Care Home: Bernard Sunley Nursing Home

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What the care home does well Prospective residents who may wish to use the service have up to date information about the home in order that they can make an informed choice about using the facilities and services offered by the home. Residents have a full needs assessment prior to using the service in order to ensure that the homes staff have the skills and abilities to meet their assessed needs. Residents are involved in decisions about their lives and have an active role in planning the care and support they receive. Residents health care is promoted and the care residents recieve is reviewed and changes recorded. The medication processes in the home are robust to protect residents from harm. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. The physical design and layout of the home supports residents to live in a safe, well maintained and comfortable environment. The control of the spread of infection and cleanliness is generally well managed. Staff receive training to ensure residents needs are appropriatly met. The management and administration of the home ensures that the home is run in the best interests of the residents. Residents views and opinions and those of others associated with the home are sought and acted upon. Residents welfare is promoted through the monitoring of health and safety in the home. What has improved since the last inspection? The home have improved the pre admission assessment documentation. The home have implemented Dementia training for all employees, offered palliative care training and some staff have undertaken training to improve their investigation and report writing skills. A team leader and registered nurse are undertaking a management course. The activity hours have been increased which has given the opportunity to employ another activities coordinator.The Smiles cafe has been opened for the use of residents and their families providing drinks and snacks. A new staff training programme has been implemented which includes induction training, end of life training, and have trained an in house moving and handling trainer in order to ensure that staff can be trained promptly. The staff supervision and appraisal forms have been revised to assist in improving the performance management of staff. What the care home could do better: Some residents rights to privacy is upheld yet systems which may infringe on other residents rights of freedom may be compromised and must be reviewed. Residents rights of choice and control about their daily life needs to be reviewed and further promoted. Improvements must be made regarding the mealtime support and supervision for some residents in the home to ensure their safety and well being. Residents are generally protected by the homes complaints and safeguarding adults procedures yet these need to be reviewed and implemented. Arrangements must be made for a risk assessment to be documented to assess the hazard being presented within the hairdressing room regarding the storage of chemicals and what actions will be implemented in order to ensure the safety and well being of residents. The staff in the home are not in sufficient numbers to support some of the residents and the deployment of staff needs in the home to be reviewed. Recruitment and vetting of staff to protect the welfare and safety of residents needs to be strengthened. The registered provider must forward to the commission an improvement plan detailing how the home intends to improve the services provided to residents to ensure their safety and well being. Key inspection report Care homes for older people Name: Address: Bernard Sunley Nursing Home College Road Maybury Hill Woking Surrey GU22 8BT     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: Suzanne Magnier     Date: 2 7 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 35 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 35 Information about the care home Name of care home: Address: Bernard Sunley Nursing Home College Road Maybury Hill Woking Surrey GU22 8BT 01483764300 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: manger@bs.fote.org.uk www.fote.org.uk Friends of the Elderly care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 25 beds providing nursing care to elderly people over the age of 60 years In respect of this service, residents may be admitted from the age of 60 YEARS AND OVER Of the 60 residents accommodated, up to 35 may be within the category DE(E) or DE, over the age of 60 years. Date of last inspection Brief description of the care home Bernard Sunley is a registered home, owned and managed by Friends of the Elderly, which provides nursing care services for up to 60 residents in the categories of old age and dementia. Accommodation in the home is arranged over two floors and includes communal lounge areas, dining rooms, single bedrooms with ensuite facilities and adapted Care Homes for Older People Page 4 of 35 Over 65 35 60 35 0 Brief description of the care home bathrooms and toilets. A cafe, chapel and enclosed patio garden are accessible for residents and their friends and families and the home is located close to local shops and offers car-parking facilities. Care Homes for Older People Page 5 of 35 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 who use this service experience adequate quality outcomes. The last key inspection of this service was completed on the 7th August 2007. This key inspection was conducted by Ms S Magnier Regulation Inspector and lasted for seven hours commencing at 10.00 hours and concluding at 17.00. The deputy manager represented the service. The inspector looked at and assessed how well the service was meeting the key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. The service had completed the Annual Quality Assurance Assessment AQAA. This initially helps us to prioritise the order of