Care Home: Bodmeyrick Residential Home

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What the care home does well People tell us that they `are reasonably happy` and feel "very much at home". Important information is obtained about people prior to agreeing to their moving to the home. This ensures that the team can meet everyone`s needs. Care plans are well structured around what each person wants and the team have a good understanding of this. The team of staff work well with professionals, which helps to improve peoples` health and social well being. Professionals tell us that there is `friendly staff` and people are `encouraged to participate in community events`. People who live at the home say that the staff are "very kind" and are well trained. Their relatives are very satisfied with the care and also say that their relations are "settled". People are treated as individuals for example their faith is respected and a Communion service is held every week for people to join in if they want to. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. People tell us that the meals are "very nice". Bodmeyrick is a comfortable place to live. People tell us that the home is well maintained. The garden has plenty of seating and so that people can enjoy being out in the fresh air. People living there say that they are encouraged to see it as their own home and that it is always clean. They are very involved in local community events like coffee mornings and regularly visit places of interest like Boscastle. Staff feel well supported and are encouraged to do training that is relevant and provides up to date knowlege. What has improved since the last inspection? New staff have been thoroughly vetted before being employed to work at the home. Staff are clear about what training the home is willing to fund. A comprehensive training programme is now available for staff and ensures that they develop their knowledge and skills to provide a better standard of care. A certificate of compliance for the electrical systems in the home has verified that it is a safe environment for those who work, visit and reside there. What the care home could do better: The diversity of people, with regard to significant relationships needs to be considered as part of the in house assessment process. This will ensure that people are not discriminated against and their needs met. People should have access to the information in their care plan that is in a format, which is suitable and respects their diverse needs.People`s needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the `Pool Activity level instrument`. This will ensure that activities are person centred and appropriate for the individual. Alternative ways should be explored to ensure that people are actively involved at meal times so that their independence, choice and autonomy is maintained. People`s dignity should be respected at all times and their needs put first and foremost, so that they are protected from potentially abusive behaviour. Best practice should be followed when updating the environment so that is it more suitable for people with cognitive impairement. Night staffing arrangements need to be reviewed to ensure that people`s needs are met whilst medication is being given out safely. The supervision of staff will ensure that they always follow best practice and are supported when caring for people living in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bodmeyrick Residential Home North Road Holsworthy Devon EX22 6HB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Taylor     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Bodmeyrick Residential Home North Road Holsworthy Devon EX22 6HB 01409253970 01409254448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Andrew Gordon Orchard,Mrs Janet Lucretia Orchard care home 28 Number of places (if applicable): Under 65 Over 65 28 28 28 28 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 0 Bodmeyrick provides personal care for 28 older people, some of whom may have dementia, mental health problems or a physical disability. The home is a detached property situated within easy reach of the facilities of Holsworthy. Originally an older type property it has been converted and extended to provide accommodation in 28 single occupancy bedrooms. A passenger lift enables residents to reach all areas of the home. There are two lounges and two quiet rooms. A day care service is provided on two mornings a week. The rear of the property comprises a car parking area. To the front is a lawn area that is pleasant and easily accessed. The home has a specially converted vehicle for taking small groups or individual Care Homes for Older People Page 4 of 31 Brief description of the care home service users out. Larger group outings use Deer Parks minibus (owned by the same Registered Persons). The home charges fees ranging from £360.00 to £400.00 per week. A copy of the last inspection report was on display in the entrance of the home. There is reference to this in the Service Users Information Handbook, where it also states that other copies are available on request from the office. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is Two stars. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Bodmeyrick under the Inspecting for better lives arrangements. We were at the home with people for 8 hours. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 10 people that live at Bodmeyrick and observed how staff looked after Care Homes for Older People Page 6 of 31 them. We met 7 staff, the manager and general manager. We sent surveys to 15 people living in the home and received 13 back. We sent surveys to 3 GPs and 3 other healthcare professionals and received 3 back. We also sent surveys to 15 staff and received 9 back. The comments people made, the resulsts of our survey and our observations are in the report. In May 2009, the fees ranged between £360 to £400 pounds per week for personal care. Additional charges are made for chiropody, hairdressing, newspapers and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk In February 2008, we received a complaint and did a random inspection to check that appropriate care was being provided for a person with an injury. We were satisfied with the care the person was being given. A report was published about this. What the care home does well: What has improved since the last inspection? What they could do better: The diversity of people, with regard to significant relationships needs to be considered as part of the in house assessment process. This will ensure that people are not discriminated against and their needs met. People should have access to the information in their care plan that is in a format, which is suitable and respects their diverse needs. Care Homes for Older People Page 8 of 31 Peoples needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the Pool Activity level instrument. This will ensure that activities are person centred and appropriate for the individual. Alternative ways should be explored to ensure that people are actively involved at meal times so that their independence, choice and autonomy is maintained. Peoples dignity should be respected at all times and their needs put first and foremost, so that they are protected from potentially abusive behaviour. Best practice should be followed when updating the environment so that is it more suitable for people with cognitive impairement. Night staffing arrangements need to be reviewed to ensure that peoples needs are met whilst medication is being given out safely. The supervision of staff will ensure that they always follow best practice and are supported when caring for people living in the home. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully involved in the assessment process and information is gathered from a range of sources ensuring that individuals needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. Evidence: In a survey 100 percent of people living in the home had been given a contract for their residency. Similarly, people were given sufficient information before moving into the home that enabled them to make a decision about moving into the home. We met the newest resident and looked at their care file to see how their needs were assessed. The manager meets with a person before they move in to the home to do an assessment. The assessment template recorded the diverse needs that the person had, for example what significant people were important to them and detailed information about the persons physical disability. However, this did not consider the Care Homes for Older People Page 11 of 31 Evidence: diversity of people with regard to relationships that are significant to them, for example if the person is in a same sex partnership. A social and economic history had also been completed. The person who we tracked had cognitive impairment and their advocates had been involved in collecting information about their life history. Additional information about this persons needs had been obtained from the local authority supporting the move into the home. This information provided the team with a picture of the social network a person has, hobbies and interests, and past working life. We looked at 3 other care files for people living in the home and casetracked their needs. Assessments completed covered how to move the person and what risks there were. Additionally, the potential risk of falls had been assessed. A person highlighted to be at high risk of choking had a nutritional assessment on their file. This has ensured that all staff have access to detailed information about the types of and presentation of foods that are appropriate for a person with swallowing difficulties. Another persons care file highlighted that they suffered long term pain due to a chronic illness. The nature of this pain, best treatment and care had been assessed and had been implemented and is excellent practice. The third person, who we case tracked, had learning disabilities. The manager had asked the persons care manager and specialist learning disability nurse to do an assessment to find out about what activities were suitable for the person. This information will enable the team to improve the quality of life for that person. The manager verified that intermediate care is currently not provided at Bodmeyrick. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive effective personal and healthcare support that is person centred and meets their needs. Evidence: We casetracked 3 people by speaking to them and also observing the care they were given. We read their care plans and concluded that individual personal preferences, routines and social activities were well known by staff and had been documented. This has ensure that all staff have a good understanding of how each person prefers their care and support to be delivered. We casetracked a person with learning disabilities and spoke to them about their care needs. The persons care plan was not in a format that is suitable for them and therefore was unable to read what had written and agreed. We discussed this with the manager, who was familiar with other total communication formats such as pictures, symbols and easy words and we have made a recommendation about this. Care Homes for Older People Page 13 of 31 Evidence: We looked at 3 care files, which demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living in the home receive appropriate care. Similarly, 100 percent of healthcare professionals in a survey verified that they are usually contacted and their advice is acted upon. We met groups of people sitting in the communal rooms during and after lunch. People told us that they regularly saw their GP if they needed to. One person told us that they were getting ready to go out to the opticians after lunch. The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. Where a high risk of development of pressure ulcers had been highlighted, we read similiar entries in the persons care plan and saw that the individual was sitting on pressurerelieving equipment. Additionally, we saw pressure relieving equipment on the persons bed. There was a good standard of information to ensure that care and health needs were assessed and monitored. Verbal information and feedback in respect of individuals personal and health care needs is given to staff at the start of each shift. This process was observed at the beginning of the afternoon shift. This handover also gave staff time to ask questions and give their view about how an individual was doing. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. All medication was kept in a secure place; controlled drugs were stored in accordance with legislation (Misuse of Drugs Safe Custody Regulations 1973). The system was easy to audit and we tracked medication given to 3 people. Records accurately reflected medication having been given as prescribed by the GP. We observed medicines being given out and best practice was followed that ensures people are given the right tablets at the right time. We tracked the care of a person that was being treated for depression and saw them being given their tablets as prescribed. The staff doing this had a good understanding of how the medicine worked and knew, for example, that it would take up to 3 weeks before the persons mental health would start to improve. Care Homes for Older People Page 14 of 31 Evidence: We met a group of 7 carers on duty during the morning shift. All of the staff we spoke to confirmed that they had done a Safe handling of medicines course. Additionally, they told us that medicines are only given by individuals that have done this course and been assessed as being competent. We looked at 1 staff file and saw a record that the manager had completed demonstrating that the individual had been assessed as being competent to give out medicines. We observed that staff always knocked on doors before entering peoples rooms. People told us that care was always done in the privacy of their room and that staff treated them with respect and kindness. One person said they all treat you nicely. Conversley, 1 person that returned a survey wrote I am deaf and need time to answer. The staff wont always wait and the call bell is not always answered. We discussed this with the manager and general manager who both said they were unhappy and would look into this to stamp out potential bad practice. During the inspection, we observed staff to be kind, patient and caring and received no further comments like this. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines and activities are flexible for people and they are listened to regarding the choice of daily activity. These could be individualized further to take account of the diverse needs of people living there to ensure that everyone leads a full and stimulating life. Evidence: Information provided by the manager verified that 100 percent of people living at Bodmeyrick are of christian faith. The home has links to the local churches and people said that a weekly service is held in the home. Additionally, people told us that they go to coffee mornings at local venues. We observed that people have unrestricted access all areas of the home. From observation and in discussion with people they told us they were free to do as they chose depending upon their abilities. According to information sent to the Commission, 5 people currently living at Bodmeyrick have dementia. We wanted to establish how peoples needs were met with regard to meaningful activity. An hour was spent in the lounges observing how staff Care Homes for Older People Page 16 of 31 Evidence: interacted with the people. This highlighted examples of good practice. During the period of observation, staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. We asked staff what they did to help these people pass the time. Staff said that it was difficult to sometimes know what people could actually do or wanted to do. We were told that one person, whose care we tracked, was known to like singing and were doing so when we met them. The manager verified that staff tended to act on instinct and information obtained from families rather than on assessed knowledge. Activities were group based and did not always reflect the level of ability that the person had given the stage of their dementia. To illustrate this point, some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the Pool Activity level instrument. This would also ensure that activities are person centred and pitched at the right level for people. The Home has a menu that rotates on a weekly basis. We asked people wether their likes and dislikes are known in respect of the meals served to them every day. People made comments like they [staff] just guess and I would like more choice. We observed people being given a meal and in one instance the person said they did not want it and was offered an alternative. Similarly, people that would be able to manage to pour out tea for themselves had to rely on staff to do this for them as the tea pot was not in easy reach of them. Therefore, some people that have capacity are not being enabled to be as independent as they should be. We observed the experiences of 3 people at lunch. Staff assisted people to eat by sitting with each person,attending to them and by supporting them at a pace that suited each person in an unrushed manner. Food was served plated to people. A pureed meal had sections separated others meals were nicely presented. No eating aids were seen, which would promote independence for people living in the home that have physical disabilities. We observed that two people used pudding dishes for their meal. One person had a plate but no plate guard and some food did fall off the plate. The same person also finger fed themself at one point. We also heard other people make positive comments about the lunch such as The food is excellent and I really enjoyed my lunch. The record of meals provided demonstrated that meals are varied. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bodmeyricks policies ensure that people are able to voice their concerns, safe in the knowledge that these will be acted upon and any potential abusive behaviour stamped out. Evidence: Information sent to the Commission by the manager states that people are protected through staff training in the protection of vulnerable adults and whistleblowing procedures. The complaint procedure is displayed on the notice board, and is in the service users guide. People are given this on admission. The manager verified that no complaints have been received in the last 12 months and no referrals made for safeguarding or to the Independent Safeguarding Authority. 100 percent of healthcare professionals verified in a survey that if they had any concerns they were usually dealt with appropriately by the management team. In February 2008, we received a complaint and did a random inspection to check that appropriate care was being provided for a person with an injury. We were satisfied with the care the person was being given. A report was published about this. 100 percent of people living in the home tell us that the staff listen and act on their wishes. However, some peoples comments indicated otherwise, for example that Care Homes for Older People Page 18 of 31 Evidence: some staff are sometimes impatient with comments like I am deaf and need time to answer. The staff wont always wait. A healthcare professional wrote in a survey that some of the carers could act more professional around the clients. Conversley, positive comments were made by both people living in the home and healthcare professionals like friendly staff and I am reasonably happy and dont think I should like to be anywhere else at the moment and Im happy and have every attention I need and Staff are always so kind. We observed staff to be kind, patient and caring and received no further comments like this. We discussed the comments made in 1 survey that suggests staff are sometimes impatient with the manager and general manager. They both said they were unhappy to hear this and will not tolerate this sort of behaviour. They told us that they would look into to the issues raised to stamp out potential bad practice. Records show that staff receive training in the protection of vulnerable adults. We talked to 7 members of staff about their understanding of what abuse is and what they would do if they suspected or saw abuse. Their responses demonstrate that they have a good understanding of what abuse is and how to ensure that people are safeguarded. Information around the home tells staff that there is the zero tolerance to abuse. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and well maintained home. Evidence: Information sent to the Commission verified that equipment is regularly serviced, that staff strive to keep the home clean, tidy and odour free. We did a tour of the home and visited almost every persons individual room. We also looked at maintenance records spoke with 4 people using the service, the Registered Manager, and staff. We also considered the results contained in the surveys we received and read 3 peoples care records. 100 percent of people in a survey commented that the home is always clean. We found that all areas of the home were clean and odour free. We found that the communal areas are well furnished and provide a homely environment for people to enjoy. Since the last inspection, all of the issues highlighted to the manager and provider had been dealt with. The Commission received written confirmation from an electrical contractor that the wiring has been checked and is in order. A maintenance book demonstrated that routine maintenance and renewal of the fabric and decoration of the home is done. We read contractors certificates, for Care Homes for Older People Page 20 of 31 Evidence: example for the fire safety systems showing that equipment is regularly maintained. There is a garden to the front of the property that is attractive with strubs and flowers in planters and appropriate seating for people. Relatives told us that they enjoy sitting out in this area with their relation on dry days and is very well used by people. We found that call bells are accessible in every room and that there is a lift to assist people when needed, in addition we saw grab rails and other equipment to assist people. 1 person reported that the call bell had stopped working. We reported this to the general manager who checked it, found that the bell had become dislodged and was returned to working order. Information sent to us by the manager verified that there are plans to upgrade the internal decor in communal areas and bedrooms over period time. New carpets for sun lounge and dining room, are due to be fitted shortly. We observed some areas such as the hallway carpet outside the office to be heavily stained and had not been highlighted for renewal in the AQAA sent by the manager. Similarly, fresh towels had been put out in 1 persons room that were threadbear. We looked in a linen cupbard and found other items of worn linen, which at the time was not being used. We discussed our observations with the manager and general manager who said that linen is regularly replaced and that all of the staff are expected to throw away old, threadbear linen as they come across it. Additionally, they told us that they were aware that the hallway carpet looking tired and is in need of replacement. However, as this is a high traffic area with a door leading outside an alternative to carpet was being considered. Replacement would enhance the accommodation people live in. Radiator guards were fitted throughout