Care Home: Alphin House

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What the care home does well The home is improving it`s assessment of prospective residents` needs, thus ensuring the home is able to meet individuals` needs if they move in. People`s lives are enriched through opportunities to take part in various activities. Links are maintained with people`s families and friends, so that people benefit from supportive and familiar relationships. Control of their own lives is encouraged through promotion of choice where possible, and their privacy is respected, which also promotes people`s dignity and rights. Food offered at the home is nutritious and enjoyable, with individuals` preferences taken into consideration as well as their social and health needs. People benefit from homely, clean and generally well maintained, safe accommodation that is adapted for their needs. People who use the service are listened to if they raise concerns and complaints, with action taken to improve the quality of the service they receive. They receive a safe level of help and support, from a committed and very caring team of staff. What has improved since the last inspection? People`s medicines are generally now handled in line with relevant professional and `good practise` guidance. What the care home could do better: Ensuring each person admitted for intermediate care gets the care or support planned will mean people`s independence is regained in a timely way and they can return home in as good health as possible. Continuing to establish person-centred care planning (based on up to date assessments of each person`s diverse needs) will help to provide people with the consistent, individualised support that they need to meet their various health and social needs. Activities organised by the home ought then be more in line with individuals` preferences and interests. More should also be done to ensure people living at the home remain part of the wider community around the home. People can be assured that the home takes action to protect them from harm, although they would be better protected if staff had greater knowledge of safeguarding procedures. And they would benefit if staff received more training related to the needs of those they care for. Establishing stable management of the home would help to ensure people receive a quality service in the long term. Key inspection report Care homes for older people Name: Address: Alphin House Alphin House Mill Lane Alphington Exeter Devon EX2 8SG     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: Rachel Fleet     Date: 1 8 1 2 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: Alphin House Alphin House Mill Lane Alphington Exeter Devon EX2 8SG 01392251728 01392493461 kay.bainbridge@devon.gov.uk http/www.devon.gov.uk Devon County Council care home 35 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Alphin House is a purpose-built care home, owned by Devon County Council, the Local Authority. It is in a residential area of Alphington, approximately two miles from the centre of Exeter. A post office, shops and village hall are within walking distance, with regular buses from these into Exeter city centre. The home offers long-stay care for people over retirement age, admitted because of age-related needs or in some cases because of a physical disability. There are also a small number of beds for intermediate care and short stay respite care, which can be occupied by younger adults also. Intermediate care is provided in partnership with and through the Primary Care Trust, for assessment or relevant care prior to an individual returning home or moving on to a rehabilitation facility. The home cannot Care Homes for Older People Page 4 of 36 Over 65 35 8 0 8 Brief description of the care home accommodate anyone with nursing needs other than needs which the community nursing service can meet. The home has level access and level gardens, with a patio at the rear. Internally, there are three units: one on the ground floor and two on the first floor, each with its own lounge and dining room, bathroom and toilets. All bedrooms are for single occupancy only, and some have en suite facilities. People are encouraged to furnish and personalise their rooms. There is a large ground floor lounge/dining room, which is also used for activities. There are wide corridors, with a passenger lift between floors. The main kitchen caters for the home and an adjoining day centre. The day centre is run as a separate service, which is not regulated by us. Weekly fees at the time of this inspection were £108.10 - £599.34. This did not include the costs of private chiropody (£20), hairdressing, toiletries, continence aids (where not provided through the NHS). Our inspection reports are displayed around the home. 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: This key inspection took place as part of our usual inspection programme. The homes last key inspection was in January 2007. Annual service reviews carried out by us since - in 2008 and 2009 - indicated that standards had not fallen at the home. We carried out an unannounced visit to the home, as part of this key inspection, which lasted 12 hours over 2 week days. Charlotte Selwood, the acting manager, assisted us. On the first day of our visit, she was involved with one of the homes Christmas entertainments, which was well attended by people living at the home. So we returned on the following day to complete the inspection and discuss our findings with her. Prior to our visit, Charlotte Selwood had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service offered by Alphin House and how it was being run. This gave us general information about people living at the home and the staff, some assessment of what the home does well, and any areas for improving Care Homes for Older People Page 6 of 36 the service. Before our visit, we sent 10 surveys to the home for people who were living there with a survey for their relatives or other advocate, if they wished to pass it to them. We also sent 10 staff surveys, as well as sending surveys