaken by all trained staff on induction and annually thereafter. Time spent with two of the nursing staff, confirmed that they have received training, which included shadowing another nurse when they first started at the home. Time spent looking at the medication systems the home has in place, showed that there are procedures in place, including audit checks, to ensure medication is stored, and given out to residents safely. Except for controlled medication, which is kept securely in a locked room, which also houses a fridge to keep medication at the right temperature, residents medication is kept in their bedroom, in a small lockable drugs cupboard. The Nurse confirmed that each resident also has their own set of Medication Administration Records (MAR), which is kept in their bedroom. A check against the amount of medication held for one resident, against what the MAR sheets stated they were holding, was found to be correct. The MAR sheets had also been fully completed by staff, to confirm that they are giving out the medication, as prescribed. Discussions with another resident identified that staff give me my tablets and wait, and watch over me, to ensure I take it. They told us, that staff had never run out of their medication, and said yes in response to being asked if they are being given their medication at the right time. They said it could sometimes be heldup if someone is ill or had died but felt naturally in such circumstances it was acceptable. Throughout the inspection, we observed staff addressing residents in a respectful and polite manner. Discussions with residents during the day confirmed that this was normal staff practise, and felt they are respected by the kind staff. Care Homes for Older People Page 16 of 36 Evidence: Discussions with one resident who had loosen their clothing, as they felt it had become too tight, as they twisted around in their chair. They told us that felt very uncomfotable in thier specialist chair. We fed back our observations and the residents comments back to the management. They confirmed what action they had taken already (which was documented in the care plan) to try and ensure the persons comfort. However, they would contact the Physiotherpist again, to further discuss what action they can take to support the person, and speak to the resident about wearing clothing which would not feel so restrictive. The AQAA informs us that each resident has an Advanced Care Plan on admission and updated/reviewed as relevant as part of the Gold Standard Framework (GSF) by the Doctor or trained nurse. This gives a chance for people, if they wish to discuss any issues about end of life care, such as would there prefer to be cared for at the home, or in hospital. The ones we looked held varying amounts of information, depending on how much the resident wanted to discuss this issue with staff at the time. We noted a comment, we are delighted with the dignified Nursing Care provided for our relative at the end of her long life and appreciate the friendliness and excellent skills of all the staff, made by a relative in the homes own survey feedback concerning end of life care. Care Homes for Older People Page 17 of 36 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. Residents are offered a healthy varied diet, which takes into account their preferences and individual dietary needs. There are activities on offer, which residents can choose to attend/join in with, and residents can receive their visitors when they wish. Evidence: The homes own survey feedback showed out of the fourteen residents who gave a rating for social activities undertaken in the home, two had rated them as excellent, and twelve as good. When we asked people we surveyed if there are activities arranged by the home that they can take part in, five replied always, four usually and two sometimes. Where people had replied sometimes, comments included mum says there are activities that she is often too weak to take part and the home would like me to take part in their activities but Im reluctant to do so because of my age and frailty however they go on to tell us I do go to day-care every week when their room is being cleaned. The AQAA , informs us that over the last twelve months, their entertainment budget has been increased, and residents have been using their minibus for outings. A resident said they would like to go out a bit more but were aware to be able to do this they need more carers. This is due to the extra staff required to support people Care Homes for Older People Page 18 of 36 Evidence: requiring a wheelchair to get around. They told us they had visited a garden centre which was quite nice. Information given in the AQAA shows that they are looking to recruit more volunteers, which would help provide the extra support needed during outings. A residents care we were tracking, we noted in their review notes, that they had requested to spend time outside in the garden. There was also comments made by a carer, who after spending one to one time with the resident, had identified activities the person enjoyed taking part in. On reading the persons activity diary, it showed that neither of the comments from the review, or carer had been acted on. The AQAA informs us that the home is still looking to improve in this area, by making it more individualise. They also said during the next twelve months they will be looking at how they can support