Care Home: Birdsgrove Nursing Home

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What the care home does well Residents are only admitted to the home following a needs assessment to ensure that the home can meet the resident`s identified personal and healthcare needs. Residents` right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Residents spoken with on the day of this visit were complimentary of the care they receive with one person commenting: `they are really good to me here, I get everything I need`. Comments received on survey forms from residents included: `They care for me well`, `The day staff are very kind and caring` and `Have always received good treatment, nothing to complain about at all. Am very happy here.` One relative commented: `They are very patient with my relative and respond to all needs.` What has improved since the last inspection? Each resident now has a plan of care that is up to date and that they, or someone close to them, have been involved in making. The introduction of a detailed care plan audit tool is helping to ensure that the care plans are accurate and reflect the current situation. Each resident is treated as an individual with the whole staff team now working together to support residents to develop and follow their own personal interests and activities within the home. Residents, relatives and social and health care professionals have all commented on the improvements in this area. The organisation has amended their recruitment and staff supervision policies to be more in line with the requirements of the Care Homes Regulations. In the AQAA, to demonstrate the improvements made in the last twelve months and those planned in the next twelve months, the acting manager stated that: `The new owners are redecorating bedrooms and day spaces. A new nurse call system has also been installed in Surrey Nursing Wing. Flooring and carpets within bedrooms are renewed as necessary. The land behind the Dementia Unit has been cleared and a retaining wall is being built. On their survey form, one of the health and social care professionals commented: `there have been considerable improvements to the home`s environment, which have benefited the people who live in Birdsgrove. Certainly recent visits indicate that more people are using the communal areas.` Residents spoken with feel that they are being consulted and included in the decisions being made regarding improvements at the home and the staff spoken with expressed enthusiasm and a strong commitment to building on the improvements already made. What the care home could do better: Staffing levels at weekends and in the evenings need to be reviewed to make sure that residents can be confident that there are enough staff available at all times. Residents receive care and support from staff that have received all mandatory health and safety training and updates but would benefit from having staff on duty at all times who are trained and competent in working with people with dementia. The quality assurance and monitoring systems in place at the home have improved, but further work is needed to ensure that they are effective in evaluating and ensuring that the home is providing a safe and good quality service for the residents and that the requirements of current legislation and the home`s policies and procedures are being followed, in practice, by the staff. Key inspection report Care homes for older people Name: Address: Birdsgrove Nursing Home Warfield Road Bracknell Berkshire RG12 2JA     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: Denise Debieux     Date: 2 6 0 4 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 40 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 40 Information about the care home Name of care home: Address: Birdsgrove Nursing Home Warfield Road Bracknell Berkshire RG12 2JA 01344422261 01344423629 birdsgrove@asterhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Counties Care Limited (Aster Healthcare) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 87 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Birdsgrove Nursing Home is registered to provide personal and nursing care for up to eighty seven older people. Their registration includes providing care for people with dementia. The home is situated in a residential area of Bracknell, on the main road to the village of Warfield. The home is divided into three wings determined by the Care Homes for Older People Page 4 of 40 Over 65 0 87 87 0 0 7 1 2 2 0 0 9 Brief description of the care home development of the establishment over time. The Surrey Wing (23 places) was originally a large domestic home which has been converted, the Berkshire Wing (35 places) a purpose built two storey extension, and the Kent Wing (20 places), a single storey extension built in the 1990s for residents with dementia. Fees range from £569 to £850 per week. This information was provided on 26 April 2010. Care Homes for Older People Page 5 of 40 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 Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 26 April 2010 starting at 09:45am. The deputy manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home and any information that CQC/CSCI has received about the service since the last inspection. People living at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit fifteen of the forty four residents were involved in the inspection and information was gained from nine on duty staff. Prior to the inspection, survey forms were sent to residents, their relatives, staff working at the home and to Care Homes for Older People Page 6 of 40 social and health care professionals. Survey forms were returned by fourteen residents, four relatives, nine members of staff and four social and health care professionals. These survey forms were correlated and the results were shared with the deputy manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. Residents care plans, staff recruitment and training records, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, relatives, health and social care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Staffing levels at weekends and in the evenings need to be reviewed to make sure that residents can be confident that there are enough staff available at all times. Residents receive care and support from staff that have received all mandatory health and safety training and updates but would benefit from having staff on duty at all times Care Homes for Older People Page 8 of 40 who are trained and competent in working with people with dementia. The quality assurance and monitoring systems in place at the home have improved, but further work is needed to ensure that they are effective in evaluating and ensuring that the home is providing a safe and good quality service for the residents and that the requirements of current legislation and the homes policies and procedures are being followed, in practice, by the staff. 