Care Home: Ardenlea Court

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What the care home does well People who will be staying at the Home have their needs assessed before agreement is reached to move in. information is given to help people decide that Ardenlea Court is the right place for them. A relative said "I had information about the Home before we looked around". Care plans are in place for every identified need. Detailed information tells staff the action to take to meet people`s needs. External professionals provide care and support as needed and information is available to help staff care for those people with high nursing care needs. Visitors said "staff are very informative and tell me everything I need to know about my husband", "they call the GP, dentist, optician whenever they are needed". People commented on our survey "the level of care, concern and willingness of the carers is exceptional". People are treated with respect, moving and handling and use of the hoist was completed in a way that maintained dignity and put people at their ease. A relative commented on our survey "they look after mum in the dementia unit with patience, affection and a great deal of care and respect". Activities are provided on a daily basis and a high level of importance is placed on social interaction and stimulation to improve people`s quality of life. People said "there are activities going on all of the time, I like to dance", "the activities are excellent" A choice of meal is provided on a daily basis and discussions are held with people to find out their likes and dislikes. A visitor said "my husband eats his meals with relish", another visitor said "my husband loves the food", a person living at the Home said "the food is great and there is plenty of it". Systems are in place to ensure that any concerns received are acted upon and action taken to address issues identified is recorded. Staff attend training to give them knowledge of the appropriate action to take if abuse is suspected. Fixtures and fittings are in a good state of repair and the Home`s maintenance person ensures that everything remains in good working order. The Home is well decorated and clean and provides a welcoming, relaxing atmosphere. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Relatives said "the staff are lovely, they care for me as much as my husband", "staff are polite and friendly, some are exception but all are very good. Other comments received from relatives during our inspection or on surveys are as follows:"I can`t speak highly enough about Ardenlea Court" "staff are lovely to me, I have been pleasantly surprised, I didn`t expect the kindness I have been shown" "I feel I can discuss anything I am worried about and they will straight away try to sort it with me" "the manager is a people`s person and it shows in how her home is run" What has improved since the last inspection? Care plans are now available for each of the identified needs of people living at Ardenlea Court. These documents describe in detail the action staff have to take to meet all identified needs. This ensures that people get the care they need to promote their health and well-being. Care plans are in place for anyone who has an "at risk" outcome from their risk assessment. These care plans provide detailed information regarding the action that staff are to take to reduce any risks identified and details of equipment needed. Criminal Record Bureau checks are received before any staff start working at this Home. This is to ensure that people living in the home are protected from the risk of abuse. What the care home could do better: Further improvements are required to medication systems and practices, although some improvements have been noted. Audits of medication received, administered and available should be undertaken on a regular basis. All medication received should be kept in it`s original packaging. Staff supervision should take place at least six times per year. This gives staff the opportunity to discuss any issues that affect their work and training etc. It also gives the supervisor the opportunity to discuss working practices, issues and areas of good practice. The results of satisfaction surveys should be made available to staff, people that live in the Home and visitors. Details of action taken to address any issues raised should be made available in the form of an action plan. This demonstrates that the Home has recognised and responded to any shortcomings. Key inspection report Care homes for older people Name: Address: Ardenlea Court 39-41 Lode Lane Solihull West Midlands B91 2AF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 3 0 0 6 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 31 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 31 Information about the care home Name of care home: Address: Ardenlea Court 39-41 Lode Lane Solihull West Midlands B91 2AF 01217117773 01217112235 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.com BUPA Care Homes (BNH) Ltd care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 60, Old age, not falling within any other category (OP) 60, Physical disability (PD) 60 Date of last inspection Brief description of the care home Ardenlea Court is a purpose built Care Home that is owned and managed by BUPA Care Homes Ltd. The home provides personal care and nursing for up to fifty-five residents over the age of 65, who are frail elderly and/or physically disabled. Of the fifty five beds available eighteen of them are under contract with the Solihull Care Homes for Older People Page 4 of 31 Over 65 0 60 0 60 0 60 Brief description of the care home Primary Care Trust to provide Intermediate care to patients following transfer from hospital. These beds are used for patients of 50 years and older falling within the following categories: sickness, injury, infirmity, surgical or investigative care and are situated on the ground floor. In addition, eight beds are registerd to provide care for frail elderly people and twenty nine for those suffering from dementia. All bedrooms have en-suite facilities and there are assisted bathing facilities situated around the home. The home is situated within walking distance of the centre of Solihull. The M42 is about two miles away and the bus and rail services are easily accessible. The property is adjacent to private housing accommodation. There is a paved garden to the rear of the property providing a seating area and there is adequate car parking space at the front of the building. Access for wheelchair users is good. There are no steps to the front door. The home has a passenger lift situated in the main corridor, which provides access to all areas inside the building. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. Two inspectors undertook this visit which took place on Tuesday 30 June 2009 between 9.00am and 3.15pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the Care Homes for Older People Page 6 of 31 past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us within the timescale required. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Four people living at the Home, six relatives and three staff returned survey forms to us before this inspection visit; their comments are included throughout this report. Care Homes for Older People Page 7 of 31 What the care home does well: People who will be staying at the Home have their needs assessed before agreement is reached to move in. information is given to help people decide that Ardenlea Court is the right place for them. A relative said I had information about the Home before we looked around. Care plans are in place for every identified need. Detailed information tells staff the action to take to meet peoples needs. External professionals provide care and support as needed and information is available to help staff care for those people with high nursing care needs. Visitors said staff are very informative and tell me everything I need to know about my husband, they call the GP, dentist, optician whenever they are needed. People commented on our survey the level of care, concern and willingness of the carers is exceptional. People are treated with respect, moving and handling and use of the hoist was completed in a way that maintained dignity and put people at their ease. A relative commented on our survey they look after mum in the dementia unit with patience, affection and a great deal of care and respect. Activities are provided on a daily basis and a high level of importance is placed on social interaction and stimulation to improve peoples quality of life. People said there are activities going on all of the time, I like to dance, the activities are excellent A choice of meal is provided on a daily basis and discussions are held with people to find out their likes and dislikes. A visitor said my husband eats his meals with relish, another visitor said my husband loves the food, a person living at the Home said the food is great and there is plenty of it. Systems are in place to ensure that any concerns received are acted upon and action taken to address issues identified is recorded. Staff attend training to give them knowledge of the appropriate action to take if abuse is suspected. Fixtures and fittings are in a good state of repair and the Homes maintenance person ensures that everything remains in good working order. The Home is well decorated and clean and provides a welcoming, relaxing atmosphere. There are sufficient numbers of staff on duty to meet the needs of people living in the home. Relatives said the staff are lovely, they care for me as much as my husband, staff are polite and friendly, some are exception but all are very good. Other comments received from relatives during our inspection or on surveys are as follows:I cant speak highly enough about Ardenlea Court staff are lovely to me, I have been pleasantly surprised, I didnt expect the kindness I have been shown I feel I can discuss anything I am worried about and they will straight away try to sort Care Homes for Older People Page 8 of 31 it with me the manager is a peoples person and it shows in how her home is run 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. 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 31 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 31 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. Each person can be confident that the information they receive is correct and that their needs will be assessed before admission to ensure that their needs can be met in a way that suits them. Evidence: There is suitable information available for people considering using this service. A guide in large print was seen, this can be made available in other languages if requested. They do not have information in other formats such as DVD or audio. In the recpetion area there are leaflets about the service and BUPA and a News Letter that is produced every four months about the service, what activities have occurred and any changes. Three people were chosen to case track during this inspection. This involved looking at their care files and any related documentation, talking to staff about the care that Care Homes for Older People Page 11 of 31 Evidence: they provide and looking at living areas and the facilities available. One of the people case tracked had recently moved in to the Home. This persons care file was examined to assess the pre admission assessment processes. The manager or a senior nurse usually undertakes pre-admission assessments for long stay people. Staff from the Primary Care Trust (PCT) assess the rehabilitation needs of people admitted to the Home for intermediate care. People admitted for intermediate care are able to stay at the Home for up to six weeks and receive rehabilitation to enable them to move back to their own home or other suitable residence. A visit is conducted to the person who wishes to move into the Home and a care needs assessment is carried out. This is used to identify peoples needs and abilities and gives the Home information to enable them to decide whether they would be able to meet these needs. Social services and the PCT decide whether people are elligable for intermediate care at the Home. Standardised documentation is used to record information. The assessments seen were very detailed and recorded peoples needs and abilities, resources, such as equipment and the number of staff needed to provide care. Care plans are developed using the information obtained during the pre-admission process and the assessment conducted upon admission to the Home. Issues identified such as a high risk of developing a pressure area result in the Home developing a care