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Care Home: Angela Court

  • Angela Court Tipton St John Sidmouth Devon EX10 0AG
  • Tel: 08702869456
  • Fax: 08702869457

The home was registered as a new service on 19 January 2009, under new ownership, having previously been a registered care home of the same name. The home now offers accommodation, personal care and nursing care for up to 37 people, whose primary care needs on admission to the home are due to old age or dementia. The Registered Provider is PSP Healthcare Ltd. Mr. Shrien Dewani, Responsible Individual, represents the company. The Dewani family have been involved in the home since the 1990s. Bedrooms are on the ground and upper floors, with a passenger lift and stairways between floors. Most bedrooms are suitable for people who may need the use of a hoist or other equipment. Two bedrooms are not suitable for people needing such care. There is an assisted bathing facility upstairs, and a ground floor level-access shower. Bathing and toilet facilities are to be improved, along with laundry facilities, once fire safety work has been completed. The lounge links 2 dining areas off the ground floor corridor, giving the opportunity of a circular walk here. The back of the home has pleasant views over the home`s gardens, with access from one lounge area to a secure, paved garden area with seating. At the front, there are sloping grassed lawns beside the home`s driveway, which is next to the church in Tipton St John, with parking areas at the front of the home. The home levies a single admission administration charge of £49.95. Weekly fees at the time of our inspection were £536-1050, depending on individuals` needs and the room to be occupied. An `Extra Services List` form can be provided by the home, showing products or services that the home can provide but which are not included in the weekly fees, with prices stated. Such extras include toiletries, transport and staff escorts, chiropody, physiotherapy, hairdressing, and newspapers. The home can provide our inspection reports on request.

  • Latitude: 50.71900177002
    Longitude: -3.2950000762939
  • Manager: Manager post vacant
  • Price p/w: £793
  • UK
  • Total Capacity: 37
  • Type: Care home with nursing
  • Provider: PSP Healthcare Ltd
  • Ownership: Private
  • Care Home ID: 19139
Residents Needs:
Old age, not falling within any other category, Dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Angela Court.

Key inspection report Care homes for older people Name: Address: Angela Court Angela Court Tipton St John Sidmouth Devon EX10 0AG     The quality rating for this care home is:   one star adequate 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 0 6 2 0 1 0 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 43 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 43 Information about the care home Name of care home: Address: Angela Court Angela Court Tipton St John Sidmouth Devon EX10 0AG 08702869456 08702869457 angelacourt@psphealthcare.com www.aalenhouse.com PSP Healthcare Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 37. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 37 places Dementia (Code DE) maximum of 37 places Date of last inspection Brief description of the care home The home was registered as a new service on 19 January 2009, under new ownership, having previously been a registered care home of the same name. The home now offers accommodation, personal care and nursing care for up to 37 people, whose Care Homes for Older People Page 4 of 43 Over 65 0 37 37 0 Brief description of the care home primary care needs on admission to the home are due to old age or dementia. The Registered Provider is PSP Healthcare Ltd. Mr. Shrien Dewani, Responsible Individual, represents the company. The Dewani family have been involved in the home since the 1990s. Bedrooms are on the ground and upper floors, with a passenger lift and stairways between floors. Most bedrooms are suitable for people who may need the use of a hoist or other equipment. Two bedrooms are not suitable for people needing such care. There is an assisted bathing facility upstairs, and a ground floor level-access shower. Bathing and toilet facilities are to be improved, along with laundry facilities, once fire safety work has been completed. The lounge links 2 dining areas off the ground floor corridor, giving the opportunity of a circular walk here. The back of the home has pleasant views over the homes gardens, with access from one lounge area to a secure, paved garden area with seating. At the front, there are sloping grassed lawns beside the homes driveway, which is next to the church in Tipton St John, with parking areas at the front of the home. The home levies a single admission administration charge of £49.95. Weekly fees at the time of our inspection were £536-1050, depending on individuals needs and the room to be occupied. An Extra Services List form can be provided by the home, showing products or services that the home can provide but which are not included in the weekly fees, with prices stated. Such extras include toiletries, transport and staff escorts, chiropody, physiotherapy, hairdressing, and newspapers. The home can provide our inspection reports on request. Care Homes for Older People Page 5 of 43 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: one star adequate 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 inspection was carried out as part of our usual inspection programme. It included an unannounced visit to the home, which took place over 10 hours on a week day. We discussed our findings with Emma Seal, the registered manager, the next day. We arrived at 10am on 17 June 2010. We were informed that of the 37 people living at the home, 14 had nursing needs. During the day, we met people working, visiting and living at the home. People living at the home talked with us about their chosen topics. Many people living at the home are not able to comment directly on the service itself, so we spent time in communal areas to observe the type of care they receive and their responses to the world around them. We also spent time observing the lunchtime and how staff interact with the people they care for. Care Homes for Older People Page 6 of 43 We carried out a Short Observational Framework for Inspection (SOFI). This helps us measure the well-being of people who are unable to comment directly on the care they receive. It also enables us to make judgements about how people occupy themselves during the day and the skills of the staff who support them. This usually lasts two hours but we finished this style of observation after one hour and twenty minutes because people were moving around, after finishing their lunch. Before our visit, the home completed an Annual Quality Assurance Assessment (AQAA), which provides the Care Quality Commission (CQC) with current information about the service, staff and people living at the home. Surveys were also sent to the home for some of the people living there. We received 3 back, and responses from the surveys are incorporated into this report. As part of the inspection, four people were followed up or case-tracked during our visit. This was to help us find out about how the home cares for and supports people with differing needs, and to find out how the home has addressed issues raised at our last inspection. To do this, we met with these people where possible, and we read the records linked to their care and their stay at the home - such as care plans and medication records. We looked around the home, considering the facilities and environment in relation to their needs. We looked at other records that also show us how the home is run, including staff recruitment and training records, the complaints log, and certain written policies. Care Homes for Older People Page 7 of 43 What the care home does well: What has improved since the last inspection? What they could do better: Asked in our surveys what the home could do better, one person commented they would like to see more residents involved in more activities. We found some evidence in support of this comment, although the activities co-ordinator is working hard to achieve this. Care planning and management of some peoples health needs must be more robust, to ensure that each person will get the holistic, individualised care they need. Such support must be provided in a way that promotes individuals privacy and dignity. Staff are respectful, but more should be done to recognise and promote peoples choices. While people are offered a varied diet, some would benefit from more individualised support to ensure they enjoy a wholesome diet and a pleasant occasion at mealtimes. Peoples concerns should be acted on in such a way as to assure people that they are listened to and that what they say is taken seriously. Care Homes for Older People Page 8 of 43 Improvements are needed to make the accommodation homely and well maintained throughout, as well as better adapted for all those for whom the service is intended. Staff should receive better training and supervision for the work they have to do, such as to ensure that peoples diverse care needs are met and met safely. 