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 40 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 40 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. Residents are only admitted to the home following a needs assessment to ensure that the home can meet the residents identified personal and healthcare needs. This home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident or their representative will be invited to visit the home. Following the initial visit to the home, and if the resident wishes to continue, the acting manager or deputy manager will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and wishes. Since the last key inspection there has been one person admitted to the home. The file for this resident was sampled during this visit and it was seen that a Care Homes for Older People Page 11 of 40 Evidence: comprehensive pre admission assessment had been carried out, prior to the person moving to the home. In the AQAA, to demonstrate what the home does well, the acting manager stated that: All service users have a pre-admission and evaluation completed prior to admission with input from interested professions. This forms the basis of the initial Care Plan. This statement was supported by the findings on the day of this inspection. Of the four health and social care professionals who returned survey forms, one felt that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for residents and three answered: usually. Care Homes for Older People Page 12 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met. The home has a plan of care that the resident, or someone close to them, has been involved in making. Policies, procedures and practices are in place to ensure the safe administration of medication. Residents right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: At the key inspection in January 2009 a requirement was made relating to the need to have comprehensive and up to date care plans, this requirement was found to be not met at our subsequent visit in December 2009. During this visit we sampled four care plans. The care plans sampled were all based on full assessments of needs and appropriate risk assessments. The care plans set out the actions which need to be taken by care staff to meet the health and personal care needs of the residents. Full assessments of social care needs are now included and are accompanied by detailed social care/activity plans. The care plans included some Care Homes for Older People Page 13 of 40 Evidence: limited assessment of the residents preferences and choices relating to how they would like their personal care delivered and their preferred daily routines and in some, but not all, instances these preferences had been included in their individual plans. All care plans sampled had been signed by the resident and/or their representative to signify that they had seen and that they agreed to the contents. Care plans had been reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon and now evidence that staff are aware of and work to the residents individual plans. The outstanding requirement has now been met. On their survey forms, comments received from health and social care professionals included: the clinical care of the residents has never been better and over last six months there do appear to have been improvements in care recording. The staff appear more pro-active about referrals to specialist advice. E.g. tissue viability nurse, dietician, raise issues with GP. Staff spoken with felt that the new care plans are better and easier to follow and of the nine staff who returned survey forms, six felt that they are always given up to date information about the needs of the residents with three answering usually. Of the four relatives who returned survey forms, three said that the home always gives the support or care to their relatives that they expect and one answered always. Residents spoken with on the day of this visit were complimentary of the care they receive with one person commenting: they are really good to me here, I get everything I need. Comments received on survey forms from residents included: They care for me well, The day staff are very kind and caring and Have always received good treatment, nothing to complain about at all. Am very happy here. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. All residents spoken with felt that their privacy and dignity was always respected. Care Homes for Older People Page 14 of 40 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. Each resident is treated as an individual with the whole staff team working together to support residents to follow their own personal interests and activities within the home. Not all residents have the opportunity to participate in local activities and facilities but the home plans to arrange and offer community outings for residents this summer, especially for those that do not usually have the opportunity to leave the home. The opportunities for residents to exercise choice and control over their lives have increased and the further development of the new care planning system will enable staff to establish and implement more person centred care plans that are based on residents individual preferences in all other areas of their day to day life. Residents are able to keep in touch with family, friends and representatives and are provided with meals that are well balanced and varied with individual choices and preferences catered for. Evidence: At the key inspection in January 2009 a requirement was made that the home must provide facilities for recreation and make arrangements to enable each resident to engage in meaningful social activities that are based on their individual preferences and abilities. This requirement was found to be not met at our subsequent visit in December 2009 and a statutory requirement notice was served. At a compliance visit Care Homes for Older People Page 15 of 40 Evidence: to the home in March 2010 we found that the home had made significant progress towards identifying and meeting the social care needs of each individual resident but that further work was needed to find ways for the staff to assess and evidence that the social care needs for residents, who prefer to