Care Home: Brigshaw House

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What the care home does well The atmosphere in the home is relaxed. Everyone we spoke to said it felt like home. People said they were happy with their choice of this home. Their comments included: `It`s lovely here` `I have settled in nicely` `It`s a nice place, everyone is so kind`. Most people who live at the home and their relatives said they were well looked after. Their comments included: `Well looked after we are here` `Never have to rush` `Staff look after her well, no complaints at all` `Care is given to individual needs` `Very accommodating to patient and families needs` `Look after me in all ways`. When asked what the home does well, staff made the following comments: `It takes good care of looking after all the residents` `Brigshaw house is a warm friendly home` `Staff do their best to care for all the residents needs and help them to keep their independence and dignity`. Staff were familiar with people`s needs and could talk confidently about the support they give. Staff were able to describe people`s preferred routines with regard to their personal care and what works well for people. They showed thought for people`s privacy and dignity and were respectful in the way they spoke to people. Staff spoke very highly of their dementia awareness training and how it had changed the way they worked with people. Their comments included: `It`s all about seeing the person as a person and not their behaviour and knowing their previous life` `We use re-direction techniques when people get upset` `It has made me think more about why people may behave or react in certain ways` `Loved the training, made me want to learn more to help people with dementia` `So important to give people time to do things and say what they want`. People were very positive about the food and meals in the home. They said: `We are very well fed` `Food is always nice and plenty of it` `Meals are very good` `Food is home cooked, home made cakes and buns`. Staff spoke highly of the manager, Their comments included: `I feel that since new manager has been here the home is so much better place to work` `She sets good standards, wants things done right all the time` `If there`s a problem she deals with it` `Can ask her about anything and she will try to help` `New manager is there for her staff no matter what the problem is`. What has improved since the last inspection? Pre- admission assessments have improved and now have more detail on people`s needs. They would however benefit from life history information that would make them more person centred and individual to the people involved. The manager has reviewed the way in which care plans are developed, however further improvements are still needed to make sure people`s needs are not missed or overlooked. In the AQAA, the manager said health care needs are now properly monitored and involve the person who uses the service and their relatives. They also work with the involvement of the community matron to monitor people`s on-going health needs. She said there was now better communication between health professionals and the home. Records showed this too. The home has introduced a new monitored dosage, pre-packed system for medication. Records were clear and in order and showed medication is now managed well. In the AQAA, the manager said that a number of improvements had been made to the environment. These included: Many rooms re-decorated and carpeted. Entrance hall and staircase decorated. A summer house in the garden. Car park re-surfaced. New curtains in many rooms. The manager has now developed a training overview which clearly shows who has done what training and when updates are due. The availability of training for staff has improved. In the last year a number of training events have taken place, to equip staff to carry out their job. The manager is currently in the process of applying for registration with the CQC. This will make sure there is someone accountable for the running of the home. The manager now sends out annual questionnaires to people who live at the home, relatives of people who live at the home and health professionals, asking for their views on any improvements that could be made. Accident or incident reports are completed and kept in the home. These have now been forwarded to the CQC when necessary. The manager analyses these every month to see if there are any patterns or trends or ways of avoiding future accidents. This makes sure that the health, safety and welfare of people who use the service is protected properly. What the care home could do better: Some staff said they did not have enough staff to meet people`s needs properly at times. They said there are times when there are only two staff on duty and some people who live at the home need the assistance of two staff which then leaves others in the home unsupervised. Staffing levels must be reviewed to make sure people`s needs are properly met. Staff must receive moving and handling training to make sure they can meet people`s needs properly and safely. People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will make sure they receive person centred support that meets their needs fully. When we asked people what the home could do better, comments included: `Provide activities for residents` `There is a list of daily activities on the wall at the home but these don`t seem to be ever done` `More residents that you can converse with and take part in activities`. Staff also commented on the lack of activity in the home. They said: `There is little or no activity for the residents even though there is a poster on the wall` `Could do better`. On the day of our visit, people sat in the main lounge looked bored at times and were falling asleep. The way in which activity is organised must be reviewed, to make sure people`s needs are met and they are not bored. This is a specialist service for people who have dementia yet there was no evidence to show how their specialist needs in terms of occupation and stimulation are being taken into consideration. Some serious consideration should be given to the re-furbishment of the home, to make it more comfortable for people and to consider the specialist needs of people with dementia and memory loss. More information should be recorded in staff`s induction records to show evidence of the training that has been given. The manager should complete the Registered Managers Award. This will make sure she is qualified to manage the home. Systems must be introduced to make sure essential safety checks, such as electrical wiring, are carried out at the time they are needed. This will ensure everyone`s safety. Key inspection report Care homes for