Care Home: Anna Victoria Nursing Home

What the care home does well Staff were very friendly and welcoming and were observed to be caring and respectful to residents. One resident said "I feel that the general helpfulness of staff calls for a special mention". Another resident told us "the home does everything I expect and sometimes better". A relative said "I can`t speak too highly of Anna Victoria, I thank God every day that we`re here". A member of staff told us "It`s a very welcoming and caring home, we`re always trying to meet the individual needs of residents". Another said "this is the best home I`ve worked in. It has a family feel". The majority of residents and relatives were very complimentary about the food . One of the nurses provided aromatherapy massage for residents on a weekly basis and this was very much appreciated by residents. A relative told us "the nurse who provides the reflexology is excellent". Residents and relatives were very complimentary about the "attractive gardens" attached to the home. What has improved since the last inspection? The accuracy of records made when medicines were given to people had improved and demonstrated that people received the medicines prescribed for them. The home carried out regular checks on medication records to ensure their accuracy. When people were not given their medication the reason why was now clearly recorded. Where people were prescribed medication on a `when required` basis and in variable doses e.g. one or two tablets, care plans now contained guidance on their use and requirements made about this had been met. What the care home could do better: Some relatives considered that standards of care were variable and could at times be improved. Care plans did not always cover residents` current care needs. Some care plans had not been updated since 2005. The manager was aware that direct supervision of care staff by senior staff needed to be increased and said that the deputy manager would be coordinating this and also carrying out some of the supervision themselves. We received feedback that the standard of palliative care was good. However, the managers did not always ensure that residents who could not communicate or who relied on staff for all aspects of care received the same level of attention and monitoring from staff. Relatives commented on the use of agency staff and the long hours that some staff were working. The manager confirmed that four new care staff had been recruited and would be starting in the near future. Where residents looked after their own medicines and stored these in their rooms, the risk to themselves and other people needed to be assessed in order to safeguard residents in the home. Relatives did not always consider that their concerns were addressed and told us that the management was sometimes defensive when issues were raised. The manager needed to foster a partnership with relatives, particularly relatives of highly dependent residents with limited communication, and involve them in regular discussions about the residents` changing care needs and the development of their care plans. Key inspection report Care homes for older people Name: Address: Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH     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: Francesca Halliday     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH 01255675609 01255673791 cnunn@annavictorianursinghome.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Anna Victoria Nursing Home care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 2 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) The total number of service users accommodated in the home must not exceed 28 persons Date of last inspection Brief description of the care home Anna Victoria provides nursing and personal care for up to 28 older people. The home provides palliative care for up to 3 residents with a terminal illness. Anna Victoria is owned by a charitable organisation, named Anna Victoria Nursing Home. The home is founded on Christian principles and there is a Christian ethos in the home. Care Homes for Older People Page 4 of 33 Over 65 2 28 0 0 2 2 0 5 2 0 0 9 Brief description of the care home The home is a two-storey building that was purpose built when first opened in 1992. There are 28 single en-suite bedrooms on two floors that are accessible by stairs and a lift. The home offers large communal areas. The rear of the home has an enclosed well-maintained garden and is accessible by ramps. The open plan sensory garden to the front of the premises provides a pleasant outlook from the home. The home has a visitors room and overnight accommodation can be arranged. There is a loop system installed at the home for the benefit of those with a hearing impairment. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the front of the home. The home is within walking distance of the main shops in Frinton-on-Sea. The fees were £792 per week and included toiletries, aromatherapy massage and reflexology. There were additional costs for chiropody, hairdressing and newspapers. This information was provided to CQC in October 2009 Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key inspection was carried out on 13th October 2009. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 26th January 2009, as well as evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. Our pharmacy inspector Derek Brown carried out two additional random inspections, on 22nd May and 10th August 2009 due to continued concerns about management of medicines in the home. A letter of serious concern was sent to the home on 13th August 2009 as requirements in relation to medicines had still not been met. Derek Brown also attended this inspection on 13th October and his findings have been incorporated into this report. During the inspection we had chats of various lengths with three residents and four Care Homes for Older People Page 6 of 33 members of staff including the manager. We spoke with four relatives during the inspection and two relatives contacted us via email following the inspection. We also spoke with two trustees who were visiting at the time of inspection. We sent out surveys prior to the inspection and we received twelve from residents, some of whom had assistance from relatives to complete the surveys, and three from staff. Comments from the surveys, emails