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 43 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 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally obtains sufficient information about people to identify their individual needs and the support they require, before offering them a place at the home. This helps to ensure the home will be suitable for them if they choose to live there. Evidence: We saw from care records that people are assessed by the manager before they come to live at Angela Court. Assessments identify each persons needs to help determine if those needs can be met by the service. They were dated prior to each persons move to the home. One assessment had little personal detail noted - the persons preferences, etc. However, a Social Services assessment had been obtained and a Pre-admission draft care plan we saw did have more information about this, such as the persons specific communication needs, and their clothing preferences. Care Homes for Older People Page 11 of 43 Evidence: We noted that the home had taken action to ensure that their assessments of an individuals needs, etc. were up to date when someone returned after a hospital stay, which is good practise. People who returned surveys to us told us that they received enough information to help them decide if the home was the right place for them, before they moved in. During our visit, someone came to look around the home, as we found other people had. We requested to see the homes Statement of Purpose and Service User Guide information that care services are required to give to prospective and actual service users. The manager later forwarded a copy of the homes brochure, which she said incorporated the required information, as she said she had just given the last copy to the person who had looked around. The AQAA told us this information could be provided in a variety of formats, such as audio versions, Braille, etc., on request. We spoke with a visitor, who told us that they had been given written information about the home, but that they and their relative had not been able to visit prior to their relatives move to the home due to the admission being an emergency. They had not seen a copy of the homes last report, and did not know where it was kept. A copy of our most recent report was not in the brochure we were sent, although it is part of the required information to be provided. We have since been told that people can request a copy of our inspection report from the home. And that a copy of the most recent version is also kept available in the homes entrance hallway. The home does not offer intermediate care. Care Homes for Older People Page 12 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning does not ensure that each person will get the holistic, individualised care they need. Although people receive safe support with their medications, some peoples health needs are not well managed, creating a risk to their wellbeing. People do not always receive support in a way that promotes their privacy and dignity. Evidence: Most people living at Angela Court have care needs associated with dementia. Some people also have physical or nursing needs, such as reduced mobility or diabetes. We looked at care plans for 4 people - some of who had nursing needs - to see how staff are guided to support individuals, and to see how peoples individual needs are portrayed. We saw that these care plans had sections for people to provide more personal information which could help create a more person centred approach by staff. A visitor told us that when their relative had moved in over a year ago, they were asked about their individual needs, such as like and dislikes. We saw the paperwork where this discussion was recorded. However, since this time they had not been asked to be Care Homes for Older People Page 13 of 43 Evidence: involved in reviews of the care provided. For another person we case-tracked, this form was blank despite the person living at the home for six months. We looked to see how one persons diabetes was managed by staff. The care plan for the persons diabetes management was basic, and did not contain key information such as the expected blood glucose level for the person and what to do if their blood glucose levels were unstable. We asked a staff member involved in this persons care about the expected blood glucose levels, and they thought this would be written in the persons care plan. We found information obtained by the home from the persons previous carers included the expected level, that it was stable, and measured daily. The homes records were showing that the persons blood glucose levels were now very variable, much higher, and only measured weekly. We looked, with the staff member, but could not find any further information about why the measurement is only taken weekly, or what action was taken when records showed that the persons diabetes were unstable, for example. We saw a tool that showed a basic monthly review of the persons needs, but there was no record of action being taken to stabilise the persons diabetes. A care plan also recorded that because of their diabetes they needed access to regular chiropody. This statement is open to interpretation. Records showed either that in 6 months they had access to a chiropodist only once, or that staff hadnt completed the records. We saw that the person was assessed as having a high risk of pressure damage and that a soft form mattress was needed, which we saw was provided. A staff member told us that a pressure relieving cushion was not needed as they were moved regularly, which we saw during our visit, and because they were able to walk at times, although this was not the case on the day we visited. During a period of observation (the SOFI described in the summary at the beginning of this report), this person did not show signs of being in a positive state of mind, showing only passive or negative states of being. We talked to staff about someone who did not have nursing needs, asking them to tell us what we would need to know if we were to care for them. They told us that the person sometimes became involved in altercations with other people living at the home, and told us that the person should not be left in a crowd. They also said they could regularly be tearful and low in mood. We looked at the daily records and saw written examples of both of these behaviours, with staff commenting Very aggressive and Tried to hit us. We looked in the persons care plan to see what guidance staff had been given to manage these care needs. There was no specific guidance apart from a risk assessment for falls, which stated Needs to be observed to not to be involved in a group of a large number of residents as [they] may get irritated and will Care Homes for Older People Page 14 of 43 Evidence: end up in a fight. We saw from their care records that they had been involved in altercations with other people living at the home. Their relative told us that recently they had a swollen lip and a cut arm, which suggests greater monitoring was needed. Staff need more comprehensive guidance to ensure they respond in a consistent approach, which can be reviewed and help keep people safe. Recent professional visitors to people at the home included Community Psychiatric Nurses, a chiropodist, and community nurses. When we first arrived, we asked about the range of needs that people at the home currently had. We were told that there were 2 people with more complex nursing needs, but that no-one had pressure ulcers at the time of our visit. The AQAA stated someone