to various health and social care professionals who supported the people living at the home. Surveys were returned from 5 people living at the home, 3 of who were helped to complete them by relatives; 1 was helped by staff. Relatives returned 4 surveys, 4 were returned by health and social care professionals, and 1 by a staff member. While at the home, we spoke with at least 12 of the 31 people living there on that day. We looked into the care of 3 people in more detail, by checking their care records and related documentation, as well as talking with staff and observing some of the support these people received from staff. We spoke with 3 care staff and 2 ancillary staff. We looked at other records, including those relating to staff, health and safety, and quality assurance. Our tour of the building included the kitchen and laundry, as well as peoples bedrooms and shared areas. Information from these sources, and from communication with or about the service since its last review, is included in this report. 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: 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. Care Homes for Older People Page 8 of 36 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. Recent improvements in the homes assessment of prospective residents needs ensures the home is able to meet their needs if they move in. People admitted for intermediate care are helped to maximise their independence and return home, although the quality of such care is at risk because arrangements for providing such support to individuals are not robust. Evidence: People new to the home told us they were settling in. They confirmed that they or their family had had sufficient information about the homes facilities, routines, etc. before the person went to stay there. This was reflected in the surveys returned, with people also telling us that they had written information about the homes terms and conditions. The AQAA had identified that the home could improve on its gathering of assessment information before people are admitted to the home. We looked at the needs Care Homes for Older People Page 11 of 36 Evidence: assessment and other information obtained before one person was admitted to the home. This had come from a Social Services care manager, health staff at the persons previous care setting, and the homes own assessment. The information was brief, focusing mostly on the persons physical needs, so may not have given a clear indication if the home would be suitable for the person in the longer term. When we discussed this with the manager, she showed us newer documentation, used by the home to assess the needs of another person. This had prompts relating to the persons wishes, pre-admission risk assessments, dietary preferences, any religious needs, etc. It provided much more individualised information about how the person wanted to be supported by staff, and their longer term goals and wishes. Surveys from professionals showed they thought the homes assessment arrangements usually or always ensured that the right service was planned for people. We saw that someone admitted for intermediate care had signed their needs assessment and care plan each week, indicating their involvement in the assessment and planning of subsequent care. A list of their current medication had been obtained from their GP pre-admission. Regular contact had been made with their GP as their condition changed, after their admission, with evidence of regular input from a physiotherapist. During our visit, we saw a physiotherapist discussing and agreeing someones care plan with them. Charlotte Selwood also told us that the home now asks for more information and is more careful to inform professionals who refer people to the home about its facilities such as about the bedrooms (in which people may need to receive care or treatment), staffing, etc. - so that people are not admitted unless the home can meet their specific needs. Care assistants said they were usually informed about new residents and their care needs before their admission. Some felt they had not always received enough information. Most felt people were admitted appropriately, in the light of the service the home offers, and that staff were given enough initial information about them to support them safely on their arrival. Someone admitted for intermediate care said they were seen regularly by a physiotherapist, and said that they got a lot of attention from the care staff. Staff said they did not work with the physiotherapists or other professionals, but had written guidance on how to support individuals. A professional we surveyed told us Care Homes for Older People Page 12 of 36 Evidence: that since staffing levels had been reduced, staff did not always carry out instructions from health team staff about people admitted for intermediate care. It was said that this was because of time constraints and priorities having to be made for the welfare of the whole home. A relative felt staff could support one person better regarding guidance from the homes physiotherapist. Care records and our observations also showed there was regular support from community-based physiotherapists and occupational therapists. The manager told us they met weekly with senior staff from the home to discuss individuals specific care and support needs, informing about any appointments planned, and receiving feedback about peoples abilities from observations made by care staff, to ensure people progressed towards greater independence. They subsequently provided the written reports that care staff told us about. The home has much higher numbers of admissions and discharges than many residential homes, because they offer intermediate care. There were 86 admissions and 95 discharges in the previous year, at this 35-bedded home. In the past, staffing levels have been higher than is usual in residential care homes, in order to provide the extra support people need to return home as quickly as possible. The acting manager told us that the home would not currently accept anyone for intermediate care if they needed assistance from two people, as new staffing levels meant the home would not be able to meet their needs. Staff we spoke with noted lower dependency levels of people at the home, attributing this to the action taken regarding reduced staffing levels. 