stay in their rooms and not participate in group activities, were being met. At this inspection the four activity/social care plans we sampled evidenced that the home has now fully met this requirement and the statutory requirement notice. We concentrated our sample on residents who either were not able, needed additional assistance or did not want to participate in group activities. The daily activity records sampled all showed that these residents had had substantial one to one contact with staff, on an almost daily basis, and that care had been taken to ensure that their past interests had been ascertained and taken into account when developing their individual social care/activity plans. At the visit to the home in March, the two activity organisers felt fully supported by the management, the registered nurses and the health care assistants and felt that all staff at the home were working together as a team towards developing and providing for the social care needs of all residents. In discussion with the two activity coordinators at this visit, both confirmed that this support and team work has continued and that the social care and activities have continued to improve. They both also described some of the new areas they are exploring e.g. the current work in the grounds of the home is to include building raised flower beds for the use of the residents who have an interest in gardening. There is some contact with the local community, inside the home, provided by visiting clergy and local schools. A few residents attend local day centres and clubs. Other residents are able to access the local community when their relatives organise and facilitate this. However, at present, there are a number of residents who do not have this opportunity. At our visit in March we were advised that the home plans to arrange and offer community outings for residents this summer, especially for those that do not usually have the opportunity to leave the home. At that time the manager advised that the provider has allocated funds for this and is fully supportive. During this visit the activity coordinators confirmed that this is still the plan and they are currently exploring transport options. Nine of the fourteen residents surveyed stated that there were always activities they could participate in, three answered usually and one answered sometimes. In the AQAA, to demonstrate what the home does well, the acting manager stated Care Homes for Older People Page 16 of 40 Evidence: that: All service users have a Person Centred Care Plan in-line with the Companys policies and procedures. Since the key inspection in December, staff have been working on identifying and improving residents social choices. Substantial evidence of this was seen in the activity/social care plans and the activities that each resident is now enjoying. In relation to autonomy and choice in the way personal care is delivered, observations of interactions between staff and residents showed that staff on duty were aware of individual residents choices and preferences as to how they like their care delivered and staff spoken with were able to describe individual residents preferred ways. Part of the preadmission and early admission process also involves gathering some information on personal care and daily routine choices and preferences, e.g. preferred time of rising. As mentioned in the last section of this report, the care plans sampled included some limited assessment of the residents preferences and choices relating to personal care and daily routines and in some, but not all, instances these preferences had been included in their individual plans. Of the four health and social care professionals who returned survey forms, one said that they felt the home usually supports people to live the life they choose wherever possible, two answered usually/sometimes and one answered sometimes. There are no restrictions to visiting times and staff support and encourage residents to maintain family contact. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining rooms was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. The majority of residents spoken with said they were enjoying their meal although two felt it was too salty for their taste. They were asked if they wanted an alternative but declined. Of the fourteen residents who returned survey forms, four said that they always liked the meals at the home, five answered usually, four answered sometimes and one left this answer blank. Care Homes for Older People Page 17 of 40 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. 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 now takes action to follow up any allegations. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. All of the relatives who returned survey forms stated that they knew how to make a complaint with three saying the home had always responded appropriately if they had raised concerns and one answering usually. At the last key inspection a requirement and a recommendation were made in relation to safeguarding the residents living at the home, following a number of concerns raised with us and the local authority safeguarding team and our findings on the day of that visit. Following that inspection we were advised that the home had taken action, that all staff had been given and signed for a copy of the Berkshire Safeguarding Adults Procedures Outline Guide and that the homes whistle blowing policy had been discussed with the staff who were now more than ever aware of Birdsgrove open door policy and that concerns will be dealt with in confidence and promptly. Staff who returned survey forms stated that they knew what to do if someone has concerns about the home and the social and health care professionals Care Homes for Older People Page 18 of 40 Evidence: who returned survey forms all felt that the home usually responds appropriately when concerns are raised. There have been no concerns raised with us or the local authority safeguarding team since the last inspection and the home have demonstrated that they now have practices in place to ensure that any potential safeguarding incidents are notified to the appropriate people and are well documented. The previous requirement and recommendation have both been met. Concerns relating to the checking and supervision of contract building workers are addressed in the Management and Administration section of this report. Residents spoken with said that they felt safe living at the home, comments received on survey forms included: no complaints and nothing to complain about at all. Care Homes for