had developed one in the last year, which the manager confirmed had now healed. The persons records also confirmed this, with the involvement of community nurses clearly shown. We saw that weight charts are kept and updated on a monthly basis. These showed that one of the people we case-tracked had lost weight. There was very little in their pre-admission assessment and subsequent care records about their dietary likes and dislikes to help staff encourage them to eat. Their care plan said they were to have snacks between meals, to try to help prevent further weight-loss. We asked staff if the person had had snacks during our visit and they said they had, with the snacks being tea and biscuits at 11am and 3pm. We noted that this was the same as everyone else was offered. A health professional we spoke with confirmed that snacks in such cases (i.e. where weight loss was a concern) should be something much more substantial such as a sandwich, yoghurt, or a supplement drink. We asked the manager about the meaning of snacks when written in care plans. She responded that this would be biscuits, fruit, cream added during cooking, or whatever the person wanted. She explained that snack boxes we saw in the kitchen would be peoples personal preferences. There wasnt a kitchen snack box for this person, but the manager told us that their family left them sweet things in their bedroom. We noted their room was locked during the day. We asked staff about this persons communication needs. Some staff were aware they needed to make eye contact with the person to get their attention and should observe them for any response. This was in their care plan. Others said they didnt know how to meet their communication needs. Someone commented that they could have a cooked breakfast if they wished, as indicated in the brochure, but didnt think other less able people were offered such Care Homes for Older People Page 15 of 43 Evidence: choices as they were usually given cereal. We asked some staff how they enabled people to make meal choices when their communication was affected by dementia. They said they would ask people what they wanted. They confirmed they didnt offer a visual choice, when we asked if this was done. Senior staff said meals were being photographed so that people could be shown photographs of the options, to help them make meal choices. At lunchtime, we saw a staff member take a dessert spoon from someones drink of fruit squash and use it to mix up the persons pureed main meal. This had been specifically and attractively served in the kitchen as the separate elements of the meal, so that people can enjoy the various flavours and colours. It is good practise to use a teaspoon when assisting people with swallowing difficulties to eat. On being given a dessert-spoonful of food, the person said Too much, to which the carer responded No its not too much. The person was not encouraged by staff to feed themself or give themself the drinks we saw they were served. We saw them help themselves to a drink when staff werent there. Professional advice in their care records was that they should self-feed as much as possible. During our inspection, we saw that some staff were more skilled than others in assisting people to move. Some staff explained what they were about to do, while others gave no eye contact and no reassurance. We saw some people being moved in ways which were not safe or good practise. We met someone who had injured their arm, and they told us they were given medication for the pain. However, despite this arm being in a sling, we saw staff holding onto the persons arm as they helped them to move. The person did not call out but they looked unhappy. We saw one person being moved in a wheelchair with their foot trapped behind a footplate, which was then rectified by another staff member. We saw another person moved in a wheelchair without foot-plates, and who was then left sitting in it with their feet unsupported. Two other people in armchairs also had their feet unsupported when we first went to the lounge. This can be uncomfortable and is poor practise for other reasons. Staff fetched one of these people a footstool some 2 hours later. We noted that some people living at the home had bruising on their hands or arms, and cuts or dressings on their legs. We looked at peoples care plans and saw that there was little guidance for staff as to how people should be moved. For example, in one persons care plan their moving and handling risk assessment stated Physically well but noticed [they have] got lots of bruises on [their] arms and legs, also few dressings on arms and legs. This was not signed or dated, and had no action plan attached to it. Minutes from a staff meeting recorded that people must be moved in line with their plan, but for people we case-tracked the plans did not provide this level Care Homes for Older People Page 16 of 43 Evidence: of guidance. This included one person who staff said had variable mobility. Staff thought there was enough equipment for moving people currently, with 1 hoist upstairs and 1 downstairs. One person we case-tracked was not moved for over 4 hours. Although they were sat on a pressure relieving cushion, their health and comfort could be put at risk through sitting for such a long period. When we asked care staff about pressure area care, they told us that this took place when people were assisted up in the mornings, taken to sit in the lounge after their breakfast, and before tea or when they were assisted to bed in the evenings. They confirmed they werent usually attended to in between breakfast and tea. One of these people was at high risk of pressure damage, according to assessments in their care records and their care plan. Their care plan said they were to have their position changed at least 4 hourly, using a hoist, but care staff we spoke with were unaware of this. We therefore also asked when people were assisted with their toileting needs. We were told by 3 care staff that people were toileted after their breakfast and at teatime. We were separately told that this was a positive change to the care routine that had been made, when we asked about changes in the running of the home in recent months. However, this meant that people might wait 6 hours to be assisted to the toilet unless they could ask for such help. Throughout our visit, we saw staff encouraging people to drink. A mental health professional told us they were impressed by how the home had been pro-actively supporting someone at the home and felt they were managing their behaviours quite well. Staff had worked out a possible cause for some of the persons behaviour and removed the problem, with positive results. The professional told us strategies had been devised to help the person concentrate on eating their meals, although we noted these were not used during our visit. We looked at how people were supported to manage their dental care. One persons care plan said that they had dentures, while care records in their room stated they had their own teeth. Staff confirmed that they wore dentures but that their bottom set had been lost 3 months previously. We found that a dentist had assessed them as needing a new bottom set of teeth, and staff told us that this had been discussed with the family. However, the persons family told us they were still waiting for this issue to be resolved. We were told by staff that the person was now eating a soft diet because of the loss of the bottom dentures, although their risk assessment for mastication had not been changed to reflect their loss of dentures. During the inspection, we saw a jar of different dentures, and staff said they had unsuccessfully tried to identify the Care Homes for Older People Page 17 of 43 Evidence: owners. Minutes from a meeting recorded that a relative asked if there was a way of marking false teeth, but there was no record of this query being addressed. Someone we spoke with was concerned that staff did not carry out regular safety check rounds through the night, after someone had fallen in a corridor and a resident had to fetch the staff to them. They thought all staff based themselves on the ground floor at night. We asked the manager how she knew that staff carried out regular checks around the whole home at night. She told us it was the responsibility of the nurse in charge of the shift to ensure these were carried out. She expected