Care Home: Brendoncare Park Road

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What the care home does well Brendoncare Park Road does well to provide a service which meets the assessed medical, physical, mental health and social needs of the people who live in the home. Residents` needs are met using a person centred approach. This means residents individual wishes, preferences, likes and dislikes, hobbies and interests and life histories ("My Life") are obtained and met. The home does well to ensure residents health care needs are regularly monitored and referrals are made when necessary to the appropriate health care professionals.These include access to a preferred GP, tissue viability and continence advisor`s and specialists in dementia care. The home does well to offer a variety of activities that are tailored to the wishes and needs of the residents. An activity coordinator ensures daily activities take place, which supports and encourages stimulation, socialisation and continued contact with the local community. The home does well to ensure the residents receive a balanced diet, prepared from fresh foods. The home caters for people with special diets and ensures regular drinks and snacks are provided during the day. Part of the service is a large period building retaining many of its period features and gardens. All parts of the home have been equipped to meet residents` physical needs and the service encourages residents to personalise their rooms with small items of furniture brought from their previous home and personal effects. Bedrooms are redecorated and refurbished if required and when they become vacant. The residents are supported by staff who are encouraged to enhance their skills and knowledge in care by attending relevant training and undertaking a National Vocational Qualification (NVQ). The management of the home does well to provide an open and inclusive environment where the manager makes herself available to meet with and listen to the views, ideas and concerns of residents, visitors and staff. Any complaints are dealt with efficiently, minimising distress to the complainant. The home does well to minimise risk of harm to residents by adopting clear health and safety procedures and ensuring all staff are only appointed once all recruitment checks have taken place, which includes obtaining a criminal record bureau check, (CRB). What people told us in `Have Your Say` comment cards, what is good about the home. "Brendoncare Park Road is a friendly, happy home. The care is excellent and residents are mostly happy and content. The staff stay for long periods, some staff have been here for over thirty years". "Brendon prides itself on the very friendly, family and homely atmosphere" "We are very happy with everything Brendoncare Park Road do". What has improved since the last inspection? This was the first visit to the service since registering with the Care Quality Commission. By undertaking an Annual Quality Assurance Assessment (AQAA) the service has identified areas where improvements could be made and how they intend to do this in the next twelve months. For example the home feels it could improve the involvement of residents and relatives in the care planning process and to ensure all staff receive training and have an understanding of residents` rights, Equality and Diversity and the `Deprivation of Liberty`. What the care home could do better: The home recognises in its Annual Quality Assurance Assessment where it could do better and its plans for the next twelve months, which includes developing their nutrition and continence care by using Care Quality Commissions triggers. Dementia care and the benefits of activities for stimulation are also included in the training programme to improve staff understanding. `Have Your Say` comment cards received from residents, relatives and staff raised concerns regarding staffing levels, although there did not appear to be problems meeting residents needs at the time of the visit, the service is advised to reassess concerns and re-evaluate the dependency levels of current residents. The service undertakes internal and external audits to ensure good outcomes for people using the service. The audit undertaken by a representative of the service (Regulation 26 visit) needs to be completed unannounced, monthly and in more detail to provide the manager with a report that tells her areas of good practice and action required to improve areas that don`t meet the standards. Key inspection report Care homes for older people Name: Address: Brendoncare Park Road Park Road Winchester Hants SO23 7BE     The quality rating for this care home is:   two star good 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: Christine Walsh     Date: 2 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Brendoncare Park Road Park Road Winchester Hants SO23 7BE 01962869287 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sfoti@brendoncare.org.uk Brendoncare Foundation Name of registered manager (if applicable) Ms Mary Andrews Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 49 The registered person may provide the following category/ies of service only: 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 categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Brendoncare Park Road is a nursing/residential care home for service users over the age of 65. It can accommodate up forty-nine service users who are elderly or requiring nursing care. Brendoncare Park Road is owned by Brendoncare Foundation who registered the service with the Care Quality Commission in July 2009. Care Homes for Older People Page 4 of 34 Over 65 49 0 Brief description of the care home The home is located on the outskirts of Winchester City Centre and can be accessed using local transport. The home sits in well tended landscaped gardens and all areas of the home are tastefully decorated and furnished. The home comprises of a large Victorian house and two attached nursing wings. All rooms are single occupancy and dependent on service users assessed needs will determine what area of the home service users will accommodate. The home provides a varied range of activities and meals. Service users can purchase daily papers, access an hairdresser, chiropodist and volunteers visit the home weekly to open a shop for personal provisions and library books. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 2 star This means the people who use this service experience Good quality outcomes. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector. The registered manager assisted with the inspection visit. This was the first key unannounced visit since the service was registered with the Care Quality Commission. The Annual Quality Assurance Assessment (AQAA) document was completed and forward to the the Care Quality Commission on time. The AQAA informed us that the diverse needs of the residents living at Brendoncare Park Road are acknowledged. This is done by using a person centred approach, taking into account residents assessed needs, their individual wishes, beliefs and disabilities. Care Homes for Older People Page 6 of 34 This includes supporting residents to make a valued contribution to their community, supporting residents to make everyday choices and to make choices in respect of their end of life care. The information obtained to inform this report was based on viewing the records of the people who use and work for the service, of which three residents and two staff records were viewed. The day-to-day management of the home was observed, records in relation to the management of the home were viewed and discussions with residents and staff took place. The people who use this service are referred to as residents in the AQAA and at the time of the visit, therefore the people who use the service will be referred to residents throughout the body of the report. Care Homes for Older People Page 7 of 34 What the care home does well: Brendoncare Park Road does well to provide a service which meets the assessed medical, physical, mental health and social needs of the people who live in the home. Residents needs are met using a person centred approach. This means residents individual wishes, preferences, likes and dislikes, hobbies and interests and life histories (My Life) are obtained and met. The home does well to ensure residents health care needs are regularly monitored and referrals are made when necessary to the appropriate health care professionals.These include access to a preferred GP, tissue viability and continence advisors and specialists in dementia care. The home does well to offer a variety of activities that are tailored to the wishes and needs of the residents. An activity coordinator ensures daily activities take place, which supports and encourages stimulation, socialisation and continued contact with the local community. The home does well to ensure the residents receive a balanced diet, prepared from fresh foods. The home caters for people with special diets and ensures regular drinks and snacks are provided during the day. Part of the service is a large period building retaining many of its period features and gardens. All parts of the home have been equipped to meet residents physical needs and the service encourages residents to personalise their rooms with small items of furniture brought from their previous home and personal effects. Bedrooms are redecorated and refurbished if required and when they become vacant. The residents are supported by staff who are encouraged to enhance their skills and knowledge in care by attending relevant training and undertaking a National Vocational Qualification (NVQ). The management of the home does well to provide an open and inclusive environment where the manager makes herself available to meet with and listen to the views, ideas and concerns of residents, visitors and staff. Any complaints are dealt with efficiently, minimising distress to the complainant. The home does well to minimise risk of harm to residents by adopting clear health and safety procedures and ensuring all staff are only appointed once all recruitment checks have taken place, which includes obtaining a criminal record bureau check, (CRB). What people told us in Have Your Say comment cards, what is good about the home. Brendoncare Park Road is a friendly, happy home. The care is excellent and residents are mostly happy and content. The staff stay for long periods, some staff have been here for over thirty years. Brendon prides itself on the very friendly, family and homely atmosphere We are very happy with everything Brendoncare Park Road do. Care Homes for Older People Page 8 of 34 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To assist people who may wish to the use the services, the home has provided information that provides clear detail and information about service and its facilities. The home will support and care for people who wish to use the services once they have established if they can meet their needs. This is done following a full assessment using the services assessment documentation and processes. Evidence: The Annual Quality Assurance Assessment (AQAA) told us we welcome enquiries to the home and invite them to visit. They receive our very comprehensive brochure containing all details about our home and Brendoncare Foundation. The AQAA also told us all prospective residents have a pre-admission assessment, which forms the basis of their person centred care plan and ensures the home has the right equipment to meet their needs. Care Homes for Older People Page 11 of 34 Evidence: The assessment records seen for three residents told us the home is capturing the holistic needs and wishes of the residents, such as, personal details, past and present medical needs, social history, preferred lifestyle, likes and dislikes and the name by which they wish to be known. We were informed residents, where they are able, are involved in the assessment process. The registered manager told