plan and ensuring that the correct pressure relief equipment such as mattresses and cushions are available upon admission to the Home. Advice regarding specialist nursing needs was available in care files and information had been obtained during the pre-admission assessment. We sent surveys to the people who live at Ardenlea Court Nursing Home and four people responded, all of these people said that they received enough information to help them decide if the Home was the right place for them before they moved in. One relative also commented the manager of Ardenlea court was helpful, we had a tour of the Home, and I had all the information I needed to know Two visitors spoken to said that the Home were extremely helpful when their loved once moved in. They both confirmed that they had all of the information needed about the Home and said that the manager was extremely helpful and supportive and gave advice and information as needed. Care Homes for Older People Page 12 of 31 Evidence: From documentation seen, discussions with the manager and a visitor to the Home, it was noted that pre-admission processes are satisfactory. Detailed information is obtained about people before they come to live at Ardenlea Court. The intermediate care unit, that is used to assess and assist people to return home, is staffed by a nurse and care staff from the service. Specialist staff such as ocupational therapists and physiotherapists are supplied through the Primary Care Trust. Staff receive training and support in this area. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that their needs are met in the way that suits them and that their medication is given to them as prescribed. Evidence: The care files of three people identified for case tracking were examined. One of these people lived in the dementia care unit on the first floor, the second in the long stay elderly nursing unit and the third was staying for a period of intermediate care. Each person had an individual care file which contains standardised documentation detailing peoples needs and the action that staff are to take to meet these needs. Information is recorded in different sections in the file for ease of reading. Areas covered in the care file include activities of daily living such as communication, maintaining a safe environment, personal cleansing and dressing. Each area is broken down into further subsections and detailed information is recorded about each identified area of need. Risk assessments were in place regarding the risk of falls, nutrition and the risk of Care Homes for Older People Page 14 of 31 Evidence: developing a pressure area. Where a risk was identified, care plans were in place detailing the action that staff should take to reduce the risk. This included details of any equipment needed to provide care, procedures for their safe use and details of checks made on equipment to ensure that it is in good working order. Fluid intake and output records and food intake records were available for those identified at risk of malnutrition. Turn charts were available for those people who are nursed in bed and identified as being at risk of developing a pressure area. Other risk assessments regarding the use of wheelchairs, hoists and bedrails were available in care files as needed. The next of kin had also signed a constent form regarding the use of bedrails and detailed instructions were available for staff regarding the height that the rails are to be set and the use of bedrail bumpers to stop entrapment of limbs in the side of the rails. Moving and handling assessments were available in each file. These record detailed information regarding the level of mobility, assistance and equipment required to aid mobility. A moving and handling plan is developed which records the equipment to be used for each activity i.e. moving in bed - use slide sheet, assistance to get in and out of bed - hoist or maxi twist hoist with green sling etc. The care plans of one person with high dependency nursing needs were very detailed and covered all aspects of care. Information was also available from external healthcare professionals to enable staff to meet specialist needs identified. Records were available to demonstrate that people have access to external health care professional such as GP, dentist, optician and chiropodist whenever needed. Those relatives spoken to confirmed that they are informed whenever the GP is called to see their loved one and that in their opinion they have access to these professionals whenever needed. All four people who responded to our survey said that they always receive the care and support that they need and the Home always makes sure that they get the medical care that they need. Relatives who responded to our survey made the following comments; the level of care, concern and willingness of the carers is exceptional they look after mum in the dementia unit with patience, affection and a great deal of care and respect All people living at the Home, seen and spoken to on the day of inspection were clean, Care Homes for Older People Page 15 of 31 Evidence: hair was neatly brushed and finger nails were clean. People were appropriately dressed for the time of year. Staff were seen moving one person in a hoist, the dignity of this person was maintained whilst performing this task. The medication management and administration is safe, there are some areas of improvement that are required. The Medication Administration Records were correctly completed and signed by staff at the time the medication is given. The MARs for the intermediate unit are usually hand written, these are checked and signed by 2 staff members to ensure that the information is correct. In one instance the counting of the medication delivered to the home was incorrect, this would mean that an audit would not be accurate. In another instance the amount of medication required had been changed on the bottles lable, and this was different to the prescription. There was supporting information to demonstrate that this change had been instructed by the individuals GP. It is important that the information on the prescription and the bottle are the same to avoid any confusion. The Controlled Drugs are stored appropriately and clear records are kept of medication given, also it is clear when medication is destroyed, which is done