Older People Page 19 of 40 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 location and layout of the home is suitable for its stated purpose. The provision of new communal lounge/dining areas on Berkshire Wing and the recent and ongoing redecoration and refurbishment of the home, when completed, will offer much improved surroundings and facilities for residents in all areas of the home. Evidence: At our visit to the home in December 2009 we reported that: improvements have included the resiting and provision of a new main kitchen, and the provision of two lounge/dining rooms on Berkshire Wing. This work has involved extensive rebuilding of those areas. Now that the main construction work has been completed, work is underway to redecorate and refurbish all communal areas, replace the carpets in the hallways, stairs and communal areas and to redecorate and re-carpet some bedrooms where needed. On the day of this visit we were shown around the home and grounds. We saw that the redecoration programme, although not complete, is continuing and there were residents socialising in the new lounges on the Berkshire Wing. Residents spoken with in one of these lounges told us that they liked sitting in the lounge chatting with other residents. On their survey form, one of the health and social care professionals commented: there have been considerable improvements to the homes environment, which have benefited the people who live in Birdsgrove. Certainly recent visits indicate that more people are using the communal areas. Comments received from relatives on their survey forms included: The residents rooms are always kept Care Homes for Older People Page 20 of 40 Evidence: very clean and tidy. One relative commented on carpets in corridors and communal lounges in some areas of the home, feeling they would look better if cleaned, especially where there were paint spots from the recent decoration. On our tour of the building we also saw that a number of the carpets in the hallways and on the stairs had been temporarily repaired with tape, however, as quoted above, we were advised in December that replacement of the carpets in the hallways, stairs and communal areas is included in the current refurbishment programme. In the AQAA, to demonstrate the improvements made in the last twelve months and those planned in the next twelve months, the acting manager stated that: The new owners are redecorating bedrooms and day spaces. A new nurse call system has also been installed in Surrey Nursing Wing. Flooring and carpets within bedrooms are renewed as necessary. The land behind the Dementia Unit has been cleared and a retaining wall is being built. Once completed it is hoped to construct a sensory garden. The continuing upgrade of the Home with new furnishings. Continue with the plans to rebuild and refurbish the Home for the needs of our client groups. The residents bedrooms visited had all been personalised with many personal belongings and mementoes, with photographs of their family and friends often being displayed on the walls and furniture. We were advised by the activity coordinators that care staff are able to use these photographs as a talking point when spending time with individual residents. Some of the furniture seen in some of the bedrooms was tired looking but mostly in good repair, although in one bedroom we pointed out to the home that the drawers in a chest of drawers unit had collapsed, making the chest unusable and potentially putting the resident and/or staff at risk of injury should they try to open any of the drawers. The safety aspect of this is addressed further in the Management and Administration section of this report. It is noted from the homes AQAA that plans are in place to upgrade the home with new furnishings over the next twelve months and it was seen that the new furniture purchased for the communal areas was of a good quality. In the dementia unit (Kent) we saw that staff had been working hard to provide an environment that was positive for people with dementia, with many reminiscence items around on furniture, shelving units and also used to decorate the walls. One relative commented on their survey form: Staff have brought in 1940 kitchen things, they love it, they all remember this and can tell you wonderful things. All I can say is my relative is very happy. This work has also started in the Surrey and Berkshire wings, mostly in the communal lounges. When completed this will benefit the residents living on those units, a Care Homes for Older People Page 21 of 40 Evidence: number of whom also have dementia. Laundry facilities are sited in the basement with washing machines suitable for the needs of the residents at the home. Care Homes for Older People Page 22 of 40 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. Staffing levels at weekends and in the evenings need to be reviewed to make sure that residents can be confident that there are enough staff available at all times. New staff recruitment and staff mentoring policies have been introduced so that residents can have confidence in the staff at the home because all checks will be done in future to make sure that they are suitable to care for them and new staff will be appropriately supervised. The home shows a strong commitment to supporting staff to obtain National Vocational Qualifications in care and has introduced the mandatory common induction standards for all new staff. Residents receive care and support from staff that have received all mandatory health and safety training and updates but would benefit from having staff on duty at all times who are trained and competent in working with people with dementia. Evidence: At the inspection in January 2009 a requirement was made relating to the staffing levels at the home and ensuring that there were enough staff available at all times to meet the needs of the residents living at the home, taking into account the layout of the home and the different dependency levels of the residents. Although this requirement was found to be not met at the inspection in December, the home have now changed the way staff work, especially relating to meeting social care needs, and we found that this requirement has mostly been met. Care Homes for Older People Page 23 of 40 Evidence: There are three shifts at the home, the morning shift runs from 8am to 2pm, the afternoon/evening shift runs from 2pm to 8pm and the night shift is 8pm until 8am. Each wing is staffed individually during the day, with current staffing levels being as follows: Berkshire Wing (currently has twenty five residents) has