us relatives play an important role in the assessment process and are encouraged to be involved where a resident has given consent or does not have the capacity to complete the assessment without support. The registered manager talked through the assessment process which includes visiting the prospective resident in their own home or hospital, inviting them to visit the home, which can be as often as they prefer before they make a final decision. The prospective resident can stay for a meal and join in activities if they wish. We were informed by the registered manager the service will obtain or undertake further assessments such as nutritional, waterlow (Waterlow is an assessment undertaken on residents where there are concerns that the resident is, or could be, at risk from developing pressure ulcers), mobility and psychiatric assessments if there is an identified need. A resident spoken with at the time of the visit confirmed she had been visited by the registered manager and asked a number of questions about what she could do and couldnt do. The home does not provide intermediate care but we were informed at the time of the visit that the home will provide respite care. The assessment documents were viewed for a resident currently using the home for respite. The registered manager informed us that the home will usually offer respite care to a resident with a view to them moving in long term at a later date. This was observed on the day when discussion took place between a short term resident and the registered manager regarding arrangements to move in on a permanent basis. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care planning and person centred processes supports the people who use the service to have their needs met in the way that they wish and prefer. The home supports the people who use the service to access health care professionals when required and addresses health care concerns of the people who use the service sensitively. The home supports the people who use the service to receive their medication as prescribed using safe medication administration practices. The home ensures the people who use the service have their privacy and dignity respected at all times. Evidence: The AQAA told us, On admission each has a comprehensive individual person centred care plan which is updated by the named nurse each month or more often if indicated. The AQAA went on to tell us risk assessments are in place to to identify Care Homes for Older People Page 13 of 34 Evidence: any residents at risk, including risk of malnutrition and risk of falls. Residents can register with a GP of their choice, medications are administered by a registered nurse and the residents dignity and privacy is respected at all times. The personal plans of four residents were viewed, these identified the individual needs of each resident and told us of how the resident wishes to have their care carried out. The plans provide detail on specific routines and details how much the resident can do for themselves. This information encourages staff to promote independence and respect residents individual wishes and choices. A member of staff told us: The care plans are detailed and very helpful. Residents who were spoken with told us they were happy and felt well cared for. One resident told us: I am very well looked after here, the staff are very kind and helpful. Four Have Your Say Surveys were received from residents, two of these told us that they always receive the care and support they need and two said usually. Three of five surveys received from relatives/friend feel the home always meets the residents needs and two said usually. Two surveys were received from staff, they told us they are usually given up to date information about the needs of the people they support and care for. There is evidence, which tells us residents are involved in the review of their personal plans and where required the plans are updated. In the four personal plans viewed there was evidence that risk assessments on residents nutritional needs, mobility and risk of falls had been completed. The risk assessments identify the nature of the risk and the actions staff need to take to minimise the risks. There is evidence that monthly reviews takes place and provides data that the risk of weight loss, pressure ulcers and falls have been minimised. The health care needs of the four residents were viewed. Their personal plans provided information on their past and present health care needs. Records are kept of visits made by health care professionals such as GPs and where required care plans have been drawn up describing the support and actions required by staff to support the resident to get better. Care Homes for Older People Page 14 of 34 Evidence: The home uses the Liverpool Pathway when supporting residents who are terminally ill or nearing the end of their life. The Liverpool Pathway is a continuous care plan that is updated frequently to reflect the changing needs of the resident, this includes pain management. A General Practitioner told us: The home does well to have a sensible and appropriate approach to patient symptoms, will keep the GP informed and make appropriate requests for visits The General Practitioner went onto say: Excellent nursing staff who work very hard. The home has dedicated areas for the safe storage of medication and registered nurses are responsible for administering medications. The systems used and in place at the time of the visit to the service provided evidence that the home ensures residents receive their medications as prescribed and required. A registered nurse informed us trained staff receive updates on safe medication practices and regular checks are undertaken on record keeping, stock control, storage, ordering and disposing of unused medications. The AQAA told us each resident has their own private room and the principles of philosophy of care are introduced to staff from the induction on-wards. This was confirmed by a member of care staff who told us she had received training specific to the principles of care. The member of staff demonstrated an understanding of the core values of care, providing scenarios where she would need to consider the residents dignity and privacy. A member of staff told us: Staff care for residents as they would wish to be treated themselves. Through the observation of activities at various times of the day told us that staff engage with residents in a respectful and dignified manner, calling the resident by their preferred name and taking time to engage in meaningful conversation. Staff who were spoken with told us they are aware of the rights of the residents and the importance of treating each resident as an individual. Care plans enforced the importance of treating residents with dignity and ensuring their privacy is respected. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does well to ensure the people who use the service are involved in a variety of activities of their choice, maintain contact with family and friends and receive meals that they prefer and which meets their nutritional needs. Evidence: The AQAA told us the pre-admission assessment includes identifying the residents preferences, choices, interests and religious requirements. The AQAA told us the service has a very energetic activities organiser and an active league of friends who fundraise and organise a library and weekly shop. The AQAA told us the service recognises the importance of maintaining ties with the local community and personal and social relationships. It went on to tell us the home provides good food from a varied menu which reflects the residents choices. The home demonstrates that the activity and stimulation of the residents is important. The home has a range of activities that have been implemented with the support of an activity coordinator and voluntary groups such as the League of Friends and local schools. Residents are made aware of the various activities taking place by notices placed around the home. These activities are displayed using various forms of media and tools to assist the residents who have a cognitive disability to have a better Care Homes for Older People Page 16 of 34 Evidence: understanding of what is available. Residents are encouraged to take part in group and individual based activities and encouraged to attend activities arranged outside of the home. Residents who are bed bound are also supported to attend activity sessions if they wish. All residents spoken with at the time of the visit told us they enjoyed the activities provided by the home, some told us they are happy to entertain themselves, it was observed that all residents had access to a television, music and reading material. Information found in three residents personal plans provided evidence that on admission the residents had been asked what their preferred leisure time, hobbies and interests were and documented. A weekly timetable of activities found in the residents perosnal plans included their specific interests. The activity organiser was not on duty at the time of the visit but there was evidence of residents engaging in meaningful activity. A relative said: The home has friendly staff and provides stimulating activities. During the course of the visit the home received visitors to the home, visitors were observed to be greeted warmly by staff, offered beverages and a quiet place to spend time with their loved one. Where visitors requested information about the care and wellbeing of their loved one staff were observed to respond sensitively, respecting the confidentiality of the resident at the same time. Have Your Say surveys received from relatives/friends told us the home always helps them to keep in touch and up to date with important information about their loved one. A relative said: Brendoncare Park Road provides a comfortable and caring home for residents and patients. Communication with staff is very good. Another relative said: The staff are always welcoming, friendly and flexible within the limits of their staffing. Care Homes for Older People Page 17 of 34 Evidence: Records seen for three residents and discussions with staff provided evidence the home is using a person centred approach. Information held in residents personal plan tell the staff how residents likes to spend their day, from getting up to going to bed. The plans provide information on how much residents can do for themselves including making choices about what they would like to wear and to eat. Displayed menus, organised activities and staff provides residents with support to make informed choices. Staff were observed and heard offering a variety of choices throughout the course of the day from what residents would like to drink, eat and do. The registered manager spoke at length regarding the training staff have received in Deprivation of Liberty and the Mental Health Act. She spoke of her plans to provide further training to all staff. The manager told us this to ensure staff are aware of their roles and responsibilities when supporting residents whose capacity to make choices and decisions about their daily lives is impaired due to their illness. Have Your Say comment cards received from four relatives told us residents are always supported to live the life they choose and one said usually. Compliments received from residents and relatives told us the service provides a nutritious and varied menu that is planned around the needs and wishes of the residents. A relative told us: The catering is very good A resident said: Special thanks goes to the chief chef and catering staff who could not more kindly and willingly provide alternative foods to that, that I cannot eat. Personal plans told us residents are asked about the food they like and dislike on admission to the home and nutritional assessments are carried out to ensure residents are receiving a balanced diet and to prevent weight loss and potential risk of illness. Records told us residents are regularly