according to the law. It was found that a medication had been removed from it original packaging and added to another box. It is important that medication remains in its original packaging. Both rooms used to store the medication and other items required are air conditioned which ensures that the temperature is maintained at a level suitable for the storage of medication. People with diabetes have the level of sugar in their blood tested regularly, the nurses use single use lancets to prick the finger, this ensures that there can be no cross infection. Each month 10 of medication is audited to ensure that it is administered and managed appropriately, actions are taken when any issues arise from this. Care Homes for Older People Page 16 of 31 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 encouraged to keep in contact with family and friends and visiting is flexible. Activities take place to ensure that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at the Home and enhances their quality of life. Meals are wholesome and nutritious. Evidence: We reviewed documentation in the ground floor lounge during the morning of the inspection, the activity organiser was present for a majority of the morning chatting, laughing and undertaking activities with people. A list of activities on offer is on display on the noticeboard in each lounge. the activity organiser confirmed that people are able to do an alternative activity if they do not wish to do the activity planned. People enjoyed chatting to the activity organiser and each other and the atmosphere was relaxed and friendly and all were laughing and joking. Activities took place in the dementia care unit during the afternoon of the inspection. The Home employs one full time (forty hours) and two part time, (ten hours each) activity organisers, this gives a total of sixty activity hours per week. A conversation Care Homes for Older People Page 17 of 31 Evidence: was held with the full time activity organiser who was extremely enthusiastic about her role and the benefits of providing regular stimulating activities for people in care settings. Trips out take place on a regular basis and a few people had visited Cannon Hill Park for the day recently. An activities news letter is produced on a quarterly basis. Records are kept to show what activities have taken place, who has joined in and whether they have enjoyed the activity or not. These records demonstrate that regular, varied activities take place at Ardenlea Court. Two activity rooms are available on the first floor, one having a music theme with pictures of musicians, and other items to give the room a musical feel and another room which contains all of the activity equipment and tables so that people can do arts and crafts, indoor gardening etc. It was noted that people go into the music room to watch films, listen to music or do other small group activities. Two people who responded to our survey said that the Home usually arrange activities that they can take part in if they want, the other two people who responded said that activities are always arranged. One person commented the activities are excellent Six relatives responded to our survey. Relatives were asked what does the service do well. Relatives made positive comments about activities and said there are various activities to stimulate the residents, the activities and the staff who do all of this are a pleasure to watch, all enjoying their work, they work hard. Music, singing etc my mother enjoys alot. Peoples religious needs are met by visiting clergy. A church of England service takes place on the third Monday of each month and the activity organiser has telephone numbers to contact people to provide services for other religions. From discussions with staff and people living at the Home it was noted that people are given choices in their daily life. They can choose when they get up in the morning and go to bed at night, where they spend their day, where they eat their meal, what clothes they would like to wear. People are able to choose whether they would prefer a bath or shower and both male and female staff are employed to provide care. Care plans record likes and dislikes and personal preferences. This helps to ensure that care is provided in a way that meets needs and is conducted in a way that meets personal preferences. People were seen wandering freely around the Home, the patio doors were open and Care Homes for Older People Page 18 of 31 Evidence: people went outside for a walk in the gardens or sat and enjoyed the sunshine. Three visitors were spoken to during this inspection, all said that staff make them very welcome when they enter the Home and offer them refreshments. It was noted that the Home has an open visiting policy, however, people are asked not to sit in the dining room at lunchtime chatting but they are welcome to have a meal with their relative. One relative who completed our survey responded to the question what does the service do well - services to visitors. Another relative commented all staff work as a team and nothing is too much trouble, from the receptionist who welcomes you to the lady who cleans the rooms. The office lady, the maintenance man, the chef, they all speak and make you welcome and help you if needed and the care and nursing team are excellent Staff were seen addressing people in a kind and courteous manner. People were seen enjoying their main lunchtime meal. The dining room was nicely laid out and the atmosphere in the room was relaxed. People spoken to confirmed that the food is good and said that there is plenty of it. They were aware that there is a choice of meal. Menus have recently been changed following consultation with people. The Annual Quality Assurance Assessment provided by the Home records that they provide a Nite Bite menu which allows our residents to choose what to eat when they feel like it, providing healthy choices at any time through the night. The manager confirmed that food is available in the kitchen on the ground floor and the kitchenette on the first floor to enable people to have a snack whenever they want during the night. All four people who responded to our survey said that they always like the meals at the Home. The last environmental health inspection was undertaken on 21 April 2009, some minor cleaning issues were identified