one registered nurse and five care assistants on the morning shift and one registered nurse and five care assistants on the afternoon shift. Surrey Wing (currently has eleven residents) has one registered nurse and three care assistants on the morning shift and one registered nurse and two care assistants on the afternoon shift. Kent Wing (currently has eight residents) has one registered nurse and two care assistants on the morning shift and one registered nurse and two care assistants on the afternoon shift. After 8pm and overnight, each wing has one registered nurse on duty with one care assistant working on Kent wing and Surrey and Berkshire wings sharing three care assistants between them. In addition to this, the two activity coordinators work across the home on Monday to Friday from 9am until 3pm. Of the fourteen residents who returned survey forms, five said that staff were always available when they needed them, six answered usually and three answered sometimes. Comments received from relatives on survey forms, when asked what the home could do better, included: Staffing levels. Weekends seem to be a problem with the lack of staff and there could be more staff available in the evenings and weekends. Of the nine members of staff who returned survey forms, three said they were always enough staff to meet the individual needs of the residents five answered usually and one answered sometimes. The deputy manager explained that, at present, staffing levels on the day time shifts are based on a ratio of one member of staff to five residents, with an increase in staffing provided based on the dependency of the residents living at the home at the time, for example the number of residents needing assistance at meal times or needing two members of staff for transfers. We were advised that staffing levels are not increased at the weekends to cover the absence of the two activity coordinators. At present the home do not gather and collate information for all residents relating to personal choices that could have an impact on staffing levels at different times of the day or days of the week, for example individual residents preferred times of getting up and going to bed, preferred times for meals etc. The responses and the comments on the survey forms were shared with the deputy manager and the provider needs to explore these further with the residents and staff to identify what the issues are, especially relating to staffing levels at weekends and in the evenings. A requirement has been made. Care Homes for Older People Page 24 of 40 Evidence: At the last inspection in December we reported that the home shows a strong commitment to supporting staff to obtain further qualifications, with over 50 of care assistants holding a National Vocational Qualification (NVQ) level 2 or above in care. This standard was not re-assessed at this visit as there has been little change to the staff team. At the inspection in January 2009 concerns were identified in relation to staff recruitment practices and a requirement was made. In June 2009 the provider told us that the requirement had been met and that: Those staff involved in recruitment of staff are fully aware of the need to adhere to the legal requirements. At the following inspection in December 2009 it was found that the requirement had not been met and that the homes staff recruitment practices still raised concerns. Following that inspection the provider was asked to send us an improvement plan. In that improvement plan the provider stated: Using the new employee check list all personnel files have been revisited and audited. The deputy and administrator have read and signed the Aster Employment Policy and this has been evidenced within their personnel file. Also at the last inspection it was found that the home were not aware of, and had not put in place, additional measures that are required when they allow people to work at the home pending the return of a full Criminal Records Bureau certificate and a requirement was made. In their improvement plan the provider stated: A mentor is appointed to work with new workers and the mentors name is noted on the new workers personnel file and also on the duty sheets. New workers never escort clients outside the home. There have been no new employees since the last inspection, meaning we were not able to assess the homes new recruitment and mentoring practices. However, we sampled the files where discrepancies were identified at the last inspection and found that any missing information had since been obtained. We sampled the homes policy folder which contained the recruitment and mentoring policies. However, the folder only contained the front page of the mentoring policy and the recruitment policy in the folder was dated earlier than our visit in December. We were advised by the responsible individual that these two policies in the folder were not the correct ones, we were shown the correct ones on the computer and given assurances by the responsible individual that the policy folder would be checked to make sure it was up to date with all of the homes latest policies. Following the inspection we were sent a copy of the new recruitment policy, dated December 2009. It was seen that this policy covers the majority of the requirements of the regulations but does not include verifying peoples reasons for leaving previous employment working with vulnerable adults or children. Care Homes for Older People Page 25 of 40 Evidence: The home is using the mandatory Skills for Care common induction standards and we were advised that staff will now be supervised until they have fully completed the induction standards. Of the nine staff members who returned survey forms, all answered that they are given training which is relevant to their role. Eight answered that they are given training which helps them understand and meet the individual needs of the residents, with one leaving this answer blank. Seven answered that they are given training that helps them to keep up to date with new ways of working, one person answered no and one left this answer blank. Comments received from social and health care professionals included: Looks after clients with advanced dementia and associated behavioural problems with a lot of care and understanding and Many of service users have dementia as a diagnosis alongside physical needs and are in the main body of the home rather than in the dementia specialised unit. Sometimes difficult behaviours are exhibited e.g. non-compliance with care - staff need training and knowledge of how best to manage these situations. At