weighed, this is done to observe for weight loss and should the resident require extra food supplements. The chef spoke about the importance of providing nutritional, well balanced and appetizing diets for elderly people, demonstrating an awareness of risks associated to Care Homes for Older People Page 18 of 34 Evidence: various conditions and illnesses that can affect the elderly. These included diabetes, dementia, cealiacs disease and diets relating to different types of religions. Residents are encouraged to eat together in the main dining rooms to promote socialisation and integration. The dining rooms are comfortably decorated and furnished and tables are dressed with linen table cloths and napkins. Residents are served their meals by staff who are trained in food hygiene and are aware of making mealtimes an enjoyable experience. Residents requiring assistance or special aids to eat are provided for. Residents were asked about the quality of their meal of which all who were asked said they had enjoyed their meal very much. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does well to ensure the people who use the service are provided with information they need should they need to raise concerns or make a complaint. The home provides staff with training in safeguarding adults to minimise the risk of the people who use the service being harmed. Evidence: The AQAA told us the home has a clear complaints procedure, which is made accessible to the residents/relatives from admission onwards. The numerical data in the AQAA told us the home had received three complaints in the last twelve months one of which was resolved within twenty-eight days. The AQAA also told us there is zero tolerance to any form of reported abuse. It is dealt with immediately and at all times the safety of the resident is upheld. Discussion took place with the registered manager on how complaints are dealt with and how the home works towards minimising concerns and complaints. The registered manager told us all complaints and concerns are dealt with sensitively, where possible face to face or by letter. The complaint is recorded, investigated by someone working for the company and promptly responded to detailing actions taken by the home. Evidence of this was seen in the homes complaint log. The registered manager keeps such records safely locked away to protect the residents confidentiality. Care Homes for Older People Page 20 of 34 Evidence: To minimise concerns and complaints the registered manager told us she visits each resident daily to establish how they are and if everything is ok. She told us she has an open door policy and will make herself available for relatives and staff if they have any concerns. This was observed on the day of the visit. In addition to meeting with residents daily the manager provided evidence that regular meetings are held with residents and relatives, this is to ensure all are kept informed of any changes to the service and to listen to residents and relatives views and ideas. Residents who were spoken with told us they had no reason to complain because they were happy with the standard of care and support they receive, but if they were unhappy they would speak with a member of staff. Staff who were spoken with appeared aware of the complaints policy and their role and responsibilities in ensuring the concern/complaint is dealt with efficiently. Have Your Say Comment cards told us on the whole residents and relatives know how to raise concerns and who to speak to if they are unhappy. In comment cards received from residents the issue of staffing levels was addressed as a concern, as there not being enough staff. A resident also mentioned this when spoken with at the time of the visit. This was discussed with the manager who said she and the service providers were fully aware of the residents and relatives concerns and a meeting had been held to inform them of the reasons why staffing levels had been reduced. This will be addressed fully in the section on Staffing. Staff spoken with at the time of the visit provided information that told us they have an awareness of what constitutes abuse giving clear descriptions of what they would do if they suspected or witnessed an abusive act. Training records provided evidence that all staff receive abuse awareness training and this is regularly updated. The registered manager demonstrated that she is aware of her roles and responsibilities in reporting suspected abuse and the steps she needs to take to ensure residents are safeguarded from harm. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does well to provide a homely, clean and comfortable environment for the people who use the service. People who use the service have the risk of cross infection minimised by standards adhered to by staff and the homes policies and procedures. Evidence: The AQAA told us the residential area of the home is large Victorian building which has capacity for seventeen single rooms. The AQAA told us all rooms are tastefully furnished and furniture is in good condition, and over the past year all bathrooms have been refurbished. The housekeeping supervisor ensures a high level of cleanliness throughout the home. A tour of the older part of the home and the two nursing wings provided us with evidence that the home has been designed and furnished to meet the needs of residents currently living in the home. It was evident that some areas of the home have been decorated and refurbished, furniture and furnishings being of good quality. The dining room provided a comfortable and pleasant environment for residents to eat their meals. Have Your Say comment cards received from residents told us the home is always Care Homes for Older People Page 22 of 34 Evidence: fresh and clean. A resident told us: The decor and surroundings are very pleasant and well kept. There is a very pleasant atmosphere. A relative told us: Our mother is kept well dressed in clean clothes and her room is kept clean and tidy with