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. There is a risk that people will not receive consistent, individualised care or support that they need to meet their various health and social needs, although care planning is becoming more person-centred to achieve this and peoples medications are managed well. Peoples privacy is respected, promoting of their dignity and rights. Evidence: When asked in our surveys what the home does well, relatives wrote about the care provided. Professionals also responded with this, although one described care as adequate whilst another said it was of a high standard. Of 5 surveys for people living at the home, 3 said they always received the care and support they needed; 2 said this happened usually or sometimes. All 5 responded that the home always or usually made sure they got the medical care they needed. Everyone at the home had a written care plan. We noted some needed revising or updating, as where the care to be given had changed, the previous care was still indicated alongside the new care actions. For example, we were told that one person had become frail so was cared for in their bedroom, with monitoring of their food and Care Homes for Older People Page 14 of 36 Evidence: fluid intake being started recently. Yet their care plan still referred to them using the dining room, with a risk assessment (more than a year old) stating that they were eating well, which clearly wasnt the case now. Another persons plan said they should be prompted to visit the toilet, but staff told us the person was independent now. Surveys from relatives indicated that they thought the service usually or always gave the support or care expected or agreed, and usually or always met the needs of the person living at the home. Professionals surveys reflected this view, in that they thought peoples needs were usually monitored, reviewed and met by the service. However, a mental health professional indicated that the home only sometimes responded to individuals diverse needs, where other professionals thought they usually or always responded to such needs. The AQAA told us that the home was changing its care plans to get more information on peoples faith needs and social histories, so that peoples needs could be met better particularly regarding matters of equality and diversity. We saw in some peoples care records a checklist that, when completed, provided information about peoples personal preferences - their routines, spiritual needs, how often they liked a bath, etc. We saw that keyworkers had partially completed these. The activities provided at the home did not seem based on or tailored to interests, activities, etc. that people pursued before moving into the home. Some staff confirmed this, giving an example of someone who had been a farmer, who tended to get bored. Information obtained pre-admission stated that someone used to go to church and the British Legion Club, but this was not reflected in their care plan. New documentation was to be introduced, which the manager felt would help staff to keep records up to date, provide consistent information, and ensure care was planned so as to meet peoples needs in an individualised way. Staff we spoke with indicated that they had good, useful hand-overs at the start of their shift but had less time to read peoples care plans for information, or to record in them. Someones care plan stated an input/output chart was to be kept, and we saw a record of what they ate and drank, in their room. Staff we spoke with were aware of it, and one said they would go to look at it when they came on duty. However, there was no evidence that information on the record was evaluated and used, as it was not reflected in daily care notes, etc. The person was fed a pureed diet, whilst in bed, by staff. They told us the person had Care Homes for Older People Page 15 of 36 Evidence: swallowing difficulties. We noted the person was not in a very upright position, was fed with a dessert spoon (rather than a teaspoon) and had a straw for their drinks. Thus they could be put at risk of choking. We were told advice had not been sought from a Speech and Language therapist, there was no guidance in the care plan on how the person should be assisted, and staff told us they had not had relevant training. Staff had arranged for someone to move to a room more suitable for caring for someone in bed, when their needs changed. Care records showed that staff were vigilant regarding peoples health, and reacted promptly to get input from appropriate professionals, as well as following up any outstanding matters after the initial contact. We noted people had been visited by community nurses and chiropodists. However, there was no evidence that someone with diabetes had an annual check-up, although staff thought the person had. It had not been considered in the persons care plan. Another persons care plan said they should have a diabetic diet, but their name was not on the special diets list in the kitchen, and kitchen staff we spoke with were aware the person was diabetic but didnt think they needed a special diet. Their care plan indicated they were to have urine tests, but records suggested this had not been done for some time. We were told that the home did not have the test equipment, but it was not clear what further was being done about this, in order to ensure the persons health needs were met. A health professional felt peoples individual requirements should be monitored more closely, and that the home could liaise more closely with other services. Another also thought communication could be better, but added it had improved in recent months. The home proactively seeks to establish peoples wishes regarding resuscitation, including the matter as part of the service contract given on admission to the home. The professionals