Care Home: Autumn House Nursing Home

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What the care home does well . What has improved since the last inspection? . What the care home could do better: . Key inspection report Care homes for older people Name: Address: Autumn House Nursing Home 37 Stafford Road Stone Staffordshire ST15 0HG     The quality rating for this care home is:   three star excellent 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: Keith Jones     Date: 2 6 0 8 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 34 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 34 Information about the care home Name of care home: Address: Autumn House Nursing Home 37 Stafford Road Stone Staffordshire ST15 0HG 01785812885 01785615506 lpowell@waverleycarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Waverley Care Homes Limited care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 67 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: Physical disability (PD) 67 Old age, not falling within any other category (OP) 67 Date of last inspection Brief description of the care home Autumn House is a care home providing personal care, nursing care and accommodation for up to 67 elderly people. The home is registered with the Care Quality Commission to care for peoplewith the following needs: - dementia, mental disorder (excluding learning disability or dementia), old age, (not falling within any other category) and physical disability. The home is owned by Waverley Care Homes Limited who also own the other care home located on the site. The home is located on the outskirts of the town of Stone in Staffordshire. Amenities, including those in Stone town centre are situated within walking distance. The home Care Homes for Older People Page 4 of 34 0 67 Over 65 67 0 Brief description of the care home consists of two floors, the ground floor is home to people requiring personal care and the first floor is dedicated to those needing nursing care. There is a passenger lift installed serving both floors. Most bedrooms have en-suite facilities, with some double rooms available. There is a patio area with tables and chairs and a substantial carparking area at the front of the home. The full range of charges were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 34 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Registered Care Manager, Area Manager Four Seasons, nursing and care staff on duty, and an expert by experience, whose input contributed to this report. An expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 74 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with nursing, personal and dementia care needs. To do this we looked at six peoples files from admission referral to the present time, and three staff files were examined. This is part of our case tracking process, and helps Care Homes for Older People Page 6 of 34 us makes judgements about the Homes abilities to meet peoples needs. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and nine survey forms returned, that we sent out to people who use the service some weeks before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Care Manager, Area Manager and Clinical managers, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 34 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. 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 8 of 34 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 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services recently revised Statement of Purpose and Service User Guide, and found them to provide an excellent, informative description of the Homes aims, objectives, and the way it operated. It is recognised that the Statement of Purpose represents the foundation on which the Home operates upon, offering those people who may use the service, and their relatives the opportunity to make an informed choice about where to live. We saw that the Statement of Purpose could be produced in large print, as and when necessary. We consider that the Service User Guide could be presented in an audio and pictorial version to help people who have difficulty reading small print. The Statement of Purpose clearly indicates the terms and conditions, which are discussed prior to admission. Fees charged are not listed in the Statement of Purpose or Service User Guide documents as routine. The reader may Care Homes for Older People Page 10 of 34 Evidence: wish to contact the service to obtain more detailed and up to date information about fees. Through our case tracking of five peoples care records we clearly identified that the Care Manager, or her deputy, conducted the pre-admission assessment. We found that the documentation identified a clear dependency assessment, forming a comprehensive foundation for care planning to meet needs, which included a copy of the care plan from social services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. We confirmed that a letter is sent on to the family, to establish the understanding from the pre admission assessment. Comments we received from surveys we sent out before the inspection to people who use the service: No place is perfect but all the staff do their best to try and make it so, and my mum considers Autumn House her home, and we have not regretted the final choice of care home. My sister had visited several times after talking to friends, and she thought it was very suitable, and I agree with her. Since coming to Autumn House we have found it very a friendly place to live in. We are very happy with the care given to us. Case tracking confirmed that a valuable exchange between people and the assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. From discussions it was evident that prospective service users and their relatives are able to visit and assess the quality, facilities and suitability of Autumn House at any reasonable time, to meet with staff and management. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving people, and their families in the admission process. The information I received was very informative and helpful. People are admitted for a trial period initially to enable all parties to evaluate whether Care Homes for Older People Page 11 of 34 Evidence: the home is an appropriate placement and mutual adjustment before any contractual agreement is signed; this is usually a period of four weeks. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated through our discussions, and examining records on case tracking. There are several people attending on a day care basis receiving valuable support. It has been recognised that services, resources and facilities are in place to meet up to four placements. There were no people assessed and referred solely for intermediary care at the time of inspection Care Homes for Older People Page 12 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Care records and case tracking we examined provided clear evidence to show that the pre admission assessment represented the foundation for a well considered, and detailed care planning process, in association with Social Services reports. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon dependency assessment and activities of daily living, frequently reviewed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with a substantial and very informative daily progress report. Established monitoring systems following a process of goals, care and evaluation of high quality care plans, appreciated by those people and relatives alike. Comment we received from relatives spoken with on the day: Care Homes for Older People Page 13 of 34 Evidence: Autumn House not only looks after my mum, but supports and informs me if she is ill or if an untoward event. They are a very special team of people. Well managed with a high level of hygiene. Its a friendly, homely atmosphere, and make visitors very welcome. If Im feeling unwell, the staff are very caring and supportive. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The AQAA stated, and we confirmed, that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. Care staff maintain all aspects of peoples personal care, overseen by the trained nurse on a daily basis, through the key worker system. As is appropriate and observed, comprehensive monitoring of people with high dependency needs is carried out, this was found to be in place, robust and effective. A daily report is maintained to control monitoring, and offer a very comprehensive account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation models of monthly assessment. Our case tracking of five peoples care confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Through case tracking, our discussions and inspection of records, it was recognised that the home arranges for health professionals should special health care needs be recognised. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their life style, complimentary regarding the quality of their lives and the care they were receiving at Autumn House. Obviously I would rather be home, but recognise that I cannot with my disability. As an alternative I have no complaints against my treatment here. I have the odd hiccough, but these are minimal and do not effect my view of the Home, and it is clean, and staff give help when needed. If I need to a doctor is always available on request, and if paramedics are needed, they get here straight away, and no time is wasted . Care Homes for Older People Page 14 of 34 Evidence: We confirmed that the administration of medicines is of a good standard to maximise protection for people who use the service. We found that the Care Manager is responsible for overseeing all matters relating to medicines, with a senior nurse taking operational responsibility for day to day actions on the first floor, and a senior carer recognized as responsible on the ground floor. The manager has effected a well developed, and smooth process of ordering, receiving, storing, and administering medicines. The process of tracking the disposal arrangements requires a review to complete the secure audit trail. Nevertheless working records were seen to be complete and easy to follow through, with no observed breaches in the administration system, although the Medicines Administration Record (MAR) on the residential unit needs securing as a more robust system. The Homely remedy listings need medical approval signatures attached. Controlled Drug management was comprehensive. A resuscitation trolley is stationed on the main corridor and is kept up to date. We found that the Statement of Purpose, admission assessment and care plans promote a sense of individuality, dignity and privacy, policies reinforced with a staff induction programme, and supervised practice, with those people we spoke with being complimentary of the degree of respect given, by each and every member of staff. We observed the free, courteous interaction between people and staff based on a level of confidence of mutual trust and respect. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. Several comments we received from visitors on the day indicated: The care is extremely good. It is clean and comfortable. If they tell you they will do something, they usually come on time or give you a reason why not. The staff are friendly and competent. I know all the staff at Autumn House, who are extremely kind, I am very pleased with my situation. We come and go as we please, there are no visiting restrictions. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussions with people confirmed that individual spiritual persuasions, Care Homes for Older People Page 15 of 34 Evidence: and individual diversity was seen to be respected. People are able to attend Anglican or Methodist church services held in the Home on a three weekly basis. Communion services are arranged every fifth Sunday in the month, and Roman Catholic services are given as requested. There were no other religious requirements at the time of inspection, although the manager was well aware of the provisions, should they arise. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. We acknowledged the friendliness, confidence and closeness within the Home of staff, residents and visitors, and the mutual respect observed. It was also acknowledged that there exist extremely good working relationships with regular professional contacts, and General Practitioners for the Home. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which peoples needs were respected, with the security that there are familiar events to the day they could relate to. Our discussions with people clearly identified a relaxed and informal atmosphere in which the peoples needs were paramount. Activity co-ordinators have a high profile in contributing to the care planning process, and is clearly well accepted by people who use the service and staff alike. The recording of social activities was seen to be an integral part of care reporting and planning. Evidence was clear in identifying events and results of efforts made. On the day of the inspection, a number of people were engaged in activities, one to one and Care Homes for Older People Page 17 of 34 Evidence: general chatting. Individual life histories are discussed and used as a basis for personalised social care offering choice and support. Some comments we received from surveys sent out before the inspection: Most functions are done well, friendly but sometimes hurried. We like flexible visiting times. There are always activities arranged each week, but now I am not able or interested in taking part in them. Generally I am satisfied, the activities are good fun, when I get involved. The staff are a hard working, practical team. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments received from relatives on the day confirm their appreciation and involvement with the progress of their loved ones health and social status Visitors are always offered refreshment, we are pleased with everything. I wonder sometimes if the resident is able, and the weather is fine, could they not sit outside. Dad is limited in what he can participate in, but he is invited and stimulated by staff encouragement. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. The Home operates a secure system of handling peoples monies, with only small amounts of petty cash, which was efficiently handled through the administrators office, and subject to internal inspections and audits by the Registered Provider. The Care Manager emphasised that the strength of protecting personal rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Regular relatives/residents meetings with people are valuable Care Homes for Older People Page 18 of 34 Evidence: forums for open communications, and are recorded. We examined the record of meetings and identified a sympathetic and positive response by the Care Manager in meeting peoples needs and requests. The Home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. We confirmed that the cook knew most of the people using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant lunch was served during inspection, served in pleasantly furnished and clean dining rooms. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people in the home. People interviewed confirmed that that the quantity and quality food provided was good: Comments we received in the course of inspection: Excellent service, the meals are varied, and well presented. Its nice to see the cooks occasionally, especially with my fussy tastes. The meals are generally very good and I like being able to dine in my own room at a time it suits me. The food can be a little bland and repetitive at times, otherwise I have no complaints. Care Homes for Older People Page 19 of 34 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. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy was seen and records examined. All people who use the service had received information on the procedure to complain, including reference to the Care Quality Commission (CQC). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. A detailed complaints record enhances quality control on this issue, with clear recognition of concerns, complaints and allegations. Comment we had received in the course of inspection stated: I dont have any problems, the staff are very kind, I know how to make a complaint, but so far havent had any. Ive been here a number of years and always found that staff are ready to listen when we point things out, and a manager who knows what to do. Care Homes for Older People Page 20 of 34 Evidence: Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. One complaint, and no safeguarding issue had been received by us since our last inspection. The overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. Individuals legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning, and policies in place, including the complaints and Safeguarding procedures. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The Annual Quality Assurance Assessment completed by the service prior to the inspection, confirms all staff employed have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining four staff files. Staff induction and in-house training programmes led by the Care Manager, clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse, of all natures. Care Homes for Older People Page 21 of 34 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. The Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: Through the course of inspection we confirmed that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking is extensive, and patios are well maintained, offering pleasant areas for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the Home. On admission the Care Manager assesses each individual persons needs for equipment and necessary adaptations. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The lounge spaces allow activities to be presented in very pleasant areas of the Home, with furniture and fittings of good quality. The dining areas are well furnished, each presented to provide a conducive environment to enjoy a good meal. Staff supervision is available throughout the day. We found that bedrooms were well maintained to meet peoples personal preferences, Care Homes for Older People Page 22 of 34 Evidence: most being highly personalised, displaying the persons own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the decor in most areas was found to be of a good standard, with a development programme for continuing upgrading of decor. There remains some old furniture in need of replacement in some bedrooms. We acknowledged that the Home have appointed a full time, dedicated painter and decorator on site, and a full time maintenance man. Each bedroom has adequate space to assist with personal care and dressing assistance. There are an appropriate number of variable height beds with integral protection rails. The nurse call alarm system was satisfactorily tested, and personal electrical equipment (PAT), that is televisions, radios, etc, where seen to be tested. There is adequate lighting, and bedside lamps are available where risk assessed. Radiators are protected; smoke detectors fitted and adequate electrical sockets available. TV and telephone points were available in each bedroom, equipped with large keypad telephones for personal use. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The heating arrangements throughout the home are by central heating with guarded radiator convection, providing an ambient temperature. Lighting facilities, including individual bed lights, and overall emergency lighting were installed and regularly maintained by the handyman. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm, and ventilation is by direct door and window airing. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the Home. The housekeeping services in the home were seen by us to be of a high standard. Those people spoken to generally remarked that they find the environment always very clean and fresh. To complement the presentation there were numerous floral and decorative displays. A comment from a survey we sent out: A home from home, all my needs have been attended to, a very pleasant environment. Well managed with a high level of hygiene. Friendly, homely atmosphere, and make visitors very welcome. I feeling unwell the staff are very caring and supportive. Over the years I have come to regard Autumn House as my home, Im very comfortable and happy with my life here. Care Homes for Older People Page 23 of 34 Evidence: The home achieves a high standard of cleanliness. Very clean and tidy at all times, it makes me feel comfortable and I feel safe, its a really nice place to live. We recognised the standard of cleanliness to be excellent throughout; there was no evidence of malodours in any of the rooms inspected. We were informed that sluices, bathrooms and toilets were cleaned on a routine basis, which we confirmed on inspection, presented a pleasant and hygienic environment. Disposable gloves and aprons were seen in use, and liquid soap and paper towels were evident throughout. There are strategically placed hand cleaning dispensers available for general use. The sluices and laundry were found to be well organised and equipped to a good standard, procedures were in place for coping with soiled/infected linen with the provision of alginate bags to minimise handling and cross infection. The areas that store chemicals displayed appropriate safety posters and information charts. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, up to date and accurately reflecting the observed standards. The Annual Quality Assurance Assessment, completed by the service prior to the inspection, confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 24 of 34 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. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: There were 32 people receiving nursing care, and 34 people receiving residential care at the time of the inspection. Three weeks of duty rotas were examined, in which the daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a foundation for a high standard of personal and nursing care. The Registered Care Manager worked supernumerary, and is supported by a Care Manager for the Residential Unit and senior nursing staff, who contributed fully to the inspection. Agency staff and staff bank coverage are used occasionally to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. Discussions with staff also confirmed their commitment to providing a quality service, and their awareness of the principles of good practice. The administration, maintenance, catering, and housekeeping hours were determined and found to be appropriate for the size of the Home, and the needs of people. Autumn House shares with the Manor House a complement of three activity coordinators, have full time maintenance and painter/decorator on site. There are eight Cadets who work a variety of shifts to provide support, attendance and assistance with non clinical activities. The Registered Providers provide a high profile presence in direction, administration and management support. Care Homes for Older People Page 25 of 34 Evidence: We sampled four staff files, and found them to be consistent and up to date. Staff are employed in accordance with the code of conduct and practice set by the General Social Care Council. We recognise that the management have established a comprehensive procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. The process would be enhanced with a letter of appointment and a copy of the contract available in the staff file. We confirmed that staff induction programmes are well established; very well designed, forming the base upon which in service supervision and training are planned and achieved. We recognize the teaching qualifications held by the Care Manager. The records we examined showed that 50 of care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further 10 undertaking NVQ training at the time of inspection. Overall the evidence shows a substantial account of a meaningful schedule of training to meet mandatory and specific demand. However there are instances where fire training and safeguarding awareness sessions have not met the obligation, to which the Care Manager offered a positive response. Staff employment and training records would be more secure with a review of the organisation of files to include members of staff in maintaining the port folio quality of records to demonstrate more clearly the good standards observed. The management were aware of their expected roles within the Mental Capacity Act 2007, including Deprivation of Liberties, with the need to ensure awareness at all levels. A training development plan for 2009/10 had been prepared by the Care Manager, who with the Providers is committed to a learning environment. Records were available to demonstrate an on going process of supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Comments we received through surveys and in the course of inspection were: Sometimes short staffed at weekends. I feel that my mother is very well cared for and I have confidence in the staff providing a high level of care. The staff are lovely people, very kind and very helpful. They should employ more staff, more conversation between