her bed linen changed frequently. Individual residents rooms were observed to be tastefully decorated and furnished, with clean bedlinen, towels and airy. In some cases residents have furnished their rooms with small pieces of furniture brought from their previous home. Bedrooms were observed to perosnalised and reflect the hobbies, interests and history of the resident. The registered manager told us she supported residents living in the older part of the house to choose the decoration, furniture and furnishings. This was noted to have been carried out to a high standard with furnishings that reflect the grandeur of the environment and needs of the residents. The refurbishment of bathrooms allows better access for residents and a comfortable environment to have their personal care needs tended to. All areas of the home were noted to be clean, airy and free from offensive odours. There is a large enclosed garden which has been tastefully landscaped and is accessible for all residents including those requiring support with their mobility. An internal courtyard provides an alternative area for residents to visit, which has been designed to meet the sensory needs of residents. The registered manager told us she has plans to involve residents more in the planting of shrubs and flowers in the Spring. The AQAA told us that 90 percent of staff have received infection control training. Staff are issued with protective clothing such as disposable gloves and aprons, antiseptic hands gels and cleaning materials are used in limiting the spread of infection. Care Homes for Older People Page 23 of 34 Evidence: A member of staff spoken with at the time of the visit confirmed that she had received training on infection control and provided verbal evidence that procedures being used in the home assisted in minimising the risk of infection. A resident told us: The cleaning of rooms and public areas is good, laundry is efficient, normally things returned the following morning. Housekeeping staff are friendly and helpful. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is taking into account the views of the people living at the service and is reviewing staffing levels so that the people feel that their needs can be met in the time available and staff feel that they have time to provide the service people need. The home undertakes robust recruitment procedures to ensure the people who use the service are protected from the potential risk of abuse. Evidence: The AQAA told us staff whose first language is not English are supported by the Foundation to attend lessons. The allocation of staff is determined by residents dependency levels which are reviewed weekly. The AQAA goes onto tell us staff are encouraged to undertake a national vocational qualification (NVQ), follows strict Brendoncare recruitment policies. Training needs are identified during appraisal and supervision and incorporated into the the annual training programme. The registered manager informed us that the home has undertaken a review of the homes staffing levels and how staff are deployed to meet the individual needs of residents. A dependency tool seen at the time of the visit assesses the level of support each resident requires on a week by week basis, or more frequently if required. Staff were observed working in an unrushed and relaxed way, giving time to residents Care Homes for Older People Page 25 of 34 Evidence: when requests were made and providing support where required. It was observed that call bells were answered promptly. Changes to staffing levels and how staff are deployed has caused concern to residents, relatives and staff who feel there are now not enough staff to meet residents needs. A resident told us: I think the home is understaffed with carers, i.e the ratio between residents and staff. They work hard, but have no time for the all important caring side of nursing, i.e the time to pause and talk to a resident for a minute. A relative told us: Initially we were confident that the warm welcome and positive attitude of carers was most appropriate for our mothers lifestyle. Recently the changes in management and staff reorganisation appear to inhibit the carers in doing their job fully. A member of staff told us: I think mostly we do our best for all the residents that come to live here. It would be handy to have more hours in the day!. The registered manager told us several meetings have taken place to address concerns and individual meetings have taken place where requested. Evidence of discussions with all concerned was seen in minutes of meetings. Have Your Say comment cards told us on the whole staff were available when required and staff are helpful, friendly and kind. Concerns recognised in comment cards and raised at the time of the inspection have been dicussed with the registered manager and services responsible individual who recoginse further discussions need to take place. Staff spoken with at the time of the visit said they enjoyed working at Brendoncare Park Road, some who have worked in the home for many years, before and prior to the change of organisation. Evidence seen at the time of the visit told us staff are rewarded for their commitment and achievements. Staff spoken with at the time of the visit told us they had undertaken or would be undertaking a National Vocational Qualification (NVQ) appropriate to the roles and Care Homes for Older People Page 26 of 34 Evidence: responsibilities. The administrator told us she had NVQ level 3 in administration. The recruitment records for three new members of staff were viewed. It was found that appropriate recruitment procedures had been followed, which included the staff member completing an application, attending an interview, providing two references and completing criminal record checks. The recruitment process was confirmed by a member of staff who told us the above had taken place prior to them starting work in the home. This demonstrates the service takes steps to minimise the risks to