surveys indicated that the home usually supported people to selfmedicate, or managed it correctly when this was not possible. There were lockable facilities so that individuals could store their own medication safely, with one person being self-medicating at the time of our visit. We saw an undetailed risk assessment for this, which did not show what had been considered in deciding the risk of harm was low. For example, we noted that the person had impaired sight, which could affect someones ability to medicate safely in a new environment. The manager said she would look into this. Medication received into the home and disposed of was well recorded, with a record now kept of medication stocks held by people who selfmedicate. Care Homes for Older People Page 16 of 36 Evidence: One person had 3 medications prescribed for use when required, without guidance for staff as to how and when these medications should be used in this particular persons case. Staff told us the person no longer required these medications - but the medication sheet had not been updated to reflect this. No compliance aids were used, and there were secure facilities for storing and transporting medication, including controlled drugs and items requiring cool storage. We discussed that it is good practise to monitor minimum/maximum temperatures of the fridge, especially as insulin was being stored (which can be adversely affected if it freezes). No issues were noted with practical administration of medication during our visit except that the morning round took until 11am. Staff assured us that if anyone were due medication at breakfast and again at lunchtime, this would be given to them at suitable intervals. We discussed with senior staff that staff had used codes they were familiar with to indicate why someone had not had their medication, but these were different to the code key on the persons administration record, for some reason. We saw action was taken to ensure that the shelf life of prescribed topical preparations (such as skin creams) could be fully monitored. We were told that staff requested medication reviews regularly, by peoples GPs, and we found handwritten changes made by GPs on some administration records. Residents felt staff ensured their privacy when bathing, etc. Shared toilets and bathrooms had locks. Bedrooms had a lockable facility of some sort - a piece of furniture in some cases - and lockable doors, with evidence that people were offered a key for their door. There are sockets in each bedroom for the homes mobile payphone, should someone wish to make a phone call in private. Surveys from the community professionals said the service usually or always respected peoples privacy and dignity. Staff were heard to be discrete in care-related conversations with residents, when in communal areas. 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. Peoples lives are enriched through opportunities to take part in various activities, although more could be done to ensure these are tailored to peoples preferences and interests, and to ensure they remain part of a wider community. Links are maintained with peoples families and friends, so that people benefit from supportive and familiar relationships. Peoples control in their lives is encouraged through promotion of choice where possible. Food offered at the home is nutritious and enjoyable, with individuals preferences taken into consideration as well as their social and health needs. Evidence: One person we spoke with commented They told me to make it like my home. Another said You can please yourself, within the boundaries, giving then the example of getting up and going to bed when they wished. People told us the routines of the home suited them. We heard staff chatting and asking people what they wanted to do next, as they assisted them. Surveys from 4 people living at the home said that the home usually or always arranged activities that they could take part in; 1 said this happened sometimes. Most people we spoke with told us they had enough to do in their spare time. Care Homes for Older People Page 18 of 36 Evidence: Decembers activity programme was displayed around the home. It included a Christmas show at the home, Bingo, Tranquil Moments, a visiting choir, games, flower arranging, a film club, music and movement, a Christmas quiz and the finals of a skittles competition. We saw from minutes of a Residents meeting held in June 2009 that menus and activities had been discussed (both of which were said to be satisfactory), as well as the homes summer fete and an inter-home quiz competition. One person said they would like more quizzes; when we talked with staff, they identified that this person particularly liked quizzes and said they therefore made sure the person was aware of any taking place. Asked whether the music playing in a lounge was music that those present liked, people told us it was not their choice of music and that staff had put it on. When talking with staff about whether activities were linked to peoples individual interests, they identified certain people whose needs were not met by activities provided. Staff felt that the recent reduction in staffing levels meant staff were less available to take people out locally, to local shops, and on bus trips (- the home has transport available). A mental health professional felt people should have more one to one time with their key workers. People felt their visitors were made welcome. They could have a meal at the home for a small charge, and help themselves to hot drinks. The home had invited peoples families and other visitors to a Christmas carol service. Relatives surveys said that the home helped the person at the home to keep in touch with them, and that the relative was kept informed of important issues affecting the person living at the home. Surveys from 4 people living at the home said staff always or usually listened and acted on what they said; 1 said this happened sometimes. During our visit, staff appeared to listen to peoples comments or responses, and assist them accordingly. Relatives indicated