people who do not wish to come out of their rooms by providing more one to one activities. Comments in the homes own survey feedback showed that a resident regarded having a chapel as part of the home as a big bonus, giving them somewhere quite to sit and pray. A resident we spoke with also told us that the chapel is used for visitors and various entertainers. During the afternoon, after hearing music coming from the chapel - we went to investigate and found residents clearly enjoying the Elvis concert, as they tapped their feet, swayed and sung along to the tunes. One resident was heard to shout out excellent as they applauded loudly. As part of maintaining links with the community, they have recommenced their friends of All Hallows Nursing Home, which involves arranging social events involving residents, relatives, visitors and staff. The AQAA tells us the home has open visiting times to enable a more normal and less regimented life, meaning family can visit at any time and have a meal with their relative if they wish. We can also accommodate any special occasion or family event/celebration that the family may wish to have in the home. There was information on the notice board on how much visitors meals cost, and how to book them. There was also information on the days menu choices, which for lunch was soup of the day or juice, followed by a choice of Sausages with Onion gravy, or Chicken with Leeks and Cheese sauce, and for vegetarians Veggie Kiev. For dessert lemon meringue, gateaux or cheese and biscuits. The menu options were printed in different colours, to support residents in identifying the diabetic, vegetarian and soft or liquidised options. We asked three of the residents sitting in the dining room, their views on the meals. Their comments included dont have any problems - meals normally very good here. They agreed the dining room offered a pleasant place to have lunch. It also enables Care Homes for Older People Page 19 of 36 Evidence: residents to mix with people attending Day Care. As we walked around the home during lunch time, we could see where staff were assisting residents with their meals, in their bedrooms. The staff we observed were undertaking this in a relaxed, unrushed manner, spending time interacting with the residents. We asked a resident, who told us that they prefered to have meals in my own room about the quality of food. They said it is good but felt the taste could sometimes be a little bland, but commented on the scampi and chip which is nice. They felt that although they asked for small portions, they found sometimes they are still too big which can put you off. We asked if they are given sufficient choice, they replied yes - choice usually of three. Another resident, whose care we were tracking, when we asked if the food they were given was tasty, they replied yes - find it good - had mince, carrots and mashed potatoes, then some sort of chocolate pudding, they went on to tell us they are on a soft diet, which reflected the information given in their care plan. Whilst talking to another resident and their visitor, we identified they felt the food was good, but not always served as hot as it should be, and felt it was because of the location of their bedroom. We fed the comments about food not always being served hot back to the management, who said they will monitor the situation and address any problems. We were given a copy of the homes food survey analysis completed in August 2009. The analysis gives feedback from the fourteen residents who had been asked their views on the catering. All had replied yes when asked if the menu was easy to understand, if they are being offered the kind of meals they like to eat, and if there is enough choice. When people were asked to rate the overall satisfaction with the catering service, two people had rated it as excellent, eleven as good and one as acceptable. Our own survey feedback showed that people had replied usually or always when asked if they liked the meals provided by the home. Comments included the home are very good about ask me what I would like and they respect and respond to my requests. The food itself is usually excellent, and gives selection and enjoyable. The homes own catering survey, also asked people if they could get a drink or snack when they wanted, all but one person had replied yes. We noted the people we visited in their bedrooms during the day, all had drinks close at hand if required. When we asked a resident, if they felt that moving into the home had restricted their Care Homes for Older People Page 20 of 36 Evidence: daily routines in anyway. They said it didnt as they are still able to decide when they get up, where they eat. and are able to go out with their family. Care Homes for Older People Page 21 of 36 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 home has a robust complaints procedure in place, and staff are trained to safeguard the interests of people they care for. Residents and their advocates can expect any concerns they have to be listened to, and acted on in an appropriate manner. Evidence: We asked a resident if they knew how to make a complaint if they are unhappy about any aspects of the service they receive, they replied yes I talk to both the management (referring to the matron and the registered manager). They also told us during residents meetings they are asked if they have any complaints. When we asked if anyone