the inspection and identify areas that require Care Homes for Older People Page 6 of 35 more attention during the inspection process. This document was received by the commission and was noted as being well documented and is referred to within the report. The information contained in this report was gathered from observation by the inspector, speaking with a number of residents living at the home, some relatives who were visiting, the care staff and information contained within the AQAA. Further information was gathered from records kept at the home. The commission received a variety of written comments from residents and people associated with the home for example health care professionals and staff. The information from the comment cards has been added within the report. A full tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, some residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the deputy manager about the findings of the visit. The registered provider was contacted by telephone following the inspection to discuss some of the findings and seek to clarification of some issues documented within the report. The commission have not received or been made aware of any notifications of complaints or safeguarding vulnerable adults referrals since the last inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? The home have improved the pre admission assessment documentation. The home have implemented Dementia training for all employees, offered palliative care training and some staff have undertaken training to improve their investigation and report writing skills. A team leader and registered nurse are undertaking a management course. The activity hours have been increased which has given the opportunity to employ another activities coordinator. Care Homes for Older People Page 8 of 35 The Smiles cafe has been opened for the use of residents and their families providing drinks and snacks. A new staff training programme has been implemented which includes induction training, end of life training, and have trained an in house moving and handling trainer in order to ensure that staff can be trained promptly. The staff supervision and appraisal forms have been revised to assist in improving the performance management of staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents who may wish to use the service have up to date information about the home and have a full needs assessment prior to using the service in order to ensure that the homes staff have the skills and abilities to meet the individuals assessed needs. Evidence: The homes Statement of Purpose and Service User guide provide up to date information for a prospective resident or their representative to make an informed choice about using the services and facilities provided by the home. The home have an admission and assessment procedure dated 2009 which was sampled during the inspection. The deputy manager and team leaders evidenced through, the five care plans sampled, that they understood the importance of having sufficient information in the completion of a full needs assessment for all prospective residents considering admission to the home. Care Homes for Older People Page 11 of 35 Evidence: There was evidence to support that the care needs assessments had been completed with the prospective resident or their representative prior to admission to the home and admissions to the home only take place if the assessment team are confident that the homes staff have the skills and experience to support the individuals assessed needs. The deputy manager confirmed that admissions to the home are undertaken on the day that the homes doctor visits in order that the resident can meet with the doctor and have a full medical assessment on admission. One written comment received by the commission from a health care professional regarding the admission processess in the home stated I am particularly impressed by the pre-admission assessments, which mean the placements are appropriate and well planned. This also means the medical care is as seamless as possible after admission. It was observed during the inspection that a prospective resident and their representatives visited the home following an assessment in order to view the home and the facilities available and to join others in having a midday meal. The home does not offer intermediate care. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in decisions about their lives and have an active role in planning the care and support they receive. Residents health care is promoted and the care residents recieve is reviewed and changes recorded. The medication processes in the home are robust to protect residents from harm. Some residents rights to privacy is upheld yet systems which may infringe on other residents rights of freedom may be compromised and must be reviewed. Evidence: All care plans sampled evidenced that residents and their representatives had been involved in the development of their care plans which also demonstrated evidence of the residents equality and diversity. The care plans sampled were person centered and included a range of information about the resident for example their life experiences and social history, how they like to communicate, their skills and abilities, and how they like to make choices in their lives, be addressed and how their health care needs are met. Care Homes for Older People Page 13 of 35 Evidence: Eight written comments about the care residents receive at the home included The home is well run and cares for its residents look after patients well being in every sense, medical emotional spiritual and physical. Most aspects of my relatives care is very well covered. Sometimes things slip but that tends to be a staffing issue which has recently improved. I think overall the home does a very good job. The most important factor is my relative is very happy here, that says a lot for the staff and in