which were immediately addressed. Care Homes for Older People Page 19 of 31 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. Each person can be confident that their concerns and complaints will be taken seriously and resolved. Each person can be confident that they are safe and that training and process ensure that staff are aware and trained to deal with adult protection. Evidence: The complaints process is robust, however this has been updated and the new process will commence on 1st July 2009. The procedure and accompanying paper work was seen and discussed with the manager, which told us that the process remains robust and instructs staff to ensure that all concerns and complaints are treated seriously. The complaints book was looked at and this told us that the manager responds quickly to any complaints raised, fully investigates them and gives feedback to the person making the complaint. There were no plans of action to show any changes made to improve the service from these complaints. The manager told us that this will be recorded in the new process. Safeguarding policies and procedures are available, and staff have a variety of training in this area to ensure that they understand and have the knowledge to recognise and report any suspicions or observed abuse. There has been one safeguarding reported, this was fully investigated by social services and the police and it was found that the home had acted properly. Care Homes for Older People Page 20 of 31 Evidence: In staff meetings new information about safeguarding are shared, also safeguarding from other areas in BUPA and from the National Press to ensure that lessons learnt are shared and improvements made. The manager told us that a Mental Capacity tool is being developed by BUPA in consultation with Graham Stokes, in the interim the Senior Nurse with Mental Health training has developed a form which has been passed by the Quality Board to assist in the assessment of capacity. These were seen in peoples files. There is information in each unit for relatives and people living there about the Mental Capacity Act and Deprivation of Liberty Safeguarding [this ensure that each persons rights are met]. One nurse is at present undertaking training in Dementia and this includes the law around Deprivation of Liberty Safeguarding, the manager told us that she would then share her learning with others in the home. Through discussion it was noted that the manager understands Deprivation of Liberty Safeguarding and her role in the Mental Capacity Act. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe, clean and well maintained environment. Evidence: Ardenlea Court is a purpose built nursing home which provides accommodation over two floors. The ground floor has two lounges, the kitchen, dining room and access to the first floor via a shaft lift. People staying at the Home for intermediate care also have access to a therapy room in which staff assist them to perform various activities to make sure they are ready to return to their own home. There is a nurses station and an office for the staff who work in the Home from the Primary Care Trust. The lounges were clean, nicely decorated and had access to the gardens. Chairs were grouped so that people could easily sit and chat to each other. People were seen going into the gardens through the patio doors. Some people sat outside enjoying the sunshine. The gardens were nicely planted and provided a pleasant, safe, outside space which had tables, chairs and benches for those who wish to relax outside. There is a small greenhouse and people have been growing tomatoes with the activity organiser. Raised planters also provide interest and brightly coloured flower displays. Gardens Care Homes for Older People Page 22 of 31 Evidence: were well tendered and bright and colourful. Corridors were clean and grab rails are provided to aid those with mobility difficulties. All of the bedrooms in this service have en-suite toilet and wash hand basins. In addition to this, three toilets and three bathrooms are provided on the ground floor. All baths are assisted to enable those people with mobility problems to have a bath. People were seen wandering freely around the building. The managers office, administration office and reception area are at the front of the building. The first floor has a lounge which has a musical theme and is used to provide activities and an activities room used for arts and crafts or small group activities that can take place away from the main lounge. A hairdressing salon which is available for use by anyone staying at Ardenlea Court, a lounge and a dining room. All of the bedrooms on this floor have an en-suite toilet and wash hand basin. In addition to this there are three toilets, two assisted bathrooms and an assisted shower room. Bedrooms seen throughout the Home were clean and no unpleasant odours were noted. Fixtures, fittings and decor were in a good state of repair. Large floor to ceiling windows provide lovely views of the gardens and let in lots of natural light to lounges and some bedrooms. Memory boxes are provided by the bedroom door of each room on the first floor. People are able to put in pictures of their choice to help them identify which is their bedroom. Those seen had been filled with pictures of pets, family and the people themselves when they were younger. Various pieces of equipment are available to help those with mobility problems, specialist beds and mattresses are also provided for those at risk of developing a pressure area. Infection control procedures are maintained, staff were seen wearing disposable aprons and gloves as needed and stocks of these items were seen around the Home. Disposable hand towels and liquid soap is available in toilets as the use of communal towels and soap my provide an infection control risk. Care Homes for Older People Page 23 of 31 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. Each person can be assured that they are cared for by staff who are suitably employed and trained to carry out their job. Evidence: The home accommodates 55 people who have various needs. There is a unit on the first floor with 29 beds for people with Dementia, the ground floor has eight permanent beds for people who require nursing due to their age and frailty and 26 beds for people using the Intermediate