the time of writing the AQAA, the home reported that almost 60 of residents had dementia. Also in the AQAA, the acting manager told us that some trained staff have completed dementia care training and that they plan, in the next twelve months, to continue ensuring that all of our staff receive training pertinent to the residents care needs with an emphasis being placed on dementia care. In discussion with the deputy manager we were advised that she is in the process of booking some staff on a dementia course later this year and that a number of staff had already received training. The figures for the number of staff who have received training in dementia care and those still needing to attend the training were not immediately available during our visit. A requirement has been made. As stated earlier in this report, the home have introduced a new care planning system and are working towards a more person centred approach. This is evidenced very well in the social care/activity plans sampled, with some choices and preferences also being included in the care plans for personal care and support. We were advised that, as yet, there has been no training for staff in person centred care planning and a recommendation has been made. In our compliance visit to the home in March of this year we reported that: Training from an external specialist in providing activities for people with dementia has been arranged at the home for mid May, with places available for twenty staff. Of the two activity organisers, one has been on an activity provision distance learning course for the past year and feels it is really useful. The other will be attending the training arranged for May and then plans to look at additional training when she has been in her new post for a little longer. Care Homes for Older People Page 26 of 40 Evidence: Of the fourteen residents surveyed, five said that the staff always listened and acted on what they said, three answered usually and six answered sometimes. The deputy manager plans to explore the latter result further. Additional comments made by residents on their survey forms included: The day staff are very kind and caring. They are friendly and supportive, They look after us and our welfare and they care for me well. One relative commented: They are very patient with my relative and respond to all needs. Care Homes for Older People Page 27 of 40 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 quality assurance and monitoring systems in place at the home have improved, but further work is needed to ensure that they are effective in evaluating and ensuring that the home is providing a safe and good quality service for the residents and that the requirements of current legislation and the homes policies and procedures are being followed, in practice, by the staff. Residents feel that they are being consulted and included in the decisions being made regarding improvements at the home. Residents control their own money and choose how they spend it. If they cannot manage their money it is managed by someone close to them. The home does not handle the financial affairs for residents. Evidence: The home have been without a registered manager since May 2009. We were advised during this inspection that the acting manager is in the process of preparing to apply to us to become the registered manager of the home. Care Homes for Older People Page 28 of 40 Evidence: At the key inspection of the home in January 2009 requirements were made relating to the management of the home and quality assurance systems. At the key inspection in December 2009 we found that these requirements had not been met and that the quality assurance and monitoring systems in place were not effective in evaluating the quality of the service or ensuring that the homes policies and procedures were being followed, in practice, by the staff. In their improvement plan, sent to us following the last inspection, we were advised of a number of new quality assurance measures that had been put in place, for example: a new care plan audit form; weekly spot checks on care plan monitoring; weekly spot checks on drug administration and storage; residents hourly check audit. The home have continued with their four monthly audits of health and safety; medication; kitchen and overview of the home. In their improvement plan we were also advised that the provider has ensured that: all senior staff are aware of the location of Policies and Procedures of the home. Each Aster Policy folder has a list of signatures from the staff stating they are aware of the specific policies within each folder. During this inspection we found that the home is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home, although more work is still needed in this area. For example: as stated in the previous section of this report, the homes policy folder was easily accessible but not all policies were complete or were the most recent version, this could mean that staff are not working to the most current policies. The responsible individual gave assurances that the folder would be checked to make sure it contained the most up to date copies of the homes policies and procedures. We sampled the new care plan audit forms and these were seen to be comprehensive and designed to assess all areas of the care plan. The deputy manager explained that either she, or the acting manager, chose two care plans a week to audit. They complete a full audit and document their findings on the forms. Any issues found are rectified and fedback to the staff, either on a one to one basis or discussed in staff meetings if the issues are more general to the staff team. These forms were designed and introduced following our last inspection in December. When asked, the deputy advised us that they would expect to audit each care plan at least quarterly, however, at present the care plans audited are chosen at random and there is no system in place to record the care plans which have been audited to make sure they do not audit the same files. It was also noted that if only two care plans are audited each week, it would mean that, when the home is full, each care plan would only be audited once every nine to ten months. However we were advised that the care plan audit procedure is still being developed. Care Homes for Older People Page 29 of 40 Evidence: During our inspection we identified a number of concerns that were potentially placing residents at risk: In one residents bedroom there was a commode that was in a poor state of repair. One arm rest was damaged and the damaged area had been taped