they or the person living at the home got enough information about the care service to help them make decisions. And professionals surveyed felt the home, whenever possible, usually supported people to live the life they chose. Surveys from 3 people living at the home said they usually liked the meals at the home, with 2 saying sometimes. People we spoke with told us they liked the food, with one adding that this was even though they were a fussy eater. We saw a list of peoples birthdays, individuals dietary dislikes, allergies and special diets in the kitchen. Some people we spoke with told us that staff preferred people to have their breakfast Care Homes for Older People Page 19 of 36 Evidence: in the dining room rather than in their bedrooms. A Meals & Refreshments notice on display clearly indicated any meals could be taken in the lounge/dining rooms or bedrooms. It also stated that breakfast was at 9am, with supper (cheese and biscuits, sandwiches, hot drinks) offered at 7.30pm at the end of the day (- tea was at 4.45pm). The National Minimum Standards for such a care home recommends there be no more than 12 hours between the last food of the day and the first. The manager confirmed that people could request an earlier breakfast if they wished, or have a snack in the night. She agreed to clarify this on the information provided. When we carried out a review of the home a year ago, food had had the least positive responses of the topics on the survey we used. Staff we spoke with thought the food had improved in the last year, with more choice offered. The weekly menu was varied. They showed icecream and fruit were always available in addition to the daily lunchtime dessert on the menu. The Meals & Refreshments notices we saw showed that a range of cereals and tinned fruits were available for breakfast, with eggs which people could choose how they wanted prepared, and toast. It also said that fruit was available throughout the day, tea/coffee making facilities were available, and that people could ask if they wanted something other than that on the days menu. And people confirmed they did ask for alternatives. During our visit, the lunch menu displayed showed it was to be chicken pie or beef salad, with stewed fruit for dessert. A buffet was to be held at teatime, as there was a Christmas entertainment taking place. Festive menus had been drawn up for Christmas and New Year. Care Homes for Older People Page 20 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. Concerns and complaints raised by people who use the service are listened to, with action taken to improve the quality of the service they receive. People can be assured that the home takes action to protect them from harm, although they would be better protected if staff had greater knowledge of safeguarding procedures. Evidence: People living at the home that we spoke with said they felt able to speak to someone at the home if they had a concern or something was wrong about the care they received. Those surveyed confirmed there was someone they could speak to if they were not happy, although 3 said they did not know how to make a formal complaint. One person added that they could speak their mind at the residents meetings. People felt that action would be taken to address the problem or any complaint. Two of the relatives surveyed said they knew how to make a complaint about the care provided if necessary, two said they did not know how to. Two said the home always responded appropriately if concerns were raised (1 did not answer the question and 1 said it didnt apply). Of the surveys returned by community professionals, 3 said the home usually responded appropriately if concerns were raised, with one saying this happened sometimes. The homes complaints procedure was displayed in the entrance hall, and included phone and email contact details for internal and external managers, Social Services Care Homes for Older People Page 21 of 36 Evidence: (Care Direct) and ourselves. The manager agreed to get our contact details updated. The complaints procedure was also in a file of information in each bedroom. The manager said it could be provided in alternative formats if necessary - audio versions if someone was blind, for example. The Complaints and Compliments logs were seen. There were 2 complaints recorded since our last visit 3 years ago; action taken to address them was also recorded. In one case, it was clear that the complainant had been involved in the resolution of their concerns. In the last year, 10 compliments had been recorded from people at the home or their relatives - mostly regarding cleanliness, the staff, general care and the food. The Commission has received one complaint about the home in the last year, which was about standards of cleanliness and cleaning arrangements. We passed the information to the provider to investigate, and have received an initial response, although we have requested some further information to confirm that the matter was fully looked into. People told us that they felt safe at the home and with staff. Staff we spoke with knew they had a responsibility to report any abusive practise they were aware of, and who they would speak to within their organisation. But not all knew the outside agencies that could be contacted if necessary, and had difficulty finding relevant information, contact details, etc. The acting manager was able to find some of this information, and she knew Care Direct was a prime point of contact, however. The home had made two alerts about safeguarding concerns within the last year. These were dealt with under the local authoritys safeguarding procedures, and the home was found to have acted properly in each case. Someone who had personal spending money kept on their behalf by the home said they were satisfied with how their money was handled. The homes recruiting procedures protect people from unsuitable staff. Minutes of staff meetings showed the topic of restraint had been discussed in recent months. Care Homes for Older People Page 22 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 