Care where they stay for approximately six weeks. The duty rotas seen told us that there are sufficient nurses and care staff available on each shift to meet the needs of the people in this service. This was also confirmed by the care received, feedback from people using the service, their relatives and staff. The service is also supported by sufficient numbers of housekeeping staff who ensure that a high level of cleanliness is maintained and the laundry is managed well. The housekeepers steam clean empty rooms and carry out high and low level cleaning. The kitchen is staffed from approximately 6:00 in the morning until 19:00 in the evening. This means that the nurses and care staff do not have to undertake any work other than caring for the people in the service. Care Homes for Older People Page 24 of 31 Evidence: There are two people employed to maintain equipment and facilities in the service, this covers a variety of work form checking that equipment remains suitable to use, to minor repairs and decorating, the gardens are also kept tidy and fit for use. The manager is supported by two senior nurses who act up when she is not available. There is also an administrator and a receptionist. The staffing of this services ensures that it runs smoothly, and there are sufficient staff to ensure that the needs of each person is met, that the service remains clean and well maintained and the administration is acceptable. Four staff records were looked at and this told us that all staff are fully checked prior to employment to ensure that they are suitable to work with vulnerable adults. Training records were seen in these four files and these told us that training is ongoing. The training matrix confirmed that staff have regular training. Eighteen staff have completed their National Vocational Qualification in Care at level 2 and above, a further seven staff have commenced this training, this means that more than 50 of staff will be qualified which increases their knowledge and practices in delivering care to adults. Care Homes for Older People Page 25 of 31 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. Each person can be confident that the running of this services involves all those who are involved and considers what is best for those who live there. Evidence: The manager has been registered for 3.5 years and previously worked as a senior nurse for eight years for BUPA. She demonstrated to us through discussion and through the organisation of this service that she is capable and understands what her role as a manager contains. She told us that she up dates her knowledge through training supplied by BUPA and also other outside agencies. BUPA also supply copies of journals and have a web site where they post up dates and new initiatives. There is an open door policy and the manager is available to her staff, people who live there and other interested parties during her working hours. She told us that she does put some time aside to ensure that the administrative work is completed. The manager is supported by two senior nurses who manage the service with direction Care Homes for Older People Page 26 of 31 Evidence: from the operational manager when she is not available. The manager receives a night report each morning about the people using the service, changes in health or staffing, and other staff issues. She also attends a hand over at each nurses station to get an update with the staff. The manager told us that she will work with the staff if required and at times does so to ensure that the service is running as she wishes. There are regular meetings with staff in the home; monthly meetings are held with heads of department, nurses, and carers. The chef and senior housekeeper meet with their staff each month to up date them on changes. There is also a monthly meeting with the staff of the intermediate unit to discuss improvements, changes that are made and any concerns or complaints raised. The manager also attends the activity meeting where discussions are held about the type of activities, improvements needed and how any money raised should be spent. Each month a visit is made by a senior manager of BUPA and an audit is carried out, this examines all the areas of the service and involves talking to staff, people using the service and their relatives [where available]. From this action plans are developed to improve areas. A recent initiative was to photocopy and distribute the information about safeguarding to all the units so these area available for everyone. People who use the service are asked to complete a survey every year, these are due to be sent out. It was recommended that the results are analysed and this is included in the information available about this service and that an action plan is developed to show how changes are made. Supervision of staff is not being carried out as required. The manager was aware of this and it was recorded in the monthly visits, an assessment of this should be undertaken and clear actions put into place to ensure that all nursing and care staff have the opportunity to attend a minimum of six supervision sessions a year. The maintenance of equipment of the home is carried out properly by the maintenance person and through contracts. The liability certificates are up to date and visible in the reception area as is required. The service manages small amounts of money for personal use for some people at the home. Records are kept electronically and receipts for all transactions are available. Care Homes for Older People Page 27 of 31 Evidence: This system is robust and this minimises the risk of mistakes. There are policies in place for the handling of lost property and valuables. Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 9 9 33 Medication should at all times remain in its original packaging. Accurate counting of medication delivered from the pharmacy must be recorded. Results of surveys should be analysed and reported in such a way that this can be shared with staff, people living at the home and relatives. This should include an action plan to show improvements to be made. All care and nursing staff should have the opportunity to attend a minimum of 6 supervision sessions a year. Records should be kept. 4 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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