Care Home: Beggars Roost Nursing Home

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What the care home does well The home has an assessment process which enables the manager to decide whether Beggars Roost can meet the needs of the individual. The ones we saw on this occasion were completed and were used to inform the care plan. The people who use the service have activities available for them to join in with if they wish or they may have activities in their room on a one to one basis. People who live at the home were generally positive about the food that the home provided and the condition of the accommodation that they occupied. What has improved since the last inspection? Work has been carried out to improve the environment with an accessible garden and conservatory. What the care home could do better: The manager must register with the commission. Health care needs must be monitored and action taken in a timely manner. Care plans must also reflect accurately the needs of the individual in relation to pressure area care. Medication must be administered, stored and managed safely. Thorough recruitment of staff must be carried out and checks must be in place before staff commence employment. Key inspection report Care homes for older people Name: Address: Beggars Roost Nursing Home Old Park Lane Fishbourne Chichester West Sussex PO18 8AP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Beggars Roost Nursing Home Old Park Lane Fishbourne Chichester West Sussex PO18 8AP 01243573750 01243576064 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Colville Care Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 28 The registered person may provide the following category of service : Care home with nursing (N) t service user of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Beggars Roost is a care home able to provide personal care and nursing care for up to twenty-eight residents over sixty-five years of age. Two of the twenty-eight residents may also have a physical disability. The home is situated in a rural area of Fishbourne on the outskirts of Chichester. The accommodation is on two floors, the upper floor having passenger lift access. Work has been undertaken to ensure ease of access to all rooms and areas in the home. Communal accommodation consists of a lounge and a conservatory, which open out onto private gardens. Care Homes for Older People Page 4 of 31 Over 65 28 0 1 9 0 2 2 0 0 9 Brief description of the care home Private accommodation consists of twenty single bedrooms and four double bedrooms. The double bedrooms have en-suite facilities and are currently being used for single accommodation. The current fees for the service are available from the home on request. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 18th January 2010 between the hours of 10:00 am and 3:30 pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited on 19th February 2009. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. We met with the manager, two Care Homes for Older People Page 6 of 31 staff, one visitor and there were four people who use the service involved in the inspection visit. The manager told us that several people who use the service and staff had been unwell the previous week, there were still two people unwell on the day of our visit we therefore limited interaction with people using the service. The registered individual Mr Colville introduced himself and was carrying out an interview for new staff. There were 25 people living in the home on the day of our visit this included one individual who was at the home for respite. We looked at four pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had ten surveys returned. Care Homes for Older People Page 7 of 31 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 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 9 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. Although the home has an understanding of individual needs using the assessment process, which also involves other professionals or family as needed. The assessment record would prove more beneficial to the process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The AQAA for the home said:All prospective clients and their relatives are encouraged to visit the home for a preliminary meeting with Matron or a senior member of staff. This meeting is used to provide information to the client or their relatives in order that they may make an informed decision about the choice of a home. Clients are given a pack which includes summaries of for example: facilities of the home including lounges, bedrooms, A summary of the fees and general terms and conditions including details of trial and notice periods. A large type version of the client guide is available for prospective clients to read with a copy held in each room and at the entrance. Each client will receive a pre admission assessment by a senior member of staff. The Care Homes for Older People Page 10 of 31 Evidence: purpose of the assessment is to ensure that the home is capable of meeting the clients needs. If the assessment determines that the home is unable to meet the clients needs then the client will be informed that we are unable to admit them. Where clients are admitted for respite care a dedicated room is provided. The room has been designed to offer additional services which are appropriate to more mobile and less dependent clients. These include; level access en suite shower room, mini bar for storage of small food items and drinks, direct dial telephone and level access to the garden. When a client is admitted via a care management service e.g. bed discharge coordinator or from another care home a full copy of the care management assessment and any care plans are requested prior to admission. There have been several admissions since we last visited in 2009 we looked at three of them. We saw that there was information on individual needs based on their present and past medical history for example, nutrition and food likes and dislikes. We saw that the assessment is reviewed after admission and six monthly thereafter. The assessment noted where individuals had particular needs such as weight and mental well being. We also saw examples on how staff are to offer support at night, moving in bed for example. The assessments had space for additional comments we saw that these had been used in some areas of the assessment in two cases. We saw that there was information from other health professionals to assist the manager in making the assessment as to whether the home can meet the individuals needs. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not always detail the needs of the individual and support staff are to give. The medication records and administration within the home do not always show that this is carried out in a safe manner to protect the people who use the service. Staff working practice does not always ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that:A person centred care plan is developed for each client. Care plans are regularly reviewed and adapted as the needs of the client change. With the consent of the client, their relatives and other interested parties such as GPs and Hospice nurses are involved in developing care plans to ensure that the care plan meets the needs of the client. Our key worker system ensures continuity of care and limits as far as possible, the number of different staff delivering personal care and therefore fosters genuine reciprocal relationships with clients. Where a client does not have the mental capacity to make their needs and choices explicit, staff are trained to recognise and respond to non verbal cues as to whether clients are happy with the choices made on their behalf. Wherever possible families, care managers and GP Care Homes for Older People Page 12 of 31 Evidence: opinions are sought and these are reflected in the care plan. Staff are trained to protect the privacy and dignity of the clients. Policies include a knock first before entering policy for all rooms. Wherever possible clients are encouraged to take an active role in their health care including the administration of their own medication Where a client is not able to manage their own health care the Home will closely monitor the health needs of the client to ensure that any health care problems can be detected early and addressed promptly. The Home conducts risk assessments on all clients to identify risks from pressure damage, falls, the use of bed rails and during moving and handling techniques. Where risks are identified appropriate action is taken, e.g. use of alternating air cell mattresses, transfer hoists etc. Clients care plans assess the risk of malnutrition and appropriate action is taken. Clients are encouraged, where possible, to maintain their existing GP. This is to ensure continuity of care during admission and settling in. The Home has a medication policy which is regularly reviewed to ensure compliance with current regulations. The manager ensures that this policy is followed at all times. MAR sheets are used for all clients. Individual lockable cabinets are provided in each room for those clients who are able to self administer medication. There were two immediate requirements and one requirement from the last visit in 2008 regarding medication, two had been met, one had not and that was for a care plan to be in place related to pain relief. The responsible individual Mr Colville has written to us to say that the care plan is in place but had not been reviewed since January 2008. We looked at four care plans. We saw instructions for staff to care for one individual: two staff to provide assistance check integrity of skin and pressure areas, ensure daily shave and teeth cleaning. We saw that this individual was receiving care for a pressure area we saw that the dressing had been changed and we saw a list of applications and dressings to be used. We saw that the individual was cared for in bed and there were instructions for staff on how to move the person within this environment. We also saw risk assessments for this individual regarding choking, falls and pressure areas. There was also a manual handling assessment and we saw that a speech therapist had visited the individual and given advice for the person to assist with swallowing. On an assessment tool used by the home for the care of pressure areas we saw that someone had recorded that the pressure area was grade 2 which was not the same as other documents on the care plan which indicated it was a grade 1. The dates for this information were two days apart. We saw for another individual that they mobilise independently for short distances and there were instructions for staff to place for example the commode near so that they Care Homes for Older People Page 13 of 31 Evidence: could remain reasonably independent. We saw instructions for staff regarding the nutritional intake for one individual who had been seen by the dietitian; staff were to encourage breakfast as the person liked this meal and to offer small regular meals with snacks in between. Although we saw fluid monitoring and turn charts for some people we did not see that this individuals food intake was monitored. We also saw that the individual was on a pain relief patch, a care plan was in place we saw that the last date of review was January 2008. We saw risk assessments for falls, choking and pressure areas, no moving and handling assessment. One care plan we saw that the individual was to have regular tests for their blood thickness. We saw on the 11th January 2010 that the clinic had been contacted by the home regarding this. Action for the home was for blood sample to be taken ASAP. We did not any records to indicate that any action had been taken. The booklet that is used to monitor the blood tests stated that the last test was carried out on 21st December 2009; with the next one due the 4th January 2010. Whilst looking at the care plans we saw that one person is living at the home within the Mental Health Act, we saw from medication records that several other people are receiving medication for their mental well being including injections to stabilise their mood. We did not see any care plans related to the care and support for individuals for their mental well being. We looked at the medication storage and administration records. We saw the medication records for 11th January 2010 to the day of the visit. The medication fridge is kept locked in the office. We saw that records had been kept regarding the temperature of the fridge however these were not weekly and during October through to the end of December 2009 the records showed three recordings of temperature. In the two days prior to the visit we saw that the temperature was recorded as 10.5 degrees C and 8.6 degrees C respectively both of which are higher than is recommended. We could not see that any action had been taken. The fridge was seen to hold medication that was required to be stored at a temperature less than that recorded. We saw that nursing staff take and record the blood pressure for individuals on medication to manage this. We saw that the list of homely remedies that the home can offer without prescription was last signed and agreed by the GP in May 2005. We saw that where medication was added to the medication records by staff by hand they had not recorded the amount received and the date. We saw that staff were not