their case the food. The facilities are first class. Medical emergencies are quickly dealt with, the manager listens to your opinions and often acts positively to them and the facilities are very good. They look after everybody well. There was evidence to support that the home has maintained links with the local general practitioner who visits the home regularly and was in the home during the inspection. Health care professionals visits are arranged for residents who require specific interventions and referrals are made where necessary to maintain residents health and welfare. The home have documented plans for assessing individuals nutrition and the management of residents body weight and where necessary pressure relieving equipment is used to promote good tissue viability. The care plans were up to date and reviewed regularly to reflect the changing needs of the residents. The care plans contained risk assessments which were relevant to the resident to reflect the hazards being presented in their daily life and the measures in place to reduce the hazards as far as reasonably practicable. The incidence of residents having falls was well monitored and where falls had occurred the residents risk assessments had been reviewed and updated in order to ensure their safety as far as possible. Whilst sampling a care plan it was noted that there was letter addressed to to whom it may concern regarding authorization of a procedure which the resident may not be compliant with. This matter was discussed with the deputy manager and a recommendation has been made that decisions made by representatives regarding the support and care requested for their friend or relative be more formalized regarding the residents mental capacity in order to ensure that the individual is not deprived of their liberty and are safeguarded from any allegation of abuse or harm. The deputy manager showed the inspector that the home are currently seeking additional information relating to residents human rights with regard to limitations on freedom and mental capacity to ensure individuals choice and promote the best interests of individuals living at the home. During the tour of the premises it was observed that residents residing in the Care Homes for Older People Page 14 of 35 Evidence: dementia unit of the home had a key pad system on their bedroom door. The deputy manager explained that this was in order to stop other residents going into the persons room without their consent and knowledge yet the resident could get out of their room if they chose to. It was observed that one resident was in their room with the door shut and did not have their call bell and drink in reach. The inspector spoke with a staff member who stated that the resident was unable to ring the bell and may spill the drink. Asked how the resident would summon assistance the staff member responded by advising that the resident would call out for staff to come to them. The inspector was advised that staff undertake half hourly checks to residents who are in their rooms and the checks are recorded. It was understood that the use of the key pad system on each residents door had not been fully reviewed since the system was implemented several years ago and no current risk assessments were in place to support the general use of the system. Following the inspection the inspector requested that the registered provider contact the local authority safeguarding team regarding the use of the key pad system on residents bedroom doors. It has been confirmed that the concern was also raised with the local authority deprivation of liberty safeguarding team who have advised that the home must complete documented risk assessments in order to ensure that the use of keypad systems on the residents bedroom doors is to ensure that the best interests of residents is being promoted. It has been required that arrangements must be made that where restrictions are imposed in respect of a resident that the reasons for any restrictions are documented and written risk assessments are kept under review. The home has a medication policy and procedure in place and continues to use a monitored dosage system. Medication records were well documented and accurate. The procedures for ordering, delivery and disposal of medicines were robust. Training records evidenced that trained staff who administer medicines had received appropriate training which was up to date. It was confirmed that homes doctor undertakes regular reviews of residents medication needs and these were well recorded. Whilst speaking with staff it was confirmed that people have a right to refuse to take medication and if the refusal continued advise would be sought in order to ensure the residents well being. Five written comments received by the commission from a health care professionals stated A good caring nursing home with a cheerful atmosphere, residents are respected and listened to with patience and understanding towards those who are difficult or with dementia. The cafe is a good friendly place to bring people together and visitors. The home promotes peoples independence, respects peoples individuality and support me as a professional. They are looking into how to make Care Homes for Older People Page 15 of 35 Evidence: the care home more of a home than an insitution and I look forward to this. They provide a good quality of care, meet peoples needs and involve family members in discussion and meet with them when appropriate. All the patients have their care individually tailored and all are treated as individuals. Throughout the day the inspector observed that people were addressed in a polite and courteous way by all staff and there was some evidence of meaningful professional relationships between staff and individuals at the home. It was observed that the bathroom and toilet doors had privacy signs and in general staff knocked on residents doors before entering their rooms. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents rights of choice and control about their daily life needs to be reviewed and promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. Improvements must be made regarding the mealtime support and supervision for some residents in the home to ensure their safety and well being. Evidence: The home was orderly throughout the day and some residents were observed moving around the home freely and having choices about where to be during the day which included staying in their room, being in the main lounge or courtyards, the Smiles cafe or being in the several quiet areas in the home including the non denominational chapel. As previously documented some residents rights to privacy and choice is upheld yet systems for example the key pad system which may infringe on residents rights of freedom and choice may be compromised and must be reviewed. Several residents were spoken with whilst being supported by staff to areas within the home. It was observed that there was an activities programme in the home and that the activities coodinators hold group sessions in the mornings. The inspector did not Care Homes for Older People Page 17 of 35 Evidence: observe any activities taking place due to being in other areas of the home. Two activities coordinators were in the Smiles cafe replenishing the stock and one resident was sitting having their coffee in the cafe. There were a variety of books available for residents to read and it was confirmed that residents have a choice about what activities they would like to do for example visiting garden centres, going to the pub or theatre, canal boat trips and also special events which were captured in framed photographs in the home. The AQAA advises that staff are involved in one to one time with residents yet this was not observed during the inspection. Six completed staff surveys were returned to the commission and staff views about the homes activities included there should be trips for most residents not just certain ones They have excellent activities schedules for each day. Several visitors were in the home during the inspection and all spoke highly of the care and support their relatives received and how in one instance that their relatives general well being and outlook had improved since moving into the home. The midday meals were observed in the nursing and the dementia units. In the nursing unit it was observed that meals and support for residents was well managed and efficient. The dining area was viewed and contained small tables which had been set with appropriate condiments, crockery, tablecloths and napkins. People were observed during the midday meal and were seen to enjoy their meal and spoke favourably about the meals served. Staff were on hand to support anyone who needed assistance. Concern was raised during the inspection regarding the poor practice on the dementia unit during the lunch time where six residents were in the lounge area with one staff member. The residents were sitting in armchairs and some, where appropriate, had not been supported to sit up to a dining table in the room. Several hazards were identified which included potential lack of dignity and respect for residents during their meal, lack of staff support, not ensuring the safety and supervision of residents whilst eating their meal and not ensuring residents were receiving an adequate midday meal. The concerns were brought immediately to the team leaders attention who intervened and sought additional staffing from one other staff member on the unit. During the feedback to the deputy manager at the end of the inspection the poor practice observed was discussed and the inspector advised that the commission would be contacting the registeterd provider regarding the concerns raised. It has been required that the dining arrangements within the dementia unit must be reviewed in order that sufficient and adequately trained staff are available to support residents during their meal times in order to take into account residents rights to dignity, respect, safety and well being. Care Homes for Older People Page 18 of 35 Evidence: The deputy manager and registered provider have advised the commission in the documented AQAA and following the inspection that there were plans in place to incorporate lounge/dining areas which would be more beneficial to residents within the dementia unit to make the mealtimes more meaningful. The registered provider confirmed that the plans were going to be implemented when the new manager takes up post in Novemebr 2009 however a decision has been made, following the feedback from the inspection, to implement the changes as a matter of urgency in order to ensure an improved standard of care and support for residents on the dementia unit during their mealtimes. Written comments about the meals from residents included perhaps send around a menu so the residents can make a choice. Food could be more wholesome like things like meat thats not minced and steak, BIG pork chops and fresh vegetables. One health care professionals comments included The food is good and the chef is willing to plan menus and to meet with the patients to assess their individual needs. There was evidence to support that residents had been asked about their views about the meals provided at the home and menus were available throughout the home to inform people about the food offered by the homes chefs. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally protected by the homes complaints and safeguarding adults procedures yet these need to be reviewed and implemented. Evidence: The home has an established complaints procedure which was evidenced as an up to date document and was available throughout the home and in each residents bedroom. It was confirmed whilst speaking with the deputy manager that no complaints have been received since the last key inspection. Written information received by the commission from eight residents at the home regarding how to make a complaint stated that five knew the homes complaints procedures yet three did not. It has been recommended that residents receive regular information regarding the complaints procedures in the home in order to ensure that they are aware of how to raise concerns and complaints. The security of the home was robust and incorporated a intercom system and people entering the home signed the visitors book. Three staff files sampled evidenced that Criminal Record Bureaux checks and Protection of Vulnerable Adult checks are carried out on all new staff. The home has a copy of the current Surrey County Council Multi agency Procedures for Safeguarding Vulnerable Adults. The homes policy regarding the safeguarding of vulnerable adults was sampled and it was noted it was dated 2005. There were some instructions for staff to follow Care Homes for Older People Page 20 of 35 Evidence: regarding what they should do to report any allegation. The inspector spoke with the homes operations manager, on the telephone during the inspection, who advised that the safeguarding procedures were under review and all staff would be made aware of the updated procedures in order to safeguard residents in their care. It has been required the homes safeguarding adults procedures need to be reviewed and implemented in order to ensure there are clear guidelines in place for people to report any allegations of harm or abuse. It was confirmed that one safeguarding referral had been made since the last key inspection and had been concluded. Records sampled evidenced that all staff had received safeguarding vulnerable adults training and where staff were due to attend the training this had been booked. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. As previously documented concerns had been raised regarding seeking additional information and assessing situations in the home with regard to the Mental Capacity Act 2005 and the Derprivation of Liberty safeguards in order to ensure the protection of the residents. Care Homes for Older People Page 21 of 35 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 physical design and layout supports residents to live in a safe, well maintained and comfortable environment. The control of the spread of infection and cleanliness is generally well managed. Evidence: The location and layout of the home remains suitable for its stated purpose and the home continues to provide pleasant surroundings for residents with suitable furniture and soft furnishings throughout the home for residents to use. The homes decoration plan was discussed with the deputy manager who confirmed that some shortfalls identified during the inspection for example the dining area in the nursing unit, the split bathroom flooring in the dementia unit and lack of adhesive of the toilet trim in a toilet on the dementia unit by the lounge had been included in the maintenance plan and would be rectified. Written comments received by the commission about the homes environment stated provides a clean and bright environment. The home is well maintained, always fresh and inviting. The control of infection in the home was well managed and staff were seen to wear protective clothing for all tasks undertaken in the home, disposal of clinical and Care Homes for Older People Page 22 of 35 Evidence: domestic waste was well managed and hand washing facilities were available to all people throughout the home. The home was clean and the general standard of cleanliness was good. One housekeeping staff member was spoken with during the inspection. The home has a passenger lift providing access to all floors and service records sampled evidenced that the lift is regularly serviced. Six completed staff surveys were returned to the commission and staff views about the homes environment and provisions included they should make sure rooms are cleaned and dusted properly as they need more cleaners make sure that clothing from the the laundry goes to the correct room and resident.make sure they have enough night pads and wipes all the time not just sometimes. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff in the home are not in sufficient numbers to support some of the residents. Recruitment and vetting of staff to protect the welfare and safety of residents needs to be strengthened. Staff receive training to ensure residents needs are appropriatly met. Evidence: The home employs thirty nine carers, fourteen of whom have achieved their National Vocational Qualifications in level 2 or above. As previously documented during the inspection it was observed that the home was not adequatley staffed at all times and staff were not at hand to meet the needs of residents. Concern was raised regarding the length of time residents were waiting to have their call bells responded to and in some instances some residents did not have their call bell or other means to summon assistance from staff available to them. It was observed that there were malfunctions within the call bell system and the maintenance person advised that this had been an ongoing problem with the call bell system for some while. It has been required that the home must ensure that the unnecessary risks to the health and safety of residents with regard to their lack of access to and the malfunctionning of the call bell system be rectified to ensure residents safety and well being. Information supplied to the commission following the Care Homes for Older People Page 24 of 35 Evidence: inspection indicated that the call bell system in the home was to be replaced with a new system on October 2009. These concerns were addressed with the deputy manager and team leader during the inspection and also with the registered provider on the telephone following the inspection. It has been required that the staffing levels and deployment of staff be reviewed in order to ensure that at all