that such rounds would be done hourly as a minimum, and stated that they were part of the written night routine given to every member of night staff. During our visit, we found one person alone and apparently distressed on the upper floor, and asked how this area was monitored during the day when most people were downstairs. The manager told us that the senior carer allocated to that floor has responsibility for carrying out checks during their shift. There was secure storage for medication, including for controlled drugs and items needed cool storage. Care staff told us that the nurses gave out all medication, even though only a minority of people had nursing needs. We saw a staff member giving out medication in a safe way. For example, we saw that they checked with each person to ensure that they had taken their medication before they moved onto the next person. Records of controlled drugs were well kept, with stocks held matching those shown in records. Medications received into the home were recorded, with signatures appropriately recorded. The medication fridge temperatures were recorded. We noted average readings sometimes said 23 degrees Celsius, whilst at other times they were at recommended levels. The manager said staff propped the room door open to cool the area, if the temperature was high. We suggested they consider other actions, as medications were being exposed to temperatures that could affect their efficacy. We look to see how peoples dignity and privacy is maintained by the practises of the staff and the ethos of the home. We did this during our visit by meeting with people, observing staff practise and visiting peoples bedrooms. We met some people who looked well cared for. For example, their hair was brushed, their clothes were clean and they were wearing matching accessories. Some people were encouraged to change their clothes if they were marked. One person told us they were looked after very well, and we saw that they received a lot of attention during the day. We saw some staff making sure that peoples hands were clean after meals or drinks. However, we met other people whose glasses needed cleaning, whose hair looked Care Homes for Older People Page 18 of 43 Evidence: unbrushed, they had stained clothes or food around their mouths. A visitor also noted that peoples appearance could be variable. Two peoples care plans stated that they should be supported with bathing or showering, while both needed support with managing their incontinence also. Their records showed that they had been assisted with a wash on a regular basis. But one person whose care plan indicated that they should be offered a wash, bath or a shower daily had only received 5 baths in 5 months according to their care records, while another person had 2 baths recorded in 5 months. This information was not captured in their monthly reviews, and there was no record that a bath/shower had been offered and refused. The manager said she was confident that this was a recording issue, and that people were having baths regularly. There were similar discrepancies with records of hairdressing. A visitor told us that they paid for fortnightly hairdressing for their relative, and the persons care plan indicated they took a pride in their appearance. However, their care records did not show that this service had been provided in the last 3 months. We saw staff assisting a person with their meal change over without explaining this. Another person was also served and assisted by several different people with drinks during the morning and with each course of their lunch. Their fluid intake chart did not always accurately reflect their fluid intake over that time. Staff stood as they assisted 2 people with their meal, and had little interaction with them. Later we saw one of these people struggling but managing to feed themself. There was nothing in their care plan to guide staff on how to provide support. Peoples dignity was not maintained by the staff practise. We read in minutes of a relatives meeting that there were still concerns that one person enters other peoples room. Peoples possessions had been interfered with, despite requests that doors be locked to prevent access. The home needs to balance keeping peoples belongings safe with allowing people access to their rooms freely which may mean better monitoring of peoples whereabouts. Generally, staff discreetly asked people if they needed to use the toilet to respect their privacy. We saw one staff member was particularly pro-active in this task in the afternoon. However, we saw a person using the toilet, through a door which was ajar while staff chatted outside, which did not maintain their dignity. One person smelt strongly of urine throughout the day. Staff told us that they kept charts to show when people had been taken to the toilet. We looked at these charts at 3pm and for some people it showed they had not been assisted to the toilet since Care Homes for Older People Page 19 of 43 Evidence: 7.30am, which is not safe practise for people with incontinence needs and poor mobility. This corresponded with our conversation with staff about people who needed assistance to move or with their toileting needs, when we were told that people were toileted around breakfast time and around teatime. This does not take into consideration peoples individual needs or promote their welfare. A staff member assured us that people had been assisted but that staff had not completed the chart. When we next checked the chart, it had been completed. The chart is a tick sheet but is not initialled by staff. When we arrived at the home, we noted some chairs were not clean and one reclining chair in use was particularly dirty. A visitor told us that they regularly found that the tables were sticky, and that their relatives room was not always thoroughly cleaned. Throughout the day, we saw carpets being cleaned and some tables being wiped in the communal areas. Staff also noticed if cushions were wet and took them away. Generally, the communal areas of the home were odour free, but when we checked 7 rooms in the evening, 3 smelt strongly of urine. We looked at bed linen on the beds and saw that 4 had sheets and duvets covers that were not clean, with one sheet smelling strongly of urine. This does not support peoples dignity. The manager said that senior carers have a specific role in monitoring standards on a daily basis. Care Homes for Older People Page 20 of 43 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to keep in touch with family and friends, as well as benefiting from the relationship the home has developed with the community around the home. Action is being taken to enabled individuals to participate in activities that are meaningful or fulfilling to them, improving the quality of their lives. Staff are respectful, but peoples choices are not always recognised or promoted. They enjoy a varied diet, although some people would benefit from more individualised support at mealtimes. Evidence: When we arrived, the majority of the people living at the home were in the communal areas, and these numbers increased as the day progressed. There was a lot of activity generally during our visit, with people moving freely around the home. We saw staff encouraging people to use a small, secure area of garden, which has been planted with sunflowers. Someone told us how people had enjoyed planting them and commented how they liked looking at them. The manager told us about a seaside themed day recently held in the garden, which they said had been successful. Although the manager said the rest of the garden was not really used by people living at the home, one person told us they enjoyed using it. And we saw the activities coordinator offer to escort someone out for a walk, when she noticed them looking out Care Homes for Older People Page 21 of 43 Evidence: of a window onto this garden. When we asked at the start of our day about any events planned for the day, we were told that there would be a musical entertainment in the afternoon. Throughout the day, we heard a range of music being played and the fortnightly music session was held in the afternoon, which a number of people responded very positively to, playing instruments, singing along and dancing with staff. Two staff arrived during the day with optic fibre lights, which they laid on the floor in a part of the lounge, and other equipment