Care Homes for Older People Page 14 of 31 Evidence: recording when they applied prescribed creams and lotions. We saw in the medication records kept by staff six gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required there was no record of why it had been given and outcome for the individual. The medication administration records did not always have a date and amount of what medication was received into the home. The home keeps Morphine and Buprenorphine as controlled medication this is kept locked in a cupboard in the managers office. Other medication is kept in individual rooms in locked cupboards. All surveys returned by staff indicated that they are given up to date information about the support they are to give people that live at the home. Surveys for people who use the service have been completed by their relative or advocate. One respondent said that that their relative is usually dressed well with make up and jewellery, which they normally would have worn when able to do so themselves. Whilst we were looking at care plans we heard a member of staff interacting with an individual user of the service, we had looked at this persons care plan and they had difficulties with swallowing. We heard the staff member in a raised voice questioning why the individual was coughing why are you coughing, you arent choking you are not eating, no one is coming so there is no need for it. We discussed this with the manager who said she would look into the matter. Care Homes for Older People Page 15 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 who use the service participate in activities appropriate to their age, peer group and cultural beliefs or as part of the local community; dietary needs are well catered for, and food available meets individual dietary requirements and choices. Evidence: The AQAA for the home said that:The home has an open visiting policy, to maintain social networks and actively encourage the participation of significant others in care giving as desired. We recognise the importance of maintaining the clients privacy. We encourage occupation and activity, through organised activities and supporting clients with their hobbies. A notice board provides information on special events activity sessions to facilitate choice. Local newspapers are provided in the lounge to ensure that residents remain part of the local community. One professional activity session is provided, which is open to clients and their relatives. A number of staff also attend to help the residents to achieve as much as possible from the sessions. An activities co ordinator provides activities between 9:30 and 15:30 four days per week. Morning sessions are provided in the lounge conservatory area, with one to one sessions provided after lunch for those who do not wish to or are unable to attend group sessions. Through person centred care planning we take a flexible approach to care delivery and daily routines, to ensure that a tailored service is delivered according to Care Homes for Older People Page 16 of 31 Evidence: the wishes of the client. Our key worker system ensures continuity of care and limits as far as possible the number of different staff delivering personal care and therefore fosters genuine reciprocal relationships and a true understanding of the individual and how they wish to live. Meal times are the highlight of the day, with fresh, home cooked food, well presented. The cook is aware of the individual preferences of each resident. Communal facilities for dining are provided inside and out, or clients can have meals served in their rooms. The views of clients and their advocates are sought wherever possible with regard to menus, facilities and activities, to ensure that the home provides the service its residents want. Information is provided about outside agencies and ways in which services can assist such as advocates and Independent Mental Capacity Advocates. Clients are able to have their own private phone lines should they wish. The garden has been landscaped with level access, raised beds and a sensory garden to provide equal access to all and encourage activity at all levels of dependence. Activities are designed to provide mental and physical stimuli, in a sensitive and signified way, involving all five senses. Activities are scheduled with recurring themes or games to provide a familiar routine. These include music singing, sewing projects, painting, chairobics. A structure timetable is display in both lounges, allowing clients to make choices about which activities they would like to attend. Some sessions are flexible to allow the changing requests and needs of the client to be accommodated. We noted that there have not been any changes in this area since our last visit. There is an activities coordinator who is employed four days a week from 09:30 to 3:00pm. On the fifth day another person is responsible for activities. The activities schedule is listed in the dining room on a weekly basis. We saw activities records for all people detailing the activities they enjoy and the ones they have participated in. There are also photographs and examples of art work they have completed such as an embroidered cushion or art work. The types of activity available include music, going out, chairobics, sewing, knitting and quizzes. People we spoke with who use the service said they liked most things offered. On the day of our visit we noted that in the morning there was craft free choice and sewing and in the afternoon the activity person went to see individuals in their rooms between 1:00pm and 2:00pm, for the last three quarters of an hour there was a game in the lounge. The manager said this time was spent with inidvduals and who was seen and length of time would depend on the individual and what they wanted to do; there might be several short visits made or fewer longer ones. As we walked around the home we asked if we could chat with individuals who had finished their meals, two individuals said they had not enjoyed their meal very much although they liked their pudding. In the dining room another individual sitting at the Care Homes for Older People Page 17 of 31 Evidence: table said they had enjoyed the meal. Care Homes for Older People Page 18 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. People who use the service are protected through the open complaints process and staff knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said:The home has a clear and accessible concerns complaints procedure which illustrates the time scales and how complaints are dealt with. The complaints procedure is described in the client guide and is displayed in the entrance hall. Clients and relatives are made aware of the complaints