times suitably qualified, competent and experienced persons are working in such numbers as are appropriate for the health and welfare of residents. Five written comments received by the commission from health care professionals regarding the staff and staffing levels at the home stated Have more staff. Often difficult in finding a nurse to assist me when two people are needed to mobilise a resident. This is a very good home and the staff training is superb. They give the management good support and welcome constructive criticism. They need to have more regular staff and retain staff. All staff are very dedicated to their work, there is good house training for staff especially on the needs for people with dementia however I think there should be more staff to residents, although I know that the staffing ratios meet national guidelines. I know that every attempt is made to keep all staff fully trained in managing those with dementia. However managing challenging behaviour is an integral part of dementia care and I think there needs to be ongoing training with managing this. Written comments received by the commission regarding the staff from residents included provides kindly and qualified staff to tend to ones needs staff are kind and friendly. The staff are friendly and helpful. Some of the carers are of poor standard but this is a general thing throughout the medical profession. Too many are foreign and cannot speak English clearly and have little common sense or the desire to please. The home has good staff. Six completed staff surveys were returned to the commission and staff views about the home included there should be more information between staff members they expect two carers at night to get up 2 residents, wash and change all residents and do breakfasts on trays for some residents and also help with breakfasts for example supporting six residents to have their breakfast in two and a half hours. We feel it is too much and night staff are not listenned to. the manager does not give enough support or meet with staff to discuss how the night carers are working. Training is ongoing and excellent care. Sometimes I think the home should acknowledge and value each staff according to their designations. The staff are able to give good quality care to residents. Good teamwork. Care Homes for Older People Page 25 of 35 Evidence: The general atmosphere in the home was quiet and orderly and staff were observed to undertake their duties in a professional manner. Staff relationships with residents were observed to be professional and the use of terms of endearment supported trusting relationships between the resident and the staff member and residents preferences on how they liked to be addressed were documented in their care plans. The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled three staff files one of a trained nurse and two carers. Whilst sampling the trained nurse file it was identified that no application form could be located and the deputy manager confirmed that the staff member had worked in the home for several years. The care staff files were well recorded and evidenced the vetting practices were robust in order to ensure the safety and protection of residents in the home. These files contained application forms, with two references, evidence that face to face interviews had taken place and the job description in order that the staff member was clear about their roles and responsibilities. It has been required that records in the form of application forms in relation to the employment of staff must be available in order to ensure that the home operates a safe vetting system to protect and promote the safety and wellbeing of residents. The deputy manager confirmed that the home is committed to the ongoing training and development of staff and the staff files and training matrix detailed that staff attended induction, statutory training and specialist training for example dementia training. The home have introduced a new training schedule which includes e-learning and a new induction programme and an Admiral nurse to work with staff on the Dementia Unit to support and improve staff skills as well as supporting residents and their relatives. The home have also trained an in house moving and handling trainer so all new staff can be trained promptly in safe moving and handling techniques. Care Homes for Older People Page 26 of 35 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 management and administration of the home ensures that the home is run in the best interests of the residents. Residents views and opinions and those of others associated with the home are sought and acted upon and residents general welfare is promoted through the monitoring of health and safety in the home yet some areas need to be strengthened. Evidence: The deputy manager is currently overseeing the day to day management of the home. The commission have been advised by the registered provider that a new manager has been recruited and will commence their post in November 2009. It is understood that this person will apply to the commission to be registered as the manager. The deputy manager demonstrated throughout the inspection a knowledge and understanding of the day to day running of the home for the benefit of the residents. It was evident during the inspection that the homes staff have open and professional Care Homes for Older People Page 27 of 35 Evidence: relationships with residents and their visitors and their views about the care and support their friends and relatives receive is listenned to and acted upon by the deputy manager. A written comment received by the commission from a health care professional about the home stated I think this is an excellent nursing home dedicated to delivering a high quality of care. They are always willing and open to discuss development of the service to maintain high standardds. The home has an internal Quality Assurance