intended to provide pleasant sensory experiences. We did not see people engaging with this, however. The home has employed an activities co-ordinator who is also a nurse, since our last inspection, who works in the week, at week-ends and evenings. She works some shifts as a nurse, which she said she found useful for her other role. She told us that other care staff offer activities in her absence. We saw her and the care staff playing Connect Four with individuals, playing cards with someone, massaging peoples hands and sitting chatting to people. People responded well to this interaction. This engagement by care staff was a very positive development since our last inspection. The co-ordinator told us that the local library service very helpfully provides sensory items, games, and items or books of particular interest to individuals. There were home-made cakes in the kitchen which the cook told us people were going to be icing the next day, with the theme of the football world cup, when England were playing a match. The activities co-ordinator told us people had also helped make jam tarts for tea, as such cooking could be used to involve most people in some way. She explained how the seaside day had offered different levels of activity for people with differing needs - some people had made sandcastles, for example, whilst others had looked at shells or felt the sand being used. She tried to ensure that each person was involved in something recreational and engaging at least 3-4 times a week. She used peoples profile sheet - a record of their background, preferences, etc. - to plan the activities. Although we did not see them, she told us she kept a record of how successful one-to-one activities had been for individuals. We saw from peoples records that they had been supported to join in group activities, completing jigsaws, flower arranging and cooking. Photographs also supplemented these records, showing people enjoying themed activities, as well as flower arranging. Care Homes for Older People Page 22 of 43 Evidence: A photo album was available, showing in-house activities and people on outings. A fete was being planned for August, which would include people from the local community both in running it and in attending it. When we chatted with people, they were generally happy to engage with us, which showed they had the capacity to be engaged and stimulated. We noticed that some people had more interaction with staff than others, and looked relaxed and engaged with them. Other people received less attention, whether they were in the lounge or in the dining room. Some people sat and observed what was going on around them. Others were more withdrawn or slept for long periods. We saw in one persons care records that communication was recognised as being important or they may stop trying. However, during our observations of this persons care, we saw that care staff were generally task orientated - rather than interacting in a person centred way to provide individual support. The brochure stated that Clergy of most denominations visit the home on a regular basis. A staff member had accompanied someone to a funeral, to provide support and care. One person had a Relatives communication record in their care notes, which we saw had been used to record conversations with someones next-of-kin about the person and their care. Although one persons care records said they had no children, some staff referred to a visitor as this persons son, seemingly unaware of their situation. When drinks were given out during the morning, people were not always offered a choice, nor did the person serving them check they were happy with what they had been given. People were also given biscuits rather than being given the opportunity to choose what they wanted. At lunchtime, we heard staff offering people a choice of drink with their meal. Some staff took the time to show people jugs with different drinks to help them with their choice. One person asked for some cranberry juice, which had not been offered, and a staff member immediately went and got them some. We also heard staff checking with people how they liked their hot drink served. We saw one person making the decision not to eat the main meal, which staff respected, although they made sure that different people checked that this was still their decision. They also tried to tempt the person with alternatives. Most staff checked with people about where they would like to sit, although on 2 occasions staff assisted people to move but did not check where they would like to sit. We saw in peoples care plans that they should be encouraged to choose their own clothing and offered a choice of bath/shower or wash, although the records we looked Care Homes for Older People Page 23 of 43 Evidence: at did not show if this had happened. A clothing sale at the home, by a visiting company, was advertised. This can promote peoples opportunities to be involved in choosing clothes they need or want. We saw that one persons preferred times of going to bed were recorded, and before we left the home we saw that this particular person was still up, which reflected their bed time preference. Earlier, we saw one person looking very tired and asking to go to bed. A staff member checked with them to make sure they had understood correctly, as they acknowledged that it was earlier than usual. We met the person and a staff member upstairs, and the person looked very relieved to be going to bed. Care plans included assessments of peoples capacity to make decisions for themselves. Out of the 4 files that we looked at, 2 had a completed last wishes form or other indication of their care should they suddenly collapse. In the other 2, these forms were blank. One person who described themselves as a fussy eater said the food was terrific. We were told that the home has a seasonal menu, an example of which we saw on the homes communal notice board. We were also told that there was now a different approach to mealtimes to prevent people having to wait too long and then getting up and losing interest. One person commented Is this the new way? However, despite this change, we saw that a number of people still were sitting for half an hour in the dining room before their meal was served. One left the table during this time, and was returned by staff again. Some staff took time to tell people what the meal was, and during the meal we heard people talking among themselves about the food making comments such as I liked that, Very nice and Very enjoyable. Several people indicated that they could eat more, such as Tried to eat the plate, very nice pudding but apart from being offered more gravy, people were not offered seconds. The cook told us that there is always more available. We noted someone using a knife and their fingers to eat mashed potato and gravy; even though staff were present and set out dessert spoons on the table, the person was not offered different cutlery. Staff confirmed that people can have alternatives to the main meal options. One person did not have either of the puddings on offer, but had to then wait for their drink and was not offered an alternative such as fruit. Someone we spoke with Care Homes for Older People Page 24 of 43 Evidence: observed that one person had difficulty using cutlery yet was not offered suitable puddings - such as fruit pieces, rather than the semolina served to them. According to the minutes of a relatives meeting, one person had asked if fruit was available, and was told that people just have to ask. However, for people with dementia it would be more appropriate to offer fruit, as given the nature of needs associated with dementia they are less likely to ask. Fruit could also be used to supplement the biscuits that are offered with drinks. There was some information about peoples dietary needs and preferences in the kitchen. We were told that whole milk and cream is used to supplement everyones diet, when we asked if the cooks were made aware of people who were losing weight. The manager said she would follow this up, as some people did not need the extra calories. Care Homes for Older People Page 25 of 43 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. Action has been taken to protect people living at the home from harm or abuse. However, peoples concerns are not always acted on in such a way as to assure people that they are listened to. Evidence: While some people living at the home were unable to comment directly on the homes complaint system, one person indicated that they were not happy with the way that their complaints were dealt with. When we asked staff if they were given any feedback after complaints had been made, one said they had been told about missing items and went to look for them. We noted a concern about the homes billing system raised in three places - in one quality survey, in the minutes from a relatives meeting, and in a discussion with a visitor. We found that the homes Complaints log was blank. The AQAA also indicated that the home had not had any complaints since our last inspection. People who returned surveys to us said that there was someone they could speak with if they were not happy, and they knew how to make a formal complaint. A visitor we spoke with was unsure about the homes complaint system but knew who to go to. A relative commented, in one of the homes quality assurance surveys, that they did not know how to make a complaint. The AQAA stated that people had been sent the complaints procedure if they indicated in the homes quality survey that they were not aware of the homes complaints procedure. Care Homes for Older People Page 26 of 43 Evidence: An up to date complaints procedure was available in the entrance hall, with contact details for relevant individuals or organisations outside the home who could be contacted if necessary. We were told that there were only 2 people living at the home who had no relatives or friends outside the home supporting them, with both being supported by the Court of Protection for their personal affairs. One of the company directors for Angela Court was appointee for one of these people, an arrangement that has been in place for several years. In the future, they should not be an appointee for anyone moving to the home as there are systems run by county councils for taking on this role. The homes self-assessment in their AQAA on Complaints and Protection had relatively little information about how the home safeguards people. However, the manager was clear about external agencies to who safeguarding alerts should be made. The written policy had been updated since our last inspection to reflect this clearly for other staff. Most staff we spoke with knew where to get relevant information, such as contact details for the external agencies; one could not name external agencies, although they knew they existed. A visiting professional told us the home had appropriately made a safeguarding alert, which was dealt with under the local multi-agency safeguarding procedures. Another, who was otherwise very positive about the home, made an observation about security at the home. On their first visit to the home (made in recent months), they had been let in by someone who was coming out of the home. They walked around the home unchallenged by staff, who saw them but who continued with their work assisting individuals. Care Homes for Older People Page 27 of 43 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and spacious place to live. However, improvements are needed to make the accommodation homely and well maintained throughout, as well as better adapted for all those for whom the service is intended. Evidence: The Responsible Individual told us that the home would be re-decorated after new electrical wiring had been fitted for the fire safety system throughout the home. They are aware that some bathrooms and toilets still look very institutional, something that they said will be addressed when fire safety alterations are completed. Someone commented that when the lounge furniture was re-arranged into less institutional, more homely groupings (rather than as chairs around the walls of the room), some domestic staff moved it back when they did the cleaning. The AQAA described adaptations for people with physical disabilities, but said little about how the home ensures that the environment is suitable for and helpful to people who have dementia. This matter was raised with the service when it was registered in 2009. During this visit, we were told that signage is to be obtained from a specialist company. We saw some pictures placed around the home to help people identify toilets more easily or identify some peoples bedrooms. New fire doors have been fitted on bedrooms to comply with requirements made by the local fire service, and the manager explained these are being painted in different colours to help people Care Homes for Older People Page 28 of 43 Evidence: distinguish their own room from others in the area. She indicated that memory boxes may be put up for individuals, to also help people find their own room. The room of one person we case-tracked, who had lived at the home for some months, was relatively bare, colourless, and with little reflecting their individuality in a positive way. Linen and linen skips had been left in the room, with boxes of catheter bags left out on view. The manager indicated the person had little personal property. We asked if the home took responsibility for making bedrooms homely, personalised and recognisable as someones room, and the manager agreed to address this. Other rooms we visited had more personal objects, including photos, pictures or furniture belonging to the individual. People were encouraged to use the garden during our visits, with sun cream applied, and shade provided. Wider lounge patio doors had been bought since our last visit, with money raised at last years fete, so that people who used wider wheeled chairs could be taken outside. We learnt that someone had injured themselves whilst out in the garden. The manager assured us that the risk assessment for the area was up to date, and said that since the incident, staff were to be present in the area if people were using it. The manager told us that she audits the homes current cleaning plan, but that the home will be adopting new methods using the Health Protection Agencys guidance when it is available in September 2010. Since our last inspection, a system has begun of deep cleaning the home every 3 months. One person told us their room had not been included in the last deep clean, which senior staff said they would follow up. One person felt there werent enough cleaners employed, while another thought there was poor supervision of domestic and care staff with regard to maintain the cleanliness of the home. Some issues noted during our visit are included in the section Health and personal care in this report. The AQAA showed that all staff had had training in prevention and control of infection. The manager said she had participated in a deep clean carried out after a diarrhoea and vomiting outbreak at the home, which included moving furniture, having sought advice from appropriate healthcare professionals on managing the outbreak. A staff member said there were plentiful supplies of disposable gloves and aprons, but the gloves were not waterproof. The manager indicated she would follow this up. The laundry area was orderly, with a second washing machine having been purchased since our last inspection. Staff pointed out that new towels had been purchased recently, so there were plenty of clean ones available. Specialist bags were used for Care Homes for Older People Page 29 of 43 Evidence: transporting very soiled washing to the laundry. Laundry skips were also available, though as at our last visit, we were told that some staff do not use these always and put dirty laundry onto the floor, which can cause cross-infection risks, carpet odours, etc. Care Homes for Older People Page 30 of 43 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. The homes recruitment practises ensure that sufficient numbers of suitable people are employed to work in this care setting currently. Staff receive support and training for the work they have to do, although this is not always such as to ensure that peoples diverse care needs are met and met safely. Evidence: One person we met told us that the care staff were fantastic and very caring. We saw some staff changing their approach to suit the individual, sometimes laughing and joking with them, other times being reassuring. Relatives commented in quality assurance surveys that they were always welcomed with a smile and a cheerful greeting and staff were always very friendly and helpful. When we arrived, the registered manager was on duty