procedure on admission, and are encouraged to discuss any issues with either the Matron or Deputy Matron as soon as possible. This enables us to delay quickly and effectively with issues before they become serious. Staff are trained in dealing with concerns and complaints and are supported with policies to assist them in the management of complaints, to include record keeping. The Home ensures that clients and their relatives have access to information about CQC and its role. Staff receive training during induction, NVQ and through regular updates on local and national guidelines relating to Adult protection issues. The management follow strict recruitment policies and procedures, ensuring that references are taken up and CRB and ISA checks are completed. The company operates a zero tolerance policy for adult abuse and responds openly to any concerns. If a bruise is found, a bruise chart is implemented to monitor and explore any possible causes and or trends that might highlight abuse or training issues. The key worker system is used to reduce the number of different staff involved in the clients care on a regular basis. This help to develop supportive relationships where clients hopefully feel Care Homes for Older People Page 19 of 31 Evidence: able to express any concerns to their key workers. The home has complaints procedure, which are outlined in the Statement of Purpose and Service User Guide and on display in on a notice board above the visitors signing in book. It includes the timescale of response and the address and phone number of CQC. The AQAA for the home states that the safe guarding adults policy was last updated in May 2008. Although the AQAA said that staff were trained to assess an individuals capacity to make decisions we could not see what training staff for this and there was no record on individual care plans regarding an assessment of capacity . We are aware of two safeguarding alerts that have been made to social services regarding care and service being given, one of which is currently being investigated. We saw that staff look at the homes protection of vulnerable adults policy, a booklet from West Sussex Council and this is discussed with the staff member and if it is felt they have sufficient knowledge the manager signs the induction sheet. We were unable to ascertain how many staff had received training in safeguarding adults as all training is kept on individual files. Care Homes for Older People Page 20 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 who use the service have a living environment which is maintained and decorated. Evidence: The AQAA for the home said:A constant programme of maintenance ensures that the home is fit for purpose and is clean, odour free and a dignified and pleasant place in which to live. A full time maintenance person is employed by the home. Patient specific slings and where infection is identified, washable chairs, are provided to reduce the risk of cross infection. Where infection is not present we avoid the use of vinyl coverings as we feel these are undignified, institutional, and uncomfortable. A range of seating is provided in the lounge, conservatory and quiet room, including a sofa, which has proved very popular, and again reduces the risk of institutionalizing care. A Flat screen television with freeview and DVD is provided in the lounge. The corridors throughout the home are decorated to a high standard with emphasis on bright lighting. Fire retardant furnishings are used. The fire alarm system has been replaced with smaller zone areas to allow faster detection of fires. Fifty percent of the home has swing free door closers directly connected to the fire alarm. Dorguards are provided in other areas, following risk assessment. Appropriate signage and fire extinguishers are provided. The home has a pager call bell system, which is monitored by computers to ensure calls are responded to promptly. The home is wheelchair accessible, as is the garden. The home is warm and client rooms are all private and Care Homes for Older People Page 21 of 31 Evidence: well furnished. The dining room and conservatory have been refurbished with new flooring, chairs, tables and furniture. A range of seating options has been included to allow maximum use by clients. All first floor rooms now have level access to the lift. Modern bathrooms with Parker bath and overhead hoists are available on each floor. The Home benefits from a new Sensory garden with wheel chair paths and seating areas. The sluice room which was in close proximity to the laundry has been relocated and the additional space incorporated into a refurbished laundry area. The laundry area has been completely refurbished with new machines. Sheets, pillow cases, bath and hand towels are now provided by an external laundry service. One room has been converted into two ensuite bathrooms for adjoining rooms. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. We could see that many people who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The grounds are landscaped and accessible. The home on this occasion was clean and free from malodours. There are 27 single bedrooms on two floors. People spoken with said that they are happy with their room. We saw that there was equipment available to support assessed needs such as nursing beds and hoists. There are suitable toilet and bathing facilities throughout the home and there are suitable laundry facilities with the correct machines, sited away from areas of food preparation and storage. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home do not protect the people who use the service. It is not clear whether staff have received all the mandatory training that is expected after induction or training to meet specific needs. Evidence: The AQAA for the home said:Nurses working within the Home are suitably registered with the appropriate body. We take care to recruit appropriate staff and follow rigorous recruitment policies and procedures, including CRB checks, ISA checks, references and a full exploration of work history and any gaps in employment. All members of staff receive induction training, which conforms to the revised TOPPS standards and have a training profile including a training plan. Each member of Staff receives regular updates. Members of Staff are encouraged to identify their own training needs through supervision, and value training. The care home has a policy of encouraging all care staff to train to a minimum of NVQ level 2. All members of staff receive regular supervision to ensure they are supported to develop good practice. A rota is on display which ensures that the home has appropriate cover at all times. Senior management within the home