process and there was evidence to support that the views from residents living in the home had been listenned to for example the home have increased the number of activity hours through the recruitment of a third activities coordinator, encouraged the chef to listen and talk to residents about their food prefereneces and dislikes, purchased new bed linen and responded swiftly to the changing needs and wishes of residents. Regulation 26 records of unannounced visits by the organisations area manager were thorough in assessing the quality of the service and it was confirmed that any issues identified would be addressed by the organisation in order that appropriate action would be taken to rectify the shortfalls. During the tour of the premises it was noted that hairdressing chemicals within the hairdressers room were not stored in complianace with the control of substances hazardous to health COSHH guidance and no risk assessment had been completed to assess the hazard. It has been required that arrangements be made for a risk assessment to be documented to assess the potential hazard being presented and what actions will be implemented in order to ensure the safety and well being of residents. The storage of other chemicals in the home were appropriate to ensure the safety and welfare of all people in the home. The homes fire procedures sampled confirmed that records were kept of fire tests and equipment checks and signage was available within the home to show people fire exits. The deputy manager confirmed that any personal allowance money that residents chose to be kept secure in the home is in safekeeping. The homes administrator and manager have access to the funds and all receipts and invoices are kept to ensure peoples finances are safeguarded. The home have a current certificate of registration and insurance and the recording of Care Homes for Older People Page 28 of 35 Evidence: accident and incidents has been maintained with the commission continuing to be informed promptly of events which affect the well being and welfare of residents living in the home. As recorded throughout the report a number of aspects of the management of the home are potentially putting the health, safety and welfare of clients and staff at risk. The shortfalls include the lack of the promotion of some residents rights to choice, control and freedom, residents safety and supervision during mealtimes on the dementia unit, lack of management of the staff resources and deployment of staff and some shortfalls regarding staff recruitment and management of risk assessments. It has been required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided to residents to ensure their safety and well being. Care Homes for Older People Page 29 of 35 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 30 of 35 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 13 Arrangements must be 27/10/2009 made that where restrictions are imposed in respect of a resident that the reasons for any restrictions are documented and written risk assessments are kept under review. In order to ensure that the best interests of residents is being promoted. 2 15 12 The dining arrangements within the dementia unit must be reviewed. In order to ensure that sufficient staff, who are appropriately trained, are available to support residents during their meal times in order to take into account residents rights to dignity, respect, safety and well being. 27/11/2009 Care Homes for Older People Page 31 of 35 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 3 18 13 The homes safeguarding adults procedures need to be reviewed and implemented. In order to ensure there are clear guidelines in place for people to report any allegations of harm or abuse. 27/11/2009 4 27 13 Arrangements must be 27/11/2009 made that the home must ensure that unnecessary risks to the health and safety of residents with regard to their lack of access to and the malfunctionning of the call bell system be rectified. In order to ensure residents safety and wellbeing by being able to summon assistance. Arrangements must be 27/11/2009 made that the staffing levels and deployment of staff be reviewed. In order to ensure that at all times suitably qualified,competent and experienced persons are working in such numbers as are appropriate for the health and welfare of residents. 5 27 18 Care Homes for Older People Page 32 of 35 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 6 29 17 Arrangements must be made that records in the form of application forms in relation to the employment of staff must be available. In order to ensure that the home operates a safe vetting system to protect and promote the safety and wellbeing of residents. 27/11/2009 7 38 13 Arrangements must be 27/11/2009 made for a risk assessment to be documented to assess the hazard being presented within the hairdressing room regarding the storage of chemicals and what actions will be implemented. In order to ensure the safety and well being of residents. The home must forward to the commission an improvement plan detailing how the home intends to improve the services provided to residents. To ensure their safety and well being. 27/01/2010 8 38 24A Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 A recommendation has been made that decisions made by representatives regarding the support and care requested for their friend or relative be more formalised regarding the residents mental capacity in order to ensure that the individual is not deprived of their liberty and are safeguarded from any allegation of abuse or harm. It has been recommended that residents receive regular information regarding the complaints procedures in the home in order to ensure that they are aware of how to raise concerns and complaints. 2 16 Care Homes for Older People Page 34 of 35 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. 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