and conversations have been included in the report where appropriate. The report was written using evidence provided by the manager and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. Care Homes for Older People Page 7 of 33 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 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs will be assessed before admission to the home. Evidence: The home had a range of information for prospective residents, their relatives and representatives. This included a statement of purpose and a service user guide. The majority of residents told us that they or their families had been given sufficient information to help them decide whether Anna Victoria was the right place for them. The manager or deputy carried out the pre-admission assessments. We looked at three assessments. All contained sufficient details of the nursing and care needs of the prospective residents to enable them to make a decision about the suitability of a placement at Anna Victoria. The manager told us that prospective residents were made aware of the Christian ethos of the home when the pre-admission assessment was carried out. The home only admitted residents as an emergency in exceptional circumstances. The manager said that in an emergency situation they would obtain as Care Homes for Older People Page 11 of 33 Evidence: much information from different sources, for example the persons GP, social services and health professionals to assess the suitability of the placement and carry out a full assessment on admission. Potential residents and their families were encouraged to visit and spend some time at the home before making a decision about accepting a placement. A trial period was offered. One resident told us they gave me a lot of support when I first came to the home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care of a variable standard and care documentation does not encourage consistency of care practices. Evidence: The majority of residents who responded to our survey told us that they always or usually received the care and support they needed. Two residents told us that they sometimes received the care and support they needed. One resident told us Over the years the service has declined its not as good as as it was. Three relatives considered that basic care was of a variable standard depending on which staff were on duty. One told us that a resident had not received a hair wash for several months which had resulting in them developing a scalp condition that caused them considerable distress. Staff who responded to our survey told us that they always or usually were given up to date information about the needs of residents. They also told us that the ways that they shared information about residents usually worked well. We observed staff interacting with residents in a friendly and caring manner. Residents told us that their privacy was generally respected. Residents rooms had signs on them reminding staff to knock before entering and a sign asking people not Care Homes for Older People Page 13 of 33 Evidence: to enter when residents were having personal care. Bathrooms also had signs identifying if they were vacant or engaged. However, we observed a member of staff walking into a residents room saying knock knock as they went in, without stopping or waiting for a response. We looked at the care documentation for three residents. There had been an improvement in the standard of the care plans that had been written since the last inspection. However, only about half of residents plans had been updated since the last inspection, despite this having been a requirement to be met by May 2009. The new care plans were more focused on the individual residents needs and demonstrated that the resident (and relatives where appropriate) had in some cases been involved in identifying their needs, abilities and preferences. However, a number of residents still had care plans that had been written some years ago. One resident had care plans written in 2005 that had not been updated since and did not reflect their current care needs. A relative said that they had received a letter stating that there would be a monthly review of residents care and care plans to which they could contribute but although they told us that the letter was sent two to three months ago they had heard nothing since. The care plans we looked at did not always cover all the residents needs as identified in the daily care records and in discussions with residents, relatives and staff. Two residents who had been identified at very high risk of developing pressure sores did not have a care plan for the prevention of pressure sores. One of these residents also had two records identifying that they had early signs of pressure sores and had previously had a pressure sore. Two residents who had suffered from some mental health problems had no care plan on how staff supported their psychological health. The lack of sufficient up to date and comprehensive care plans could result in a lack of consistency in care practices amongst staff. One resident confirmed this when they told us, Each carer has their own way of doing things. Mid morning we noticed that one resident, who depended on staff for all their care, had an extremely dry mouth, cracked and peeling lips, flaky skin on their face and did not have their glasses on. There was initially a defensive response from the manager when we brought this to their attention. Later in the day when we visited the resident again their condition was much improved and they had their glasses on. This resident did not have a care plan about their mouth care and skin care. The daily care records we sampled were of a variable standard. They generally needed to have more information on the residents physical and mental health, the care provided and how they had spent their day, in order to demonstrate that staff were monitoring their condition on a daily basis. A number of records were seen that had statements such as assistance given with personal hygiene without identifying what support and care Care Homes for Older People Page 14 of 33 Evidence: had been given. The home had a number of risk assessments to assess the risk of residents developing pressure sores or having a fall and the risks involved in moving and handling residents in different situations. However, a nutritional