had raised any, they told us people would like to go out a bit more - but always need more carers (see Daily Life and Social Activities section of this report). Residents we surveyed told us that staff listen and acted on what they say. They also told us they knew who to speak to if they were not happy nurse, key worker, cleaner. All but one resident told us that they knew who to make a complaint to, and where the resident said they did not know who to complain to they informed us that their family do. One resident gave as an example of when they complained, and the action taken by staff to address their concerns. Information on how to make a complaint is given in the homes Statement of Purpose and Residents Handbook, although it was noted that it did not give our current Care Homes for Older People Page 22 of 36 Evidence: address and contact details. The AQAA tells us that the home has a clear and accessible complaints procedure, reviewed regularly and adhered to. Any complaints are fully investigated, recorded and responded to and acted upon appropriately. At the time of completing the AQAA (September 2009) they informed us that they had received seven complaints. We spent time looking at the type of complaints (covering care and communication issues) they had received, how the home had responded in dealing with them. We found that the home had responded appropriately, investigating concerns made, and writing back, or meeting with the complainant, to give feedback on their findings. Where a shortfall in staff practice had been identified, the home gave the person complaining information on what action they had taken, to ensure the situation did not happen again. The AQAA told us that they have updated residents questionnaires to include do you feel safe and do you know how to complain. Their survey analysis showed that all twenty five completing their survey had replied yes to both questions. The AQAA also informs us that Managers and Staff have knowledge and awareness through training of Mental Capacity Act 2005 including Deprivation of Liberty Safeguards which is important to safeguard the rights of the people their care for. Training records seen confirmed that safeguarding training is being undertaken at the home. Staff completing our surveys, all confirmed they know what action to take if a person raised concerns about the home. We asked two members of staff what action they would take if they witnessed or became aware of safeguarding issues, for example if a resident told them that a member of staff had shouted at them. Both staff demonstrated that they are aware of the correct actions they must take check resident is okay - then report to the manager. As part of the homes recruitment process the AQAA tells us that staff undertake a POVA (Protection of Vulnerable Adults) and enhanced CRB (Criminal Records Bureau) check, before commencement of employment. The sample of two recruitment records we checked, showed this is happening. This is to ensure that the prospective member of staff does not have a criminal record or have their name on a list, which prevents them from looking after vulnerable people. Care Homes for Older People Page 23 of 36 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 can expect a homely environment which is kept well maintained, and clean, providing a safe place for people to live in. Evidence: During the inspection we spent time with two members of the maintenance team, who are responsible for the day to day and long term up-keep of the home. This is to ensure it meets the environmental, and safety needs of the people living and working there. They told us once every two years a Health and Safety consultant visits the home, and completes a risk assessment/audit of the premises. The report we were shown, identified that they last visited in October 2008, and gave details of work/recommendations to be undertaken, which the home is addressing. Discussion with the Estates Manager identified that money is set aside each year for extra work to be undertaken, and for purchasing new equipment, which is identified as costing over a thousand pounds. We were informed that equipment purchased for residents wellbeing this year included seven air mattresses and four specialist chairs. We were also told (and observed) that on-going work has included replacing carpets and wardrobes in some rooms. Future planned work includes refurbishing the hairdressers and putting in a new fire panel, which will give the individual room number where the alarm has been set off, making it easier to find where the fire is. Care Homes for Older People Page 24 of 36 Evidence: The AQAA informs us that they have new matching curtains, duvet covers. A resident had fed back in the homes own surveys that it is lovely to see new summer curtains up. We asked a resident whose room had the new curtains if they liked them, they replied yes quite nice I would go for plain rather than pattern - but theyre nice. The Manager confirmed that although the home supplies soft furnishings, residents can also use/purchase their own. Bedrooms we visited had been personalised by the resident, and evidenced lots of their own memobillia and items to make them more personalised. One of the vacant rooms we visited, we noted was for double occupancy. We were informed that although it was a double room, it hasnt been shared for two years, when it was occupied by a married