residents. The home provided evidence that new staff undertake the Skills for Care Induction programme and are supported by the register manager and senior staff to complete the induction in a timely manner. The registered manager informed us that all new staff are supernumerary for the first week, working alongside senior staff and completing their induction as they progress through the next few weeks. Discussion with staff and evidence in staff training files told us the service provides a varied training programme which includes regular mandatory updates, such as moving and handling and courses specific to needs of the residents such as Dementia awareness and Equality and Diversity. Have Your Say comment cards told us that staff feel they receive training that is relevant to their roles, training helps them to understand and meet the individual needs of residents and keeps them up to date with the new ways of working. A member of staff told us: I like doing training, I like to know what I am doing and that I am doing it right. Residents and relatives told us they feel the staff are skilled and experienced to meet assessed needs. A member of staff confirmed that she had received a variety of training which included, fire safety, infection control, moving and handling, first aid, Dementia care training and safeguarding adults. The registered manager told us nursing staff are supported to undertake training specific to their roles and responsibilites and which is required under the terms of the Nursing and Midwifery Council. Currently the manager is supporting trained staff to undertake mentoring courses so they can support and supervise carers. Care Homes for Older People Page 27 of 34 Evidence: Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from an experienced manager who ensures reisdents views are sought and listened to, their finances and health and safety is protected by robust policies and procedures. The service must however ensure monthly regulation 26 visits take as required by the Care Homes Regulations. Evidence: The AQAA told us the home has a registered manager in place who has twenty seven years experience in commissioning and managing Care for the Elderly and who focuses on the delivery of care. The AQAA goes onto tell us about the management structure, the services open door policy and through the process of quality auditing ensures the service is meeting its objectives. The AQAA told us the Foundation has financial controls in place to safeguard residents finances. Through spending time with the registered manager and observing practice, evidence was gathered to demonstrate the manager conducts herself professionally, has an Care Homes for Older People Page 29 of 34 Evidence: awareness of the day-to-day running of the home and the needs of the residents. The manager told us she visits each resident daily, seeking their views and spending time with them answering queries and concerns. The manager also told us she will work along side staff as a role model and mentor. Staff spoken with at the time of the inspection told us they found the manager supportive and always available when required. Mary has really good ideas and is taking things forward. She is a good manager who has an open door policy and is always accessible. The manager is very good she will work along side you and is very understanding. The manager provided evidence that the service undertakes several quality audits to ensure the home is meeting its annual objectives and the National Minimum Standards for Older Persons. These include medication audits, health and safety audits, regular staff and resident meetings and regulation 26 audits. Regulation 26 visits must be carried out unannounced on a monthly basis, the purpose of the visits is to audit the standards in the home against the Care Homes for Older Peoples National Minimum Standards and provide a written report detailing the outcomes for the people who use the service, the provider is required to keep a copy of the regulation 26 report in the home in order that it can be viewed at the time of a key inspection. Evidence found at the time of the visit told us regulation 26 visits are not taking place unannounced, monthly and had scarce information. This does not demonstrate a thorough audit is taking place. The responsible individual must be aware of their responsibilities in conducting regulation 26 visits. The home supports residents with their personal finances, the service has policies and procedures in place and the administrator uses an auditing system that safeguards residents personal finances. Staff supervisions was not covered in full during this inspection visit, however staff who were spoken with said they were receiving supervision and felt well supported by the manager. The home provided evidence that all serviceable utilities such as gas and electrics are Care Homes for Older People Page 30 of 34 Evidence: regularly tested. The home has an on site maintenance man who deals with day to day health and safety audits and repairs. Records told us fire safety equipment is tested as per fire safety regulations and staff receive regular fire safety training. Staff spoken with at the time of the visit confirmed they have received fire safety training, which included using fire safety equipment, such as extinguishers and undertaking a full evacuation of the building. Training records confirmed that staff receive regular health and safety training which includes, moving and handling, first aid and food hygiene. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 26 It is required that the home recieves a thorough unannounced monthly regulation 26 visit. The people who use the service must be safe in the knowledge that the home is being regularly monitored and audited to ensure they are receiving a quality service. 08/03/2010 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 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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