with another nurse and 6 care assistants, looking after 37 people (14 of who had nursing needs). The care team were supported that day by 2 kitchen staff, a laundry person, 2 cleaners, a maintenance man, gardener and an Activities person. The home also employs an administrator, who was not at the home that day. Although one staff member felt there were not enough staff and that staff were stressed by this, staff appeared cheerful even though continually occupied in supporting people at the home. We noted a good staff presence in the lounge areas Care Homes for Older People Page 31 of 43 Evidence: during our visit, where care staff engaged with individuals - a positive development since our last visit. We looked at information in files for 3 staff that provided an audit trail of decisions made during their recruitment. All 3 files contained the correct level of information to help the home ensure that the person was appropriate to work with vulnerable people. For example, written references, identification, complete application forms, and police checks. The homes AQAA did not include information, in the self-assessment section, on how induction of new staff is managed. But elsewhere it confirmed that the home had a staff development programme that meets the National Minimum Standards for the service. These include induction training to nationally recognised standards. Newly employed staff who we spoke with confirmed they had shadowed colleagues as part of their induction, in a supernumerary capacity. They had undertaken a days course on mental health, which had included dementia. The company employs staff, who we were told were qualified for the role, for training staff on certain topics - such as safeguarding and manual handling. The manager confirmed all new staff had manual handling training - including 3 hours of practical work - early in their employment, before assisting people on their own. Most training, however, is provided through DVDs, with questionnaires to check understanding. Staff we spoke with told us there were monthly training topics, with the infection control DVD to be watched in June 2010. One said they would appreciate more face-to-face training as they found it easier to learn this way. The manager assured us that the DVDs are updated by the company that provides them, so that staff will be aware of any new legislation, current best practise guidance, etc. We were told that ancillary staff receive most of the same training as care staff, such as safeguarding and on challenging behaviour. The AQAA stated that 7 of 19 care assistants have a recognised care qualification, which is a relatively low proportion. It also stated that the home had enlisted the help of Age Concern and Help the Aged - now known as Age UK - to help staff achieve care qualifications (NVQ2 in Care). An Acting Senior Carer we met was going to undertake a care qualification (NVQ3 in Care), as was another new staff member. Both already had another care qualification. We observed that staff had varying practical skills when supporting people during our visit. Some interacted in an individualised way with people, while others were more Care Homes for Older People Page 32 of 43 Evidence: task-oriented or directing. We asked the manager about staff achieving recognised qualifications that are more related to caring for people who have dementia. She told us that staff were to undertake accredited long distance courses on dementia care, but funding had fallen through. The activities co-ordinator was booked to attend a days course relevant to her role in working with people who have dementia. Care Homes for Older People Page 33 of 43 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interests of the people living there, with work ongoing to promote the safety and welfare of everyone at the home. People would benefit if care staff received more supervision to help them develop their skills. Evidence: The registered manager told us that she has just re-started a course to obtain a qualification for managers of care services, as she had been unable to continue with a course she was to take previously. She hopes to complete it within 3 months, although we learnt during our visit that she is leaving the home in August. She had been on a recent training day run by the Health Protection Agency, relating to infection control, as well as attending updates on other safe working practises. We saw that the manager spent time in the communal areas, chatting to people. One person we spoke with was concerned that senior staff were not regularly at the home at week-ends and in the evenings, when they felt standards were not always maintained. Care Homes for Older People Page 34 of 43 Evidence: The manager confirmed that no-one was being held under Deprivation of Liberty Safeguards. 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. The home was registered as a new service early in 2009. We were told that they carry out an annual survey for people living at, working in, and visiting the home. Surveys are sent out from the companys head office and returned there, with the option of being anonymous. We looked through these returns, and were told that responses will be collated and the results fed back using a visual chart, once the staff surveys had been returned. We were told that the home responds to people on an individual basis, where appropriate and possible. We noted results on display dated from the previously registered service. We saw minutes from meetings for relatives, people living at the home and staff. A visitor told us these meetings are advertised on the homes notice board, where the minutes are also displayed. The manager told us that minutes were also e-mailed to families who live abroad. Staff said there had been recent staff meetings; some said these were opportunities for discussion, others didnt think they were. They confirmed, however, that they see the providers representative on their monthly visits who spoke with them. They also said they had formal supervision, and felt senior staff were available to them and helpful. We observed during our visit that some care and ancillary staff showed good skills or abilities for supporting people who have dementia, whilst others were less skilled. Following our last inspection, we recommended that staff were appropriately supervised, especially regarding their practise, to ensure that individual staff are supported to develop the practical skills and competency they need to meet the diverse or changing needs of the people who live there, and fulfil the aims of the home. Senior management staff had written to us when we asked them to, describing action that had been taken to address requirements made following our last inspection. During our visit, we found that action had been taken as described. We have also received copies of reports made by the service providers representatives, who make monthly unannounced visits to the home as required by regulations for quality assurance purposes. These show a variety of areas are looked at on these visits - the environment, care records, relatives meetings, etc. There was less in them evaluating the actual care and support provided by staff, their interactions with people, their Care Homes for Older People Page 35 of 43 Evidence: practise, etc., however. The manager confirmed she also saw these reports. The home does not hold personal spending monies for individuals. The homes brochure includes the following: Residents may require extra items that are not included in the main fee such as hairdressing, toiletries and newspapers. Whilst it is our preference that residents supply their own personal items, we understand that there may be some residents who will need us to supply these items for them. In order for us to be able to do this we ask for a payment of £100 on account. These funds are held in a special residents account. When expenditure is made from this money it is itemised on a statement. When the balance left to spend falls below £25 we will ask for another top up of £100. To request any extra services please ask the manager for an Extra Services Form. Mr Dewani, Responsible Individual, told us during our visit that these accounts are held at the service providers head office. And that top-ups are accepted 4 times a year only, so larger amounts may be required if individuals expenditure is more than £100 every 3 