couple. The manager confirmed that currently it is used as a single room for people staying on respite care, but gives the flexibility if a double room is asked for. A resident told us that they had been asked along with another resident to go to the opening of the gardens at All Hallows Hospital which they felt were lovely. This had spurred them to hold a raffle, and use the proceeds to buy some plants to enhance the garden at the home as they feel it has got potential. Another resident, whose bedroom looked out at the gardens, also commented on the lack of colour and points of interest. We could not see any winter planting in the raised flower beds. When we fed back peoples comments to the manager, they said they are going to put some bulbs in, and also looking to move the summer house. They admitted that more work needs to be undertaken in the garden, but work had been on hold as they were looking at putting in planning permission for a conservatory. The maintenance person showed us the records they kept of weekly tests of the hot water outlets, to ensure the hot water is maintain within a safe comfortable temperature. We asked a resident if they found the temperature of their shower was okay, and they replied yes - if not I would soon say so. Whilst walking around the home, saying hello to people who were having a rest on their bed after lunch, we heard a resident calling out mother, mother. When we went into their room, we found the sun was shining directly on their face, and they were squinting. We asked if they would like us to pull the curtains across a little, and in doing so, took the sun off their face. We informed the staff what we had done, and they confirmed that the sun does get very bright, and they would monitor to ensure people are not disturbed by it. Residents we surveyed told us that the home is kept clean and fresh, comments Care Homes for Older People Page 25 of 36 Evidence: included the staff take great pains to keep it so. There are no bad or institutional smells which further reflected another residents comments spotless and smells nice. All the areas we visited as part of our inspection which included bedrooms, sluice and communal rooms were clean, tidy and free from any unpleasant smells. We also found evidence throughout the home that staff are being supplied with disposable gloves aprons and hand washing facilities to support them in following safe hand hygiene and infection control procedures. The home has systems in place to reduce/stop the risk of any potential infections being spread through the home, which could affect a residents health. This includes having a link nurse, who staff can go to for advice about infection control. We looked at the infection control audit undertaken by Norfolk Community Health Care infection control team in November 2008. Their comments included overall fair audit , saying the home should be commended on the progress that has been made over the recent past. They had identified some issues to address, which they said can be easily rectified. Attached to the report, was the homes action plan, which gave information on how the issues have been/are being addressed. The AQAA informs us that they have also had an Environmental Health Inspection in April this year, which they received a good report, and that any recommendations made had been implemented. We looked at the report which showed the recommendations made, which included replacing a badly scored chopping board, which has now been undertaken. Care Homes for Older People Page 26 of 36 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 can expect the home to recruit new staff safely, and ensure that they receive training, so they have the skills and knowledge to provide a good level of care. Evidence: When we asked a resident (who had told us that the nursing staff are very, very good), about the staffing levels at the home, they informed us that a lot of times people dont come in to work. They felt Saturday and Sunday can be a nightmare as care staff do not always turn up. Feedback given through our staff surveys and time spent talking with staff during the inspection, confirmed that residents physical care needs are being met, but at times they can feel rushed. They also felt when staffing levels are higher (as the numbers are linked to occupation, not dependency), they have more time to spend talking to residents. When they are short staffed, they feel they only have the time to speak to the residents whilst undertaking their tasks. When we asked staff surveyd if they felt there are enough staff on duty to meet the assessed needs of the residents, three replied usually (sickness is always an issuemanagement try very hard), and one member of staff replied never. The person replying never, had not given any further information to identify why they felt this way. Under what the service does well, a member of staff said we provide good, quality care, meeting individual needs. Care Homes for Older People Page 27 of 36 Evidence: Discussion with the management identified there has been a higher sickness rate at weekends, and as part of supporting staff and monitoring sickness they have introduced return to work interviews for all staff even if they have been off for one day. They have also been looking to see how they can make the staffing levels more flexible, by changing shift times and the number of staff on duty, so they have more staff