enjoy the benefits of homely, clean and generally well maintained accommodation that is adapted for their needs. Evidence: The home looked homely and generally well maintained, including the decor and soft furnishings. Christmas decorations were up in the various communal areas around the home. There was plenty of natural light because of the homes large windows. People we spoke with were satisfied with the lighting and heating in bedrooms and lounges, including in the evenings. Some areas were very warm. We noted radiators were covered but they did not have individual controls to allow for personal preferences or comfort. One dining room had a sink unit that looked tired, with some signs of wear and tear on walls in the area. A couple of bathrooms were being used for storage. The manager was not aware of any annual development plan for the home, that might show plans for maintaining the fabric and fittings of the home at a good standard. People who used walking frames said they got around without encountering difficulties (tripping hazards, uneven surfaces, etc.). They, and staff, told us repairs were attended to quickly, staff saying equipment breakdowns happened only occasionally. The AQAA showed routine maintenance (of the electrical systems, hoists, etc.) was up Care Homes for Older People Page 23 of 36 Evidence: to date. A log was kept of fire safety checks. We found this was up to date, with servicing by external contractors carried out in December 2009. We also noted that where checks had usually been carried out weekly, very occasionally there was no record that a check had been carried out, and this should be monitored. The building is wheelchair-accessible, including the shower facility. Baths are adapted for people with physical disabilities. We saw handrails, grab rails in toilet areas, raised toilet seats and perching stools, for promoting peoples independence and thus their privacy. Armchairs in lounges were of various heights. The home has pendant call bells, which some people were wearing, enabling them to get staff help when not able to reach wall-fixed call systems. Particular signs were seen to help some people identify which was their room, most rooms being identified by a number rather than displaying the persons name. Staff we spoke with generally felt they had enough equipment to do what was required of them - we were told the home had ordered some new towels, for example. One staff member suggested an extra hoist would be useful so that staff did not have to spend time moving 1 hoist between floors. There are separate facilities for staff, so they do not use any facilities intended for the residents of the home. We received one complaint (anonymous) in the last year, about deteriorating standards of cleanliness at the home. The provider investigated the anonymous concerns and indicated that the home was generally kept sufficiently clean. On this unannounced visit, we found the home looked clean, orderly and it was free of malodours, with domestic staff seen during the morning working around the home. People confirmed that they were satisfied with standards of cleanliness, including in shared bathrooms and toilets; one person added Toilets are cleaned as soon as staff know there is a problem there, when asked if there were any problems with cleanliness. Responses in returned surveys were that the home was usually or always fresh and clean, except for one person who said it sometimes was. The laundry area was orderly despite there only being one washing machine and one tumble drier for laundry from over 30 residents. Hand-washing facilities were available; flooring and walls can be easily kept clean. There was clear information on appropriate wash programmes for thoroughly cleaning items, including advice from the local infection control nurse specialist. Care staff confirmed they always had disposable gloves and aprons available to them, and specialist bags to use for transporting very soiled laundry. Care Homes for Older People Page 24 of 36 Evidence: However, we found that although staff wore disposable gloves when helping people with personal care, to minimise cross-infection, they did not wear disposable aprons. It is good practise to do wear them, and the manager agreed to seek further advice on this from relevant professionals. All staff were wearing cloth aprons when serving food, telling us these aprons were laundered daily, as is appropriate. Staff described appropriate hand-washing procedures, and we saw disinfecting hand gel around the home. The home has separate sluice rooms with machines for washing bedpans properly, etc. Care Homes for Older People Page 25 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 receive a safe level of help and support from a committed and very caring team of staff, and would benefit further if staff received more training related to the needs of those they care for. Evidence: Asked in surveys what the home does well, people who lived at the home referred to the care they were given, and to the staff - describing them as friendly, obliging and very caring. When we arrived, the Acting manager was on duty with an Assistant manager through the day, with 6 care assistants on duty in the morning, and 4 care assistants on duty in the afternoon. There are 2 staff on duty overnight, for 31 people. Day staff were supported by a part-time receptionist/clerk, domestics (who undertook cleaning and laundry duties) and kitchen staff. Staff told us that care staff levels had been reduced in the last year by 1 carer, at certain times of the day. People surveyed said staff were usually available when they need them, with one person also commenting that they had less time now due to reduced staffing levels, and one person saying they were sometimes available when they needed them. People we spoke with described staff as kind, and said they were generally available. They felt staff responded sufficiently quickly to call bells, coming as soon as they could Care Homes for Older People Page 26 of 36 Evidence: although they were sometimes busy so were delayed. Some