over. This could potentially be a source of infection. The other arm rest had previously been repaired (as evidenced by some remaining tape) however, the foam at the front of the arm rest was damaged and a part was missing, leaving the sharp end of a screw, holding the armrest on from underneath, protruding upwards and in a position where it could easily cause injury to the arm or hand of anyone using the commode. We were advised that that commode would have been for that residents sole use and in their room since their admission to the home a number of weeks previously. The deputy could find no record that any staff had reported the damage even though the resident needs the assistance of two staff to use the commode. We were later advised that that commode had been replaced and that the provider had approved the replacement of all commodes at the home. In the same room, as mentioned earlier in this report, we found that the four drawer chest of drawers was damaged. All but the bottom drawer were off their runners and resting on the drawer below. The drawers, when put back on their runners would not stay in place and fell down when any drawer was opened, creating a risk to the resident and staff of trapping fingers or other injury. Again we were advised that that chest of drawers had been replaced prior to the end of our inspection. We saw in the diary that this chest of drawers had been reported as needing repair at the end of March and there was a note to say this had been completed, however, there was no record of a maintenance request being reported since that date. In one bathroom, we found a yellow, half full, clinical waste bag was on the floor and not in a foot operated stand. We were advised by the deputy that the other bathroom on that floor had a foot operated clinical waste bin that staff should have been using and that staff knew the yellow bags should not be left open on the floor. We found the other bathroom on that floor did have the correct foot operated bin. However, the bin was rusted around the lid and the area behind the lid hinge had a build up of dirt and needed cleaning. We were advised that that bin should have been replaced and that new bins had arrived recently. On investigation the deputy found that the new bin had been stored in the basement. In a sluice room on the first floor we found that the door was not locked and that there were cleaning sprays and chemicals left in a carrier by the sink. One of these chemicals was labelled acid cleaner. We were advised that the cleaners are aware that these chemicals must be locked away when not in use. In a small tea making area near the kitchen there is a fridge used to store large boxes of milk for the milk dispensing machine. The fridge, when opened, did not appear to Care Homes for Older People Page 30 of 40 Evidence: be working, with the light off and the interior felt warm. The fridge thermometer in the fridge was reading 14 degrees C. There were two large containers of milk stored inside, which we were advised was for the residents for their breakfast and drinks. We were advised that the fridge was working when the chef had put the milk inside the night before. We were later told that the fridge had been switched off accidentally and had been turned back on. At present, this fridge is not included in the daily fridge temperature monitoring required for fridges used to store food items for residents use. Concerns about failure to monitor fridges used for storing food and drink for residents use was also raised at the inspections in January and December last year. One practice was also identified that could be placing residents at risk of harm or abuse. We were on one wing and observed one of the contracted builders enter the wing, go down the corridor, enter a bedroom (not occupied) and call out of the window to a workmate outside. He then came back down the corridor, entered the security keypad number into the pad by the door and left the wing, going to the kitchenette/tea making room near the kitchen. When followed up we were advised that they were the builders that had been working in the home for months and that they had been given permission to come into the home and make their own drinks. However, no checks (e.g. CRBs, references etc) had been carried out prior to employing the builders and allowing them to have unsupervised access to the residents living areas. In the absence of the suitability checks, no other measures have been put in place to ensure that residents are protected from the risk of harm and abuse. For each of the concerns identified above, the home has policies and procedures in place which, if followed in practice, would have been effective in removing, reducing or preventing the risks to residents. Requirements have been made relating to the specific risks described above but the provider needs to explore why risks to residents are not being identified, reported and dealt with by the staff and management at the home. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. All sections of the AQAA were completed and the information gave a reasonable picture of the current situation within the home. The evidence to support the comments made was mostly satisfactory, although there were areas where more supporting evidence would have been useful to illustrate what the service has done in the last year. The AQAA gave us some limited detail about the areas where the home still need to improve. The ways that they are planning to achieve this were not always Care Homes for Older People Page 31 of 40 Evidence: explained. For example: in the management and administration section of the AQAA the acting manager identified what they could do better as: Ensure that all staff understand their role and those policies and procedures relevant to their role. However, the plans for improvement in that section did not mention how this identified improvement would be made. The monthly visit reports, made on behalf of the provider under regulation 26 of The Care Homes Regulations, were sampled for the first three months of this year. It was seen that one of these visits had been carried out by the responsible individual, but it was recorded on the reports that two visits had been carried out by the acting manager of the home. This was discussed with the responsible individual as the visits have to be carried out by a person who is not directly involved in the conduct of the home. We were advised that this was a typing error and that the responsible individual had carried out all three visits himself. The reports did not have the date of