on at peak times. This is still a work in progress and although some changes have been made to the staffing rota, further changes are being planned, following a meeting with staff. The people we surveyed, when we asked if they felt staff are available when they needed them, five replied always and six usually. Comments included whenever I have needed attention, they have come as quickly as possible - as there are over 50 patients here. and they come in to see me at very frequent intervals - I have a buzzer I can press but have not needed to use it. The home keeps a three monthly call bell audit, which we were given a copy. It gave information on audits undertaken during the period January to September 2009, showing calls per day and the average minutes taken to answer the call bell. Calls per day varied from 230 to the highest noted (15th of February 2009) which was 841. The overall quarterly average for July to September showed that they averaged 460 calls per day, with an average response time of 1.90 minutes. A relative told us that they found most staff very good, however they do get frustrated when, on occasions they will say I will go and sort that out for you - but dont give feedback. Another resident felt that some staff need to be taught how to make a bed properly, as not all staff pulled the bed away from the wall, to tuck the sheets in. Instead they leaned across the bed to tuck the sheets in, which resulted in the bedding being pulled out when they move back. An analysis (January 2009) of the questionnaires sent out by the home, shows out of the fifteen staff completing the questionnaire, when asked if they felt they receive adequate training to keep you up to date in doing your job, thirteen staff replied yes and two no. Comments included courses and/or training are available and types of training could be improved. The AQAA informs us that they have robust staff recruitment in place, to ensure all the required recruitment checks are undertaken. By ensuring they obtained Care Homes for Older People Page 28 of 36 Evidence: references, validate a person identity, and undertake checks to ensure there is nothing preventing them working with vulnerable people, will safeguard the interest of the people they care for. We looked at two recently employed staffs recruitment paperwork, and found all the required recruitment checks had been undertaken. This included the person undertaking an occupational health assessment to ensure that they are both physically, and mentally fit, to undertake their role. Staff had been issued with a job description, to ensure they are made aware of what their role involves. Staff surveyed told us that CRB checks and references had been carried out prior to them starting work. They confirmed that they had received an induction training which very well or mostly covered what they needed to know to get them started in their role. With one member of staff saying how they felt the way staff are being mentored now as new staff are kept with the same mentor for most shifts in the first few weeks, is much better. The AQAA also informs us during the next twelve months they will continue to invite a resident to be present at staff recruitment interviews. The AQAA (at the time of completing) told us that they employ forty-one permanent care workers, twenty-eight of whom have achieved and National Vocational Qualification (NVQ) at level 2 or above in Health and Social Care. This shows that they have over the minimum fifty percent of their staff qualified to this level, and the AQAA states they will be continuing to further increase the percentage of staff at NVQ level. A member of staff we spoke with, told us that they had just started on an NVQ 3 training course, which they are enjoying. Another member of staff said they just passed their NVQ 2. Staff surveyed told us that they are being given training which is relevant to their role, keeps them up to date with new ways of working, and supports them in understanding the individual needs of the people they are looking after. When we asked visiting health care professionals and social care managers if they felt the homes staff have the right skills and experience to support individuals social and health needs, four replied always, one usually and one sometimes. Comments included Nursing care has improved greatly over the last two years. care assistants offer me intelligent and considered observation and clearly know their clients. Nursing skill level appears good now. Two health professionals felt that as more and more individuals require support with their mental health needs that staffing skills in this area are lacking. They felt training for staff in areas such as memory loss, dementia, and hallucinations would help improve the service being provided to support people Care Homes for Older People Page 29 of 36 Evidence: with their mental health needs. The home currently has an application with ourselves to be registered to care for people whose primary care need is dementia. In preparation for this the management confirmed that they are focusing on providing staff with more training to support people with their mental health needs, which should address these comments. Care Homes for Older People Page 30 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect the home to be run by an experienced management team, who are committed to working in the best interests of the people