are skilled and have a range experience and qualifications appropriate to care of the elderly and palliative care. Regular staff meeting are held. The Key worker system has been refined to increase job satisfaction and therefore retention, by encouraging staff to engage more with their clients. Division of staff into teams, ensures skill mix and that new staff are supported by Care Homes for Older People Page 23 of 31 Evidence: senior staff. The Deputy Matron has a specialist background in palliative care to support the Matron. The Matron and Deputy Matron have completed a Manual Handling Train the Trainer course. This coupled with the training DVDs allows us to provide in house, on the job training. At the time of the visit there were 25 people living at the home. The staffing structure at the home consists of the responsible individual, the registered manager, deputy manager, nursing staff, care staff and domiciliary staff. There is one nurse and two care staff on each night. We looked at the rota and on the day of the visit the manager was also the nurse on duty, with five care staff. In the afternoon there is usually one nurse and three care staff. The manager told us that she had called another nurse in for the afternoon so that she could assist us and do some management administration work. There have been a few people employed by the home since our last visit and we looked at three of these files. We saw that in two cases there was only one reference, on the third file one of the references had been received after the start date. We saw that the individuals had commenced or completed a basic induction into the how the home runs and other areas such as fire safety and moving and handling and they had started the Skills for Life induction pack. It had been noted at the last inspection that the home had not sought references for staff before they commenced work, the inspector had discussed this with the manager and agreement was reached and this was noted in the report. As we found that the home is still not doing this, a requirement has been made. All staff information is kept at the home locked in the administrators office. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures for example recruitment, medication and care planning do not promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said:The home is well managed providing leadership and guidance for staff. The directors support the manager, providing guidance on changes of law and local and national policies. The directors encourage an ethos of customer care and service, and seek where possible to provide services and facilities which enhance the quality of life of our residents. The health, safety and welfare of clients and staff are promoted and protected. The home provides clear contracts of residency and itemises invoices for the clients. All monies received from Free nursing Care are refunded in full. We note that the AQAA states that the manager is registered this is not the case. Since the visit the Responsible Individual Mr Colville has contacted us to say that the managers application is underway. Care Homes for Older People Page 25 of 31 Evidence: There are areas of concern that have not been managed following our visit in 2008, examples of this are medication and recruitment. Requirements and immediate action were required with regard to medication after the visit in 2008. At our visit in January 2010, we found that the immediate requirements had been met and the requirements had been partially met. In addition at this visit we found that the management, administration and recording of medication places people who use the service at risk and new requirements have been made. The report for the inspection visit to the home in 2008 recorded that discussion had taken place with the manager regarding taking up references before employment commences. During our visit in January 2010 we found that this has not happened and a requirement is made on this occasion. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the manager has undertaken staff meetings. The manager stated that the home does not look after any money for people that use the service. The registered provider carries out Regulation 26 visits each month and completes a report. The home sends a questionnaire to the next of kin or representative of the individual and or the person using the service after admission. The last survey sent out to all people and or their representative as part of the service monitoring its quality was in 2008. The manager said the survey form is currently being updated to be more user friendly. We looked at the records for fire safety training and monitoring of equipment. Records indicated that tests and training had been carried out. Care Homes for Older People Page 26 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 27 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 1 7 15 15 Sch 3 (1)(b) The registered person must ensure that residents must have clear individual care plans describing the support that staff give to meet identified needs. This includes mental well being support. To ensure that all needs for all individuals are supported. 18/03/2010 2 8 15 15 Sch 3 (3)(m) The registered person must ensure that the individual health needs are met for example blood tests which may lead to a change in medication, and that action to be taken is written clearly, and that there is a plan of action to follow through on care and treatment. To ensure that all needs for all individuals are supported 18/03/2010 Care Homes for Older People Page 28 of 31 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 and that people receive treatment in a timely manner. 3 9 13 13 (2) The registered person 18/03/2010 must ensure that records are kept of when medication is administered or any reason why it may not have been. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 9 13 13 (2) The registered person must ensure that a record is kept of the amount of medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 5 9 13 13 (2) 18/03/2010 The registered person must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. 18/03/2010 Care Homes for Older People Page 29 of 31 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 This will ensure that the individual receives the correct medication and helps to monitor their health. 6 29 19 19 Sch 2 (7) The registered person must ensure that a thorough recruitment including references is carried out before staff commence employment. To safeguard the people using the service. 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 18/03/2010 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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