were concerned at the possible impact of reductions in staffing levels that they had heard about, but had no specific concerns currently about their care. Staff we spoke with felt the change in staffing levels meant they couldnt take people out as they used to, and that they were stretched when working in certain areas of the home - as one person now had to cover a dining room as well as assisting people in their bedrooms at mealtimes, for example. During the inspection, people looked well cared for and content. Staff were occupied but did not appear rushed or unprofessional in any way. People we spoke with who needed help with mobility said staff never hurried them. The AQAA showed no use of agency care staff, and we were told that the home is no longer permitted to do so, by the provider. Staff cover is arranged between the local authoritys various care services. Three staff files were checked. They each included information required to find out if applicants were suitable to employ in the home, obtained before individuals actually began working there. This included relevant police checks and two positive references. The 2 care staff included in the sample had care qualifications or relevant experience. We noted that the home used an induction programme for care staff that met accredited standards. One staff member told us that they had shadowed colleagues when newly employed for about 2 weeks. They had still not been allowed to carry out certain care after that until they had had specific training (on manual handling). The manager explained that the provider has a computerised system for identifying when people were due training updates on safe working practise topics and certain training that the provider expected all staff to undertake. She was thus aware that 3 staff members were overdue an update, and told us that they were on a waiting list for the next planned training session. She said that the provider arranged additional training sessions if a number of people were on a waiting list. The AQAA showed three-quarters of the care staff have a nationally recognised care qualification - an improvement since our last visit. This ensures some initial skills and knowledge relevant to caring for those with conditions of old age. Relatives surveyed felt staff had the right skills and experience to look after people properly, and that the service responded to peoples different individual needs. We asked staff about needs relating to the conditions or disorders of the people we Care Homes for Older People Page 27 of 36 Evidence: case-tracked or met otherwise. Some staff were knowledgeable as to how the condition might affect the person, whilst others were less aware. Staff confirmed they had not had recent updates on impaired sight, or how diabetes might affect someone conditions that current residents had, for example, as noted during our last visit to the home. The survey from the staff member showed they thought they were not getting appropriate training. Where other professional surveyed thought the home usually or always responded to individuals diverse needs, a mental health professional indicated that the home only sometimes responded to individuals diverse needs. We noted from records and conversations that few staff had had recent updates of caring for people with mental health needs. This was reflected in the AQAA in relation to the needs of people living at the home and staff training. One person with poor sight felt staff didnt understand their condition and how it affected them - similar to our findings at our last visit. Care staff are also responsible for leading social events and activities for people at the home, a topic not included in the training programme. We had received a complaint in the last year, which included that staff were being asked to do domestic duties when they hadnt been trained for the role. We therefore looked at the staff file for one of the domestic staff, during our visit. We found that they had had training on various safe working practises (including safe manual handling and infection control). But we could not find a record of their induction, or evidence that they had had training on safe handling of substances such as cleaning chemicals or products, which may be hazardous to health.The acting manager said that she also had identified possible training needs in this respect. In responding to the complaint, the Responsible Individual told us that relevant information (product information, etc.) was available to staff. But this does not ensure staff understanding of any hazards, or of their role and responsibilities. The home has training videotapes, which the manager thought would be helpful for staff updates, but she also agreed to look into other training possibilities. Care Homes for Older People Page 28 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 living at the home are provided with a safe standard of service, but a lack of stable day-to-day management of the home is creating a risk to the quality of the service they receive, which is not in their best interests. Evidence: The registered manager present for our last key inspection has since moved to another of the providers services. People told us that they saw the current acting manager regularly, and that she made herself available if they wanted to speak to her. We recently learnt that she is also being moved, however. Staff have been told that the next manager to be appointed will be a permanent appointment - the home having had 3 unregistered managers in the last year. Care staff we spoke with confirmed there are always senior staff available for advice or to report matters to, and felt supported by senior staff at the home. Care staff confirmed they have had supervision sessions, when they could discuss any training they feel they need, etc., but that these were now relatively infrequent - as Care Homes for Older People Page 29 of 36 Evidence: reflected by records we read in the staff files.These showed meetings had taken place 6 months or longer ago. The AQAA had identified this as an area for improvement. Staff meetings were said to be both informative and occasions when staff could share their thoughts as well. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. We saw our last inspection report was available around the home. We read more recent monthly reports, made by external managers on behalf of the homes provider, that are required by us for the homes own quality assurance purposes. One of these identified a problem due to the lack of heating controls, which we had raised at previous inspections. The AQAA indicated the views of people living at the home had been used when assessing what the home does well and what it could do better. This is excellent practise, which helps to ensure that the home is developed in line with the wishes of people who live there. The manager told us that surveys are left in bedrooms used by short-stay or intermediate care residents, for them to complete if they wish. Matters raised on individual surveys were looked into, although the manager suggested that the response rate could be improved. There was lack of clarity about any overall analysis of these (to identify any general strengths or areas for improvement) or sharing of the outcome, and regarding the views of long-stay residents, although the AQAA indicated these matters were addressed. People living at the home told us that residents meetings were held; these were held 6 monthly, with minutes from the December meeting to be made available shortly. The manager confirmed staff did not act as appointee for anyone living at the home. The personal monies records of 3 people living at the home were checked. These were well kept, with two signatures recorded to verify each transaction recorded, and receipts available. Peoples cash balances are not kept individually, so could not be checked during our visit. The manager confirmed that all personal monies records are reconciled weekly with the cash total held, with forms seen relating to this process, to verify the right amount of money is still available. Minutes of staff meetings showed safe working topics had been discussed - such as manual handling and infection control matters - as well as training records showing Care Homes for Older People Page 30 of 36 Evidence: that staff had formal updates as well. Staff felt they had a safe working environment, and felt generally they had the equipment they needed to do their job safely and properly. They confirmed they had not participated in fire drills, as indicated by a lack of records, although their understanding of procedures had been checked through quizzes or walk-around sessions. We also discussed with the manager that there were no personal evacuation plans for people living at the home, which would inform the homes general fire risk assessment. The kitchen area was clean and orderly, with food portions in fridges covered and dated, temperature records kept, and in-house audits evidenced. Where we checked at random, upper floor windows were restricted. Care Homes for Older People Page 31 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 32 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 1 8 12 You must ensure that there 15/02/2010 are robust systems for ensuring people at the home have access to relevant specialist health services, especially regarding people with diabetes and swallowing difficulties To promote their health and welfare by ensuring their needs are met safely and appropriately. 2 30 18 You must ensure that people 31/03/2010 employed to work at the home, whether care staff or ancillary staff, receive training appropriate to the work they are to do So that peoples individual health, personal and social needs are met, appropriately and safely. 3 31 9 Under the Care Standards Act 2000 11 (1), you must submit an 31/03/2010 Care Homes for Older People Page 33 of 36 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 application for registration of a manager for the care home To ensure anyone who manages the home is fit for this role in the long term, and so they are not guilty of an offence under the Care Standards Act 2000 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 6 It is recommended that arrangements for intermediate care be better monitored to ensure staff are deployed in sufficient numbers, with sufficient skills and competence, to meet peoples assessed needs and provide agreed care or support. It is recommended that all care plans are sufficiently detailed to ensure that people will get consistent, individualised care or support that meets their diverse health and social needs needs. It is recommended that there are more opportunities for people to engage in leisure, social and cultural activities, as well as in local community activities, which are linked to their preferences (including hobbies, interests, etc. that they enjoyed before admission to the home). Staff should be fully aware of the local authoritys safeguarding procedures, including those for reporting concerns about abuse to appropriate agencies outside the home. It is recommended that action is taken to ensure that staffing numbers and skill mix are appropriate to the assessed needs of people living at the home, which includes their social needs and enabling people to engage 2 7 3 12 4 18 5 27 Care Homes for Older People Page 34 of 36 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 in local and community activities and visits. 6 33 It is recommended that the results of surveys are made available to prospective residents, people who use the service, their representatives and other interested parties, including the Commission. It is recommended that there is an annual development plan for the home, reflecting outcomes for people who use the service. It is recommended that you keep a record of the fire drills carried out at the home, and seek advice from the local fire authority regarding personal evacuation plans for people living at the home. 7 33 8 38 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. 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. 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