months. He said the itemised statement of expenditure is sent with requests for top-ups from the head office. Receipts for the expenditures are not routinely provided, but he confirmed these can be shown if required, with some being kept at the home. We noted that billing arrangements are still a concern for a small number of people (see Complaints & Protection section in this report). We saw an Extra Services List form that clearly set out products and services that the home can provide but which are not included in the weekly fees. Prices were also given, with space for adding any Special Instructions against each product or service selected. At our last inspection, we asked the manager to inform us by phone of any notifiable incidents in line with the Commissions guidance, following this up in writing when fuller information was available. We discussed with the manager that we had not been notified by phone, although we had received written notifications. Information in the data section of the homes AQAA showed servicing or maintenance of most of the main facilities was up to date. We noted the self-assessment section included nothing about promotion of safe working practises. We asked to see evidence of any safety checks carried out routinely to manage risks to peoples health and safety. As at our last inspection, we were told these were kept by the handyman, who was not available. However, the manager emailed copies of these records to us the next day, which showed checks were carried out in recent weeks relating to fire safety measures, bed-rails and window restrictors. We also asked for evidence that gas appliances had been serviced within the last 12 months, and were shown a certificate Care Homes for Older People Page 36 of 43 Evidence: dated August 2009. Work to improve the homes fire safety measures was ongoing. We were shown an Environmental Health Officers report dated 16/3/10, following their inspection of the homes catering facilities. The cook on duty told us the kitchen work surfaces had been replaced recently, which we saw was something recommended in the report. Leftovers in the fridge were covered and date. The area looked clean, and cleaning schedules had been signed regularly. New staff told us their recent manual handling training had included practical training such as use of handling belts and wheelchairs. They told us they had training on other safe working practises, as reflected on the training board displayed in the main office. They felt they had a safe working environment, and that any repairs were addressed in a timely way. The manager audited accidents occurring at the home, with computerised records of this shown to us. She told us she used them to identify certain problem areas for action, to prevent further accidents. However, we had difficulty in following up individuals accidents or injuries that we noted during our visit, as accident forms were not kept with other care records for individuals. We saw 3 people in the lounge with dressings on their shins. When we asked staff about these wounds, they werent sure how they had occurred. There were no accident forms readily available to clarify if they were due to externally caused injury, where we tried to determine this. And we could not find this information in other care records. Care Homes for Older People Page 37 of 43 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 38 of 43 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 7 15 Each persons care must be reviewed in a way that uses available information and evidence, with action taken to revise the care planned & ensure that peoples needs are met, if the evidence shows that the care being delivered is no longer appropriate. This is with particular reference to people who have diabetes or other conditions that require certain monitoring. 15/08/2010 This will help to ensure that peoples changing needs are identified and met in the most appropriate way for an individual. 2 7 15 You must ensure that each 15/08/2010 persons care plan is sufficiently comprehensive & detailed, providing clear Page 39 of 43 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action guidance on the care they require from staff to meet their various health & welfare needs In order that peoples different health and welfare needs are met in a personcentred, safe and consistent way. 3 8 12 People must have their health and welfare needs met. This includes taking actions to prevent deterioration or health problems due to diabetes, weight loss, pressure damage, mobility problems, mental health needs (such as those triggering aggression) and incontinence This will help to ensure that people remain healthy for as long as possible. 4 10 12 You must ensure the home 15/08/2010 is run in ways that respects peoples privacy and dignity, with regard to how they are supported as well as care of their property and environment So that peoples self-esteem and rights are promoted and protected. 15/08/2010 Care Homes for Older People Page 40 of 43 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 8 It is recommended that when staff assist or carry out interventions with individuals who are at risk of falling (such as assisting them to walk, move in a wheelchair, etc.), there are systems in place to ensure that such action is done appropriately and safely. This may include sufficient training, supervision or monitoring of individual staff practise. It is recommended that you further develop the home so as to maximise peoples capacity to exercise personal autonomy and choice, regarding drinks, meals and other aspects raised in this report, through staff development, improved signage, etc., as also discussed in this report. You should ensure that people are offered individualised assistance to eat and to have sufficient and suitable food, maintaining their independence while ensuring they have a balanced and adequate diet. It is recommended that you acknowledge peoples complaints and evidence how they are addressed, so that people feel they are listened to and as part of the homes quality assurance processes. It is recommended that the home is made homely throughout (especially including individuals rooms and shared toilets and bathroom/shower facilities) kept well maintained and free from offensive odours, with action taken in the short-term as well as the longer term to promote this. It is recommended that specialist facilities such as signage are provided in a timely way to assist people who dementia or other cognitive impairments to use their environment positively and maximise their independence, so the home is suitable for its stated purpose. It is recommended that at least half of the care staff (excluding the registered manager & staff who practise as registered nurses) have achieved NVQ Level 2 in care (or an equivalent). It is recommended that staff have training that ensures they can meet the changing needs of people living at the home and fulfil the aims of the home as set out in the Statement of Purpose, particularly regarding supporting 2 14 3 15 4 16 5 19 6 22 7 28 8 30 Care Homes for Older People Page 41 of 43 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 and caring for people who have dementia. 9 33 It is recommended that any self-assessment by the home provides sufficient detail to identify and assess how well the home is achieving in relation to regulated matters, including the core standards. It is recommended that more be done on a daily basis regarding direct staff supervision, to promote appropriate care practises and develop the skills of individual staff so that all staff can meet peoples diverse or changing needs and fulfil the aims of the home. It is recommended that individuals records - including those relating to personal care such as baths and hairdressing, as well as information on any accidents they have - are kept up to date and in good order ie readily available. This is so that it is clear what care or support they may require, as well as enabling staff to have necessary information to plan and evaluate the care or support individuals require and receive. 10 36 11 37 Care Homes for Older People Page 42 of 43 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 43 of 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

Other inspections for this house

Angela Court 17/06/10

Angela Court 16/07/09

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