risk assessment had not been introduced despite this being discussed at the last inspection and the manager telling us that the MUST nutritional assessment was due to be implemented soon. The manager told us that they monitored what residents ate if they lost weight and obtained supplements if necessary. However, one relative told us that the forms for monitoring residents intake were frequently not filled in. The home had a range of equipment to enable them to meet residents nursing and care needs. These included a range of hoists, syringe drivers, electric beds and a range of pressure relieving equipment. The home used the services of GPs from two local practices. The manager said that the home had a good relationship with both practices and said that the GPs visited residents when needed. A GP from one of the practices visited the home once a week and a nurse practitioner from the other practice also visited once a week. Residents who responded to our survey told us that the home always or usually made sure that they received the medical care they needed. The home had good links with specialist nurses, with speech and language therapy and with dieticians from the local NHS. A chiropodist visited the home every six weeks and dental and optical checkups were arranged. The manager said that a local NHS dentist visited the home. We looked at the practices and procedures for the safe handling and use of medication. Most medicines were stored securely for the protection of residents but where people looked after their own medicines and stored these in their rooms, the risk to themselves and other people had not been assessed to safeguard people in the home. The temperature of the clinical room where medicines were stored was monitored and recorded but had been at the maximum of 25c on several occasions. It is important to continue this monitoring and if necessary take steps to ensure the temperature is maintained below 25c. The temperature of the fridge used to store medicines was also monitored and recorded regularly but had been recorded outside the maximum recommended range on several days without any action taken to investigate the performance of the fridge or the quality of medicines stored there. The failure to store medicines at the correct temperature could result in people receiving medicines which are ineffective. We expect the home to manage this rather than make a requirement on this occasion. We looked at the records made when medicines were received into the home, when Care Homes for Older People Page 15 of 33 Evidence: they were given to residents and when they were disposed of. We found these had improved since the last inspection and the records accounted for all medicines in use and demonstrated that residents received the medicines prescribed for them. The requirement made about this at the last inspection had been met. Where people were prescribed medication on a when required basis and in variable doses e.g. one or two tablets, care plans now contained guidance on their use and the requirement made about this had also been met. Nursing staff who were responsible for handling medication had received recent refresher training and had been assessed as competent to undertake this task. The home specialised in providing palliative nursing care but the manager told us that they would only admit up to three residents with palliative care needs at a time. Four of the nurses had completed the ENB care of the dying and their family course and one had a counseling certificate. The nurses and managers had received training in implementing the Liverpool Care Pathway for the dying patient and had good links with the local Macmillan nurses. One of the nurses was qualified to provide complementary therapies such as aromatherapy, reflexology and gentle massages, which were particularly helpful for relieving the symptoms of residents receiving palliative care. A relative told us the nurse who provides the reflexology is excellent. The manager told us that they had conversations with residents, and their relatives when appropriate, about their wishes for end of life care. We noted the details recorded in some residents files. The feedback we received about the standard of palliative care in the home was good. However, the managers needed to ensure that residents who did not have palliative care needs but could not communicate or who relied on staff for every aspect of their care received the same level of input or monitoring from staff. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a range of activities but independence is not consistently encouraged and promoted. Evidence: The home had two part time activity coordinators. They were responsible for booking entertainments, providing one to one contact with residents and arranging group activities for residents who wished to join in. Residents who responded to our survey told us that the home always or usually arranged activities that they could take part in if they wanted. A resident told us that they were encouraged by the increase in activities and would like to see that continued. Another described the activities coordinators as very enthusiastic. A resident told us For those who might like it there are activities suited to their age and interests eg music and gentle exercises or speakers coming in. There are also prayer meetings. The manager told us that they now had a Nintendo Wii, which a number of residents thoroughly enjoyed. She said that the home were looking to purchase additional programmes to suit residents interest and needs. The manager said that they aimed to have an outside entertainer two to three times each month if possible. The home was setting up links to the National Association for Care Homes for Older People Page 17 of 33 Evidence: Providers of Activities (NAPA). A relative was very appreciative of the fact that the resident they visited was regularly involved in activities even though they had limited communication. One resident showed us the activity programme and although they said that they generally did not want to join in activities they said that the activity coordinator spoke with them and said Im happy with that. One resident told us maybe staff could provide some exercise for residents like me that are in bed for most of the day. Residents told us that there were a range of activities including