the month when the visits had been carried out and there were no details of which residents and staff members had been interviewed during the visit or the outcome of those conversations. There was also no information relating to the required inspection of the premises or the findings of that inspection. Requirements have been made. There are regular, formal, residents meetings which are minuted and we were advised that any points raised by residents are actioned and feedback given. Residents views are also being sought as their care plans are being rewritten and reviewed and residents are able to meet with their key worker member of staff. Informal meetings have frequently been held with residents, both in group settings and on a one to one basis, as the staff team have been working with the residents on developing and introducing new activities at the home. At the last inspection in December 2009 it was found that policies and procedures are in place to protect residents financial interests and we were advised that the home does not handle the financial affairs for residents. Following a recommendation regarding record keeping made at the last inspection, the provider confirmed in their improvement plan that all registered nurses had been supplied with a copy of the Nursing and Midwifery Councils record keeping guidance. As stated above, the home is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home, and improvements in the overall management of the home have been seen during this inspection and commented on by social and health care professionals and relatives of the residents, some of these comments have been quoted earlier in this report. Care Homes for Older People Page 32 of 40 Evidence: Residents spoken with feel that they are being consulted and included in the decisions being made regarding improvements at the home and the staff spoken with expressed enthusiasm and a strong commitment to building on the improvements already made. Care Homes for Older People Page 33 of 40 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 34 of 40 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 27 18 The registered person must 30/06/2010 ensure that, at all times, staff are available in such numbers as are appropriate for the health and welfare of all residents. This requirement relates specifically, but not exclusively, to staffing levels at weekends and in the evenings. So that residents can be confident that the home is run in their best interests and that their choices and preferences in relation to how and when they receive their care is ascertained and taken into account when calculating staffing levels. 2 30 18 The registered person must ensure that at all times there are staff working at the home, in sufficient numbers, who are suitably qualified, competent and 30/07/2010 Care Homes for Older People Page 35 of 40 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 experienced in working with people with dementia. This applies to staffing on any wing where people with dementia are accommodated. So that residents can be confident that they receive care and support at all times from staff who are suitably qualified, competent and experienced. 3 33 26 The registered person must supply a copy of the Regulation 26 visit reports to the CQC link inspector for the home, each month, for the months of April September 2010. So that the registered person can ensure that the home is run in the residents best interests and that their health, safety and welfare is being protected. 4 33 26 The registered person must 30/05/2010 ensure that the care home is visited at least once a month by the responsible individual or an employee of the company who is not directly concerned with the conduct of the home. The visit must be unannounced and must 30/09/2010 Care Homes for Older People Page 36 of 40 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 include the activities set out in Regulation 26(4) (a-b). So that residents can be confident that the home is run in their best interest. 5 38 13 The registered person must 03/05/2010 make arrangements to prevent residents being placed at risk of harm or abuse. This requirement relates specifically, but not exclusively, to occasions when the registered person employs the services of external contractors who have not been subject to the recruitment checks required for people that work in care homes and have contact with vulnerable adults. So that residents can be confident that they are not being placed at risk of harm and abuse. 6 38 13 The registered person must 30/05/2010 make suitable arrangements to prevent infection and ensure that all fridges at the home used to store food and drinks which are for the residents use are included in the daily fridge/freezer temperature checks. So that residents can be Care Homes for Older People Page 37 of 40 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 confident that they are protected from any unnecessary risks to their health and welfare. 7 38 23 The registered person must ensure that equipment provided at the home for use by residents or persons who work at the home is maintained in good working order. This requirement relates specifically, but not exclusively, to commodes and bedroom furniture. So that residents can be confident that they are protected from any unnecessary risks to their health and welfare. 8 38 13 The registered person must 30/05/2010 make suitable arrangements to prevent the spread of infection at the home and provide suitable equipment for the disposal of clinical waste and ensure that any such equipment is kept clean and well maintained. So that residents can be confident that they are protected from any unnecessary risks to their health and welfare. 9 38 13 The registered person must ensure that unnecessary 30/05/2010 30/05/2010 Care Homes for Older People Page 38 of 40 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 risks to the health or safety of residents are identified and as far as possible eliminated. This requirement relates specifically, but not exclusively, to the correct storage of substances that are hazardous to health (COSHH). So that residents can be confident that they are protected from any unnecessary risks to their health and welfare. 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 30 It is recommended that the registered person provide all staff, involved in writing and implementing the new person centred care plans, with training in person centred care planning. Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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