they care for. Evidence: Since we last inspected the home, they have become registered under a new provider the All Hallows Healthcare Trust Limited, but this has not affected the running of the home. The AQAA informs us that there have been organisational changes in the management of the home, to support Mrs Janet Dunning by ensuring the home meets regulatory requirements in her absence. This is due to Mrs Dunning being registered manager for other services provided by the Trust, based a short distance away at All Hallows Hospital. The day-to-day management of the home, is now the responsibility of the previous Deputy Matron, who has been promoted to Matron. Time spent with the Matron, and discussions with residents and staff, confirmed that Mrs Dunning still retains constant contact with the home, by visiting regularly, and is being kept fully up to date with the Care Homes for Older People Page 31 of 36 Evidence: running of the home. Comments included although covering two sites - management side very close, down here 3 times a week, on call 24 hours a day, still very involved ,not sure of anything - Janet is always there. Time spent with Mrs Dunning, confirmed that she is keeping her regulatory knowledge updated, and is fully aware of her responsibilities of ensuring the home is meeting/exceeding the care homes for older people National Minimum Standards. Staff and residents we spoke with were aware of the new organisational structure of the home, and felt comfortable to raise any issues. Discussions with staff identified that they felt they have benefited from the other organisational changes introduced September with the introduction of having one Sister and one Charge Nurse on days and one on nights. A visiting health care professional told us that they have been visiting the home for many years, and have noticed vast improvements over the last two years, which they felt was certainly down to the leadership of the Matron and Deputy Matron. A resident we surveyed commented on the good feel of the home, which reflected our observations and feedback from people we visited during the day. People we spoke with described the staff as kind, friendly and approachable. A health care professional told us when I make suggestions, I think that they are taken on board in a positive way - staff seem pleased to be offered help which could potentially improve quality of life for individual. This reflected our observations, where any discussions about areas they could improve in, was taken positively, and straight away led to discussions about how they will be looking to address them. Information supplied by the home during our inspection shows that they have different systems in place to gain feedback from people living, working and associated with the home. We were given a copy of their 2009/10 Business plan, which sets out aims and objectives which covered all aspects of the running of the home. The business plan shows that one of the tasks to be undertaken questionnaires to be sent to residents, analysed and used as a tool for improving quality has been completed. We have used information obtained from these questionnaires, throughout the different sections of these report, as further evidence of work being undertaken. The manager confirmed that if they receive any poor comments back on the surveys, if the person has written their name on the survey, they will go back to the person - otherwise, they will address the issues raised as part of their on-going improvement plan. On a residents notice board in their bedroom, we saw an invitation to a forthcoming relatives and residents meeting to be held in November. Which reflected an earlier Care Homes for Older People Page 32 of 36 Evidence: conversation with a resident who told us that they had a residents meeting to go to second day next month. We asked what kind of topics are discussed, and they said they always ask if they have any complaints, and give people a chance to discuss what is going on at the home. The home has on display their insurance liability certificate, and the have a business plan in place which we were given a copy of, and shows that Financial targets - as set in the year 2009/10 budget will be achieved. The AQAA provides a list of all the policies and documents they have in place, to ensure the safety and well-being of the people living, working and visiting the home. This includes having guidance for staff, on moving people safely, what action they need to take if a resident goes missing, fire safety, and how to handle food safely. Information held in staffs training records also showed that they are receiving training to support them to have the skills and knowledge in these areas. The home has also provided us with information to show that they are monitoring any incidents that happen at the home, and recommended action taken to reduce the risk of it recurring. For example where a resident was found on floor in room, a sensor/touch mat was put insitu, to alert staff that the resident had got out of bed, so they could go and check to see if the resident required any assistance. Care Homes for Older People Page 33 of 36 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 34 of 36 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 Care Homes for Older People Page 35 of 36 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. 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