physical games, crafts, scrabble, lexicon but not trips out from the home arranged by staff. One resident told us I would like to go to the shops. The manager told us that they were hoping to source a national vocational qualification (NVQ) in activities for the activities staff and also hoping to organise activities at weekends. A library van visited the home on a monthly basis to leave a stock of books. They provided large print and talking books when required. A church service was held every Sunday, communion was held on the first Wednesday of every month and a prayer meeting was held on the second Tuesday of every month. The home had no restrictions on visiting as long as individual residents were happy with this. Meals for relatives were provided free of charge or with a voluntary donation. The home had a guest room for the use of relatives and friends when needed. The room enabled relatives and friends to remain, free of charge, in the final stages of residents illnesses if they wished. Relatives told us that they were made to feel very welcome when they visited and a resident said refreshments are always available and offered to my visitors. One relative said that they appreciated the way that staff cared for them as well as the resident they visited. The manager told us that they had links with local schools and encouraged them to visit the home. Residents told us that they were given the support they needed but encouraged to be as independent as possible. They said that they had the choice of when they got up and went to bed, where they ate their meals and where they spent their day. However, one relative told us that residents were not always encouraged and supported to regain their mobility, flexibility and dexterity following a stroke. They said that the resident they visited was not supported or encouraged to feed themselves even when some movement had returned to their arm. The dining room was an attractive place to eat. It was laid out like a restaurant with linen cloths on the tables. There were choices at every meal and alternatives if residents did not like what was on the menu. The majority of residents who responded to our survey told us that they always or usually liked the meals in the home and only one said that they sometimes liked the meals. One resident told us The food is good. They are very helpful in getting me a substitute if I cant eat whats on the menu. A relative told us that they were very happy with the standard of meals. They Care Homes for Older People Page 18 of 33 Evidence: said I eat here sometimes and the food is wonderful. Another relative said that the person they visited did not get offered a choice of food and frequently missed or had very delayed meals as they ate in their room. They felt that this was due to poor communication between staff. The kitchen looked clean and well organised and there was plenty of fresh fruit and vegetables in store. The kitchen staff had information on residents preferences and dietary needs. They told us that they regularly visited residents to check on their preferences for the menu and any changes to their diet and aimed to visit all new admissions to chat about their dietary needs within 24-48 hours. The manager confirmed that there had been no requirements made at the last environmental health inspection. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured that their concerns will be promptly addressed. Lack of safeguarding training potentially puts residents at risk. Evidence: A copy of the complaints procedure was held in each residents room. The manager was aware that the contact details of CQC in the procedure needed to be updated and said that this would be addressed following the inspection. The majority of residents who responded to our survey told us that they knew how to make a formal complaint and who to speak to if they were not happy about something in the home. The majority also told us that staff always or usually listened and acted on their concerns. Two residents we spoke with told us that they could not remember raising any concerns during the time they had been in the home. Staff told us that they knew what to do if someone had concerns about the home. We looked at the complaints register and saw evidence of appropriate investigation and response to complaints. However, two relatives did not consider that they always received an appropriate response or that appropriate action was taken when they raised concerns or complaints. The manager was defensive when we mentioned an aspect of poor care that we observed during the inspection (see section on health and personal care). The managers defensive response to complaints was identified in the last inspection report and three relatives considered that she could still be defensive when concerns or complaints were raised with her. The manager acknowledged that she could be defensive and said that she would try in future to regard the raising of concerns or Care Homes for Older People Page 20 of 33 Evidence: complaints as a positive part of quality assurance and an opportunity for the home to continually improve standards. The home had a policy on safeguarding residents from abuse and a whistle blowing policy for reporting poor practice or abuse. There was evidence that staff used the services of advocates to assist residents who had no relatives to act on their behalf. Information on the advocacy services was available in residents rooms and in the entrance hall. The manager told us that staff were given a copy of the Essex County safeguarding booklet. We looked at the training records but it was difficult to establish whether sixteen staff had received any safeguarding training. The manager told us that safeguarding training was booked later in the month and that she would be arranging additional training sessions. However this was raised at the last inspection and was not addressed. A member of staff we spoke with had a good understanding of the types of abuse that could occur and how to report any poor practices or abuse they observed. Two residents told us that they felt safe in the home and a relative confirmed that the resident they visited felt safe in the home because of the extremely good care. We have not received any safeguarding alerts about the home since the last inspection. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and well maintained home. Evidence: We inspected parts of the premises during the inspection. The home was clean and well maintained. All residents were accommodated in single rooms. Residents bedrooms were personalised and demonstrated their individual tastes and preferences. The home had four baths and two showers, which enabled residents to have a choice of bathing facilities. The two shower rooms did not have hand wash basins but the manager confirmed that basins had been installed following the inspection. The home had a large communal room that was divided into three seating areas. There was also a quiet room on the first floor so that residents had a choice of where to sit if they did not want to remain in their room. Residents had portable call bells, which the manager told us could be used in any part of the home and in the gardens. Residents told us they enjoyed using the gardens in the warmer months. A relative told us the gardens are marvelous, theyre so pleasant for residents. Another described the gardens as immaculate. Residents who responded to our survey told us that the home was always or usually kept fresh and clean. Two relatives told us that residents rooms were not always cleaned regularly or thoroughly but that standards had improved following a complaint they made. Staff followed appropriate procedures for handling soiled linen Care Homes for Older People Page 22 of 33 Evidence: and had access to a good range of personal protective equipment. The laundry room still had walls with peeling paints and cracks but the manager said that this would be redecorated soon. The door to the laundry room had a keypad installed to prevent unauthorised access. A relative described the laundry service as excellent. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The long hours worked and lack of training for some staff potentially impacts on the standards of care provided to residents. Evidence: The majority of residents who responded to our survey told us that staff were always or usually available when they needed them, only one resident told us that staff were sometimes available when they needed them. A resident told us that shortage of staff could sometimes cause problems and another told us More staff are needed to get through the work involved for each resident without undue pressure. Two staff who responded to our survey considered that the home usually had enough staff to meet residents needs and one member of staff considered that there was sometimes enough staff. One relative was concerned about the high absenteeism, staff turnover and the long hours staff were working and said that one evening three out of five care staff had been from an agency. The manager said that she monitored sickness very closely and said that the majority of staff had legitimate reasons for sickness such as injury and operations. The manager told us that she used agency staff to cover sickness on occasions but said that she tried to keep agency usage to a minimum and used the same staff wherever possible in order to provide continuity of care. We looked at the rotas for five weeks and noted that staffing levels were generally adequate for the Care Homes for Older People Page 24 of 33 Evidence: numbers and dependency of residents. However, one member of staff was working very long hours. They worked fifteen days without a day off and nine of the shifts were fifteen hours long. These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents in the home at risk or at a disadvantage. The manager said that she had recruited three more care staff who were due to start work in the near future and said that another carer was due to start work in January 2010 so that staff overtime and use of agency staff would reduce considerably. The home had links with Anglia Ruskin University and had established a programme whereby student nurses spent time at the home as part of their training to gain experience within the nursing home sector. We spoke to one student nurse who was on a placement and they told us that their mentor in the home was very supportive. Staff told us that the home carried out checks such as criminal records bureau (CRB) and references before they started work. They considered that their induction covered everything they needed to do their job. They also told us that they were given training that was relevant to their role, helped them understand the needs of residents and kept them up to date with new ways of working. We looked at files for three staff who had been recruited since the last inspection. The records generally showed a good recruitment process was being followed. Staff had a CRB and protection of vulnerable adults list check. References were taken up, a declaration of any previous convictions and a health declaration had been made by the applicant and identification was on file. A record of the interviews was also made. The manager said that they explored issues raised on the CRB, there was no record of this but the manager said that this would be done in future. One member of staff did not have adequate references and the manager said that they would obtain a further reference as soon as possible. Care staff were encouraged to complete the national vocational qualification (NVQ) at level 2 and a high proportion of care staff had completed NVQs or were currently undertaking them. The statement of purpose stated that all staff were required to attend mandatory training each year. The manager had a training programme and booked training on an annual basis. The records demonstrated that some staff had received very little training in the past three years and indicated that training needed to be given a higher priority in the home if staff were to remain up to date with current care and health and safety practices and provide residents with a good standard of care. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential risks to residents health, welfare and wellbeing are not always identified and addressed. Evidence: The manager and deputy were both registered nurses and both had completed NVQ level 4 in management. The manager had been in post since January 2001 and had completed the ENB qualification in care of the dying patient and family and the ENB teaching and assessing in clinical practice. The deputy manager had been in post since July 2004. Staff told us that they often had support from the manager and met with her to discuss how they were working. Two residents told us that they did not see the manager very often as shes always in the office. However, a relative told us the management is excellent, matron and her deputy are always available when I need them, they are supportive and friendly. The trustees carried out inspection visits in line with Regulation 26 every month. One of the trustees we spoke with told us that they were taking on the responsibilities for Care Homes for Older People Page 26 of 33 Evidence: quality assurance on behalf of the board of trustees. The manager said that the home carried out surveys twice a year but the ones carried out earlier in the year had not been analysed. This inspection identified that a number of issues raised at the last inspection had not been addressed. The care plans were not up to date and in many cases did not reflect residents needs, this may have been part of the reason that care was seen to be of a variable standard. Some staff had received very little training in the past three years. The concerns about care issues identified by three relatives demonstrated that care staff needed more regular direct supervision of their care practices by senior staff. The manager was aware that the systems for supervisions needed to be developed. She said that she hoped the deputy manager would be taking on more of the supervisory role, would carry out more 1:1 sessions and work alongside care staff on a regular basis. The manager needed to take a more positive and proactive response to concerns and complaints as part of good quality assurance and in order to improve standards in the home. A small amount of money was held for residents who did not wish to keep it in their bedroom. The majority of services such as hairdressing and chiropody were invoiced directly. The manager told us that the system for holding money was audited monthly. We looked at the monies held for two residents, double signatures were used for all transactions and we found the balances to be correct. There were systems in place for assessing health and safety and fire risk in the home. Equipment such as hoists, bath hoists and the lift were serviced six monthly to ensure that they were safe for residents to use. Water temperatures were checked on a regular basis to reduce the potential risk of scalding and the outlets not currently in use were flushed in order to reduce the risk of Legionella. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 The manager must ensure 01/05/2009 that care plans are drawn up in consultation with residents, relatives and care staff where appropriate. In order that residents priorities, preferences, abilities and wishes are reflected in the plans and they are written in a language that is accessible to residents, relatives and care staff. 2 30 18 The manager must ensure 04/05/2009 that a training review is carried out for each member of staff. In order to identify the training needed for staff to undertake their role and provide good support and care to residents. 3 33 24 The manager must ensure that the quality assurance audits are comprehensive. In order to identify and address risks to residents health, safety and welfare. 01/07/2009 Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The manager must ensure 23/11/2009 that highly dependent residents who cannot communicate or who rely on staff for all their care needs are allocated a member of staff to monitor and support them on each shift. In order that their personal and care needs can be met. 2 7 15 Care plans must be drawn up in consultation with residents, relatives and care staff where appropriate. In order that residents priorities, preferences, abilities and care needs are reflected in the plans and to encourage consistency of care practices. 01/02/2010 3 9 13 Where residents look after their own medicines and store these in their rooms, the risk to themselves and 01/12/2009 Care Homes for Older People Page 29 of 33 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 other people must be assessed. In order to safeguard residents in the home. 4 14 12 Staff must support and encourage residents to retain or regain their mobility, flexibility and dexterity as far as possible. In order to maximise their independence and improve their wellbeing. 5 15 16 Staff must ensure that all 23/11/2009 residents receive their meals in a timely manner. In order that their nutritional needs are met. 6 16 22 The manager must ensure that all concerns and complaints are addressed in a prompt and positive manner. In order to encourage residents and relatives to raise any concerns they have and to improve standards within the home. 7 18 13 Staff must receive regular training in safeguarding vulnerable adults. In order to protect residents in the home. 04/01/2010 23/11/2009 01/12/2009 Care Homes for Older People Page 30 of 33 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 8 27 18 There must be sufficient 04/01/2010 staff employed by the home. In order that residents wellbeing and safety is not compromised by staff working excessively long hours. 9 30 18 The manager must ensure that all staff receive regular training. In order that they can safely provide residents with the care and support they need. 05/04/2010 10 33 24 The manager must ensure that the systems for quality assurance are developed. In order to improve the standard of care and services for residents. 01/02/2010 11 36 18 The manager must ensure that care staff are directly supervised. In order to monitor care practices and improve standards of care. 07/12/2009 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 7 Staff should ensure that they record information on residents physical and mental health, the care provided Page 31 of 33 Care Homes for Older People 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 how they have spent their day. In order to demonstrate that they are monitoring residents condition on a daily basis. 2 10 Staff knocking on residents doors should ensure that they wait for a response before entering. In order to protect residents privacy and dignity. The manager should ensure that residents have the opportunity to have trips out of the home. In order to improve their wellbeing. 3 12 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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