the home. Therefore, people we spoke to felt that their surroundings were safe and provide a comfortable place for them to live in. The home has guidance on infection control that is accessible to staff. Information sent to the Commission verified that the Department of Health Guidance Essential Steps had been used to audit practices to establish the effectiveness of infection control measures in place. We observed that protective clothing is accessible for staff to use and we observed staff regularly washing their hands after caring for people. This demonstrates good practice and protects people living in the home from the risk of infection. Information sent to the Commission verified that 50 percent of staff has done infection control training and further in house sessions are planned. We looked at the laundry, which is situated in the home. We met the member of staff who was doing the laundry and saw that there is a good system in place that ensures clothes and linen and washed separately for infection control purposes. There is 1 Care Homes for Older People Page 21 of 31 Evidence: domestic washing maching and a tumble dryer to cater for 28 people. We were told that the washing machine was not spinning properly and had been reported. We observed that staff were having to hang out very wet washing, which had not been spun properly. It was a very warm sunny day, so the laundry was drying but there was quite a backlog to get through. Staff verified that if it had been raining it would have been difficult to get the linen dry and this would have put additional pressure on staff when needing to change beds. We discussed that laundry arrangements with the manager, as these are now inadequate for the needs of people living in the home. The provider owns another home locally, which has a large laundry with dedicated staff. The manager said that they would revise the laundry arrangements and could consider having linen only laundered at the other home. We observed that linen and clothes are taken to the laundry in receptacles and clean clothing is returned to people the same day after being washed, dried and ironed. People looked well turned out in their own clean clothes. We tracked the care outcomes for 3 people and looked at their care records. These demonstrated that people had been offered the option to be vaccinated against flu. Similarly, we saw information about infection control measures and alcohol gel in the entrance hall for visitors to use. These measures help to minimise the risk of cross infection to people living in the home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices at Bodmeyrick have improved and therefore protect the people living there. The current review of the night staffing arrangements will ensure that peoples needs are met. Evidence: Mixed response with regard to giving feedback about care and support that people receive. 100 percent of people living in the home tell us that the staff listen and act on their wishes. 61 percent responded to their care needs being usually or sometimes met with comments like they come as quickly as they can. Sometimes I have to wait a bit and I am deaf and need time to answer. The staff wont always wait. and the call bell is not always answered. Information sent to the Commission by the manager verified that the staffing level had recently been increased between 8am and 8pm. We looked at the duty rosters for the weeks commencing 11th and 18th May 2009. There were 7 care staff, the registered manager and general manager on duty. Additionally, there were 2 cleaners, a cook and kitchen assistant on duty. We observed that peoples needs were being attended to promptly and no further concerns were received during the inspection. We discussed the roles and responsibilities of a care worker with a group of 7 staff. All of the staff had a clear understanding of their role and lines of accountability. We also Care Homes for Older People Page 23 of 31 Evidence: discussed staffing levels. Individuals reported that staffing levels had increased recently and therefore felt less pressured as a result and had more time to care for people. The group raised concerns about the night shift, at the beginning of which 2 staff give out medicines together as per policy. Staff said that this has meant that sometimes they are unable to answer bells as promptly as they would like to. We discussed this issue with the registered manager, also making her aware of comments we received in surveys. We looked accident records with her and saw that a number of these occured during the period when medicines were being done on the night shift. The manager said that she had also been made aware of these concerns and was reviewing the night shift arrangements. She said she was considering setting up a twilight shift so that there is an extra member of staff on duty between 8pm to 10pm and then from 7am when medicines are being given out. This measure would, if implemented ensure that there is sufficient staff on duty to meet the needs of people living in the home whilst medicines are being given out. We examined the files of three of the newest staff. Two satisfactory written references had been obtained for all of the staff prior to employment. Independent Safeguarding Authority checks had been undertaken and criminal records bureau certificates had been obtained also before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. Information sent to us by the manager tells us that 62 percent of staff hold NVQ level 2 in care and 100 percent have completed the induction training. Additionally, staff in a survey verified there are regular training sessions that encourages working in new ways and provides knowledge that is relevant. We spoke to a group of 7 staff who told us that in May 2009 the following courses are being done about diabetes, dementia awareness, equality and diversity and nutrition. Information sent to us by the manager states that they use the North Devon College and also have short courses provided by BHTS. A nurse educator works across both homes owned by the same provider. New staff said that their induction was very thorough and they felt well supported and eager to learn. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: The Registered Manager has nearly 4 years experience in running the home. She has achieved the NVQ level 4 in care and management. Throughout the inspection we found that she had a clear understanding of her role in meeting the stated aims and objectives of the home. Similarly, she provided the Commission with a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it she outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had been improved. Our main concern at the inspection has been that comments we received suggested that some staff might be impatient and people feel Care Homes for Older People Page 25 of 31 Evidence: rushed. However, we are confident that this matter had already been addressed to some extent with the increase in staffing levels between 8am to 8pm and we received no other comments from people living in the home about this during the inspection. As discussed under the staffing section, the night staffing arrangements are being looked at and proposed measures, if implemented, should ensure that peoples have access to prompt assistance if needed whilst medicines are given out safely. We observed that there are clear lines of accountability within the home. People told us that the registered provider is also very much hands on. We observed people being asked for feedback about lunch, their care and activities during the inspection. There is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager whenever they wish to do so. A residents meeting takes place every 6 months. People told us that Bodmeyrick is well run and they liked to call it home. Similarly, peoples comments in surveys were I am reasonably happy and I dont think I should like to go anywhere else. This is like home and quite happy and Im happy and have every attention I need and always good care and support. The staff are very good. 3 surveys from healthcare professionals were gnerally positive about the management of the home and verified that peoples needs are usually met. Evidence was also seen of systems that monitor the quality of the service provided. This included questionnaires and audits of health and safety for example. For people that are unable to look after their own money, Bodmeyrick holds a small float of money for people whose relatives are unable to do this for them. The money is kept in secure facilities. People we spoke to verified this and told us that either they managed their own money or relatives did this for them. We saw records that the home kept and checked balances which were correct. Appraisal records were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. We looked at 3 records and 1 of the staff had had a 1:1 with the manager in the last 12 months. Information sent to the Commission also verified that the manager works alongside staff every day. A more formal approach to supervision had been identified as an area for improvement. This will ensure that staff consistently follow best practice when caring for people and also have the opportunity to reflect and identify any gaps in their knowledge and experience. Comprehensive Health & Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We Care Homes for Older People Page 26 of 31 Evidence: saw various examples of this with regard to audits done, which included medicines, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, and staff told us that the alarm was regularly. A certificate verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Nearly all of the staff on duty held a current first aid qualification. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating, electrical and fire alarm systems. The manager had verified in information sent to the Commission that portable electrical appliance checks had been done and we were told by people living there that an electrician had looked at their appliances. The provider sent the Commission a copy of the certificate of electrical compliance. Therefore, we concluded that the health and safety of people living, working and visiting the home is maintained. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The diversity of people, with regard to significant relationships needs to be considered as part of the in house assessment process. This will ensure that people are not discriminated against and their needs met. People should have access to the information in their care plan that is in a format, which is suitable and respects their diverse needs. The diverse needs of people are taken into account when organising individual and group activities so that everyone leads a full and stimulating life. For example, use an assessment tool to establish exactly what individuals are able to do and indentify suitable activities accordingly. Alternative ways should be explored to ensure that people are actively involved at meal times so that their independence, choice and autonomy is maintained. Ensure that people in the home are treated with respect and patience, by supervising staff and taking a proactive approach to stamping out inappropriate behaviour. The diverse needs of people living in the home should be considered with regard to the decor, furniture and fittings. In particular, best practice should be implemented with Page 29 of 31 2 7 3 12 4 14 5 18 6 22 Care Homes for Older People regard to making the environment more suitable for people with cognitive impairement. 7 36 Staff should receive 1:1 supervision six times a year and a record be kept of it. This will ensure that staff follow best practice and are supported when caring for people living in the home. 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