patients and staff. I dont see some staff (eg laundry). I wish the care staff had more time to talk to us. (Dictated) Care Homes for Older People Page 26 of 34 Evidence: The full time staff are very good, most of them have been at the home a long time, so they know the needs of the patients if there are any problems. Three staff on duty were interviewed, each having had a statement of terms and conditions, although the document is not kept on file for verification. It is a declared policy that recruitment is based on equal opportunity. Each member of staff spoke well of the training and supervision offered to them, and of the good working conditions that prevail. Each were very settled and enjoyed their positions, and were proud of the high standards of care given. There were no problematic issues raised by the staff. Care Homes for Older People Page 27 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: We acknowledge that the Care Manager Lesley Powell has continued to demonstrate clear competence over 17 years in managing Autumn House, in establishing a solid professional management style that has been implemented, to achieve excellent standards of set aims, objectives and care. An experienced General Nurse with a Certificate in Education, a qualified assessor for NVQ and the Registered Managers Award, and has actively promoted, and enhanced the Key worker and Named Nurse team concept. She is supported by a Care Manager for residential care, and a team of Registered Nurses. The Registered Providers have demonstrated a high profile and involvement in the smooth running of the home, and are prepared to delegate a wide range of management responsibility to good effect. We acknowledged the openness Care Homes for Older People Page 28 of 34 Evidence: and confidence in the observed interactions of staff, relatives and people who live in the home. The relationships were seen to be of mutual trust and respect. Several comments made by people who live at Autumn House, and visitors we spoke with reinforced the strong foundation of confidence they had in the leadership. I have always found Mrs Powell to be very approachable and fair, she leads by example, and has my full commitment in keeping the standards of care as high as we possibly can. Since coming back to working in Autumn House, I continue to be very impressed with the highly professional approach to providing a quality service, with high standards and a very caring manner. Our examination of records showed appropriate risk assessments are in place for people, through care planning and recording, staff selection and of the general environment, these are up to date and accurate. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. We recognise that the Providers with the Care Manager have developed a formal approach to monitoring quality across a wide range of activities. An examination of administrative, monitoring, planning and care records showed an organised and a professional attitude to effective record keeping. They were found to be well maintained, accurate and up to date, ensuring that peoples rights and best interests are safeguarded. We identified that individuals are encouraged to be independent with regard to financial affairs with the assistance of their relatives. Small amounts of cash were efficiently handled by the administrative officer, and is audited by the Homes accountant as a yearly check. We examined the outcome of a quality assessment providing peoples comments on the standards of service, and with the results of our survey conducted with people living in the home and their relatives, showed a clear indication that the home is run in those peoples best interests. We made a random sample examination of the procedures manual, and found it to offer a very comprehensive reference. Policies on missing person, medication administration, managing abuse and PAT testing were examined, and found to be up to date and informative. The Home has an open door policy and a commitment to equal opportunities. As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. Cascading supervision Care Homes for Older People Page 29 of 34 Evidence: programmes are established as part of the normal management/training process, with all care staff receive six sessions of individual formal supervision annually. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. We found that the health and safety of people who use the service and staff, are promoted with safe storage of hazardous substances, regular electrical PAT, servicing of gas appliances and regulation of the water system. The accident book was seen and found to be in order for staff and people using the service, with a three monthly analysis of trends and frequency undertaken by the Care Manager. We found the administration and management of the home is efficient, uncomplicated and sensitive to the needs of people living in the home. Care Homes for Older People Page 30 of 34 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 31 of 34 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 1 Consideration be given to producing the Service User Guide in an audio version, to assist people with poor eyesight to make an informed decision. The Care Manager will ensure that the Medicines Administration Record (MAR) on the residential unit be secured as a more robust system. The Homely remedy listings need medical approval signatures attached, to confirm that those Homely medicines administered are approved by a prescribing General Practitioner. The process of tracking the disposal of medicines arrangements requires a review to complete the secure audit trail of all medicines administered by the Home. Review bedroom and communal furniture for repair/replacement. The Care Manager is advised to initiate a letter of appointment following the interview agreement, and maintain a copy of the employment contract in the staff file The Care Manager is advised to maintain the schedule of Page 32 of 34 2 9 3 9 4 9 5 6 24 29 7 30 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 mandatory training for all staff as prescribed in the care standards recommendations. Care Homes for Older People Page 33 of 34 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 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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