older people Name: Address: Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 1 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN 01132868421 F/P01132868421 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cymar Care Homes Limited Name of registered manager (if applicable) Mrs Amanda Machin Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Brigshaw House provides a service for up to twenty one older people, some of whom may have dementia, but do not require nursing care. The home is situated in Allerton Bywater, a former mining village midway between Leeds and Castleford and is close to local amenities and public transport. The building comprises of an older house with the addition of purpose built accommodation. There are seventeen single and two double bedrooms, good dining facilities and spacious sitting areas. There is car parking space at the front of the home and at the back there are extensive and well kept gardens, which are quiet and private. Care Homes for Older People Page 4 of 35 Over 65 0 21 21 0 1 7 1 1 2 0 0 8 Brief description of the care home Copies of previous inspection reports are available in the front entrance of the home. Information on fees is available by contacting the manager of the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 10am - 6pm on the 16 November 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor Care Homes for Older People Page 6 of 35 progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was reasonably well completed and gave us some of the information we asked for. Survey forms were sent out to people using the service, staff and health care professionals. A number of these have been returned and the comments made have been used in this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the manager. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Pre- admission assessments have improved and now have more detail on peoples Care Homes for Older People Page 8 of 35 needs. They would however benefit from life history information that would make them more person centred and individual to the people involved. The manager has reviewed the way in which care plans are developed, however further improvements are still needed to make sure peoples needs are not missed or overlooked. In the AQAA, the manager said health care needs are now properly monitored and involve the person who uses the service and their relatives. They also work with the involvement of the community matron to monitor peoples on-going health needs. She said there was now better communication between health professionals and the home. Records showed this too. The home has introduced a new monitored dosage, pre-packed system for medication. Records were clear and in order and showed medication is now managed well. In the AQAA, the manager said that a number of improvements had been made to the environment. These included: Many rooms re-decorated and carpeted. Entrance hall and staircase decorated. A summer house in the garden. Car park re-surfaced. New curtains in many rooms. The manager has now developed a training overview which clearly shows who has done what training and when updates are due. The availability of training for staff has improved. In the last year a number of training events have taken place, to equip staff to carry out their job. The manager is currently in the process of applying for registration with the CQC. This will make sure there is someone accountable for the running of the home. The manager now sends out annual questionnaires to people who live at the home, relatives of people who live at the home and health professionals, asking for their views on any improvements that could be made. Accident or incident reports are completed and kept in the home. These have now been forwarded to the CQC when necessary. The manager analyses these every month to see if there are any patterns or trends or ways of avoiding future accidents. This makes sure that the health, safety and welfare of people who use the service is protected properly. What they could do better: Some staff said they did not have enough staff to meet peoples needs properly at times. They said there are times when there are only two staff on duty and some people who live at the home need the assistance of two staff which then leaves others in the home unsupervised. Staffing levels must be reviewed to make sure peoples needs are properly met. Staff must receive moving and handling training to make sure they can meet peoples needs properly and safely. People who use the service should have detailed care plans and risk management Care Homes for Older People Page 9 of 35 plans, clearly outlining all their support needs. This will make sure they receive person centred support that meets their needs fully. When we asked people what the home could do better, comments included: Provide activities for residents There is a list of daily activities on the wall at the home but these dont seem to be ever done More residents that you can converse with and take part in activities. Staff also commented on the lack of activity in the home. They said: There is little or no activity for the residents even though there is a poster on the wall Could do better. On the day of our visit, people sat in the main lounge looked bored at times and were falling asleep. The way in which activity is organised must be reviewed, to make sure peoples needs are met and they are not bored. This is a specialist service for people who have dementia yet there was no evidence to show how their specialist needs in terms of occupation and stimulation are being taken into consideration. Some serious consideration should be given to the re-furbishment of the home, to make it more comfortable for people and to consider the specialist needs of people with dementia and memory loss. More information should be recorded in staffs induction records to show evidence of the training that has been given. The manager should complete the Registered Managers Award. This will make sure she is qualified to manage the home. Systems must be introduced to make sure essential safety checks, such as electrical wiring, are carried out at the time they are needed. This will ensure everyones safety. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, people who use the service can be sure that the home will meet their needs following assessment. Evidence: People said they were happy with their choice of this home. Their comments included: Its lovely here I have settled in nicely Its a nice place, everyone is so kind. Most people said they had received enough information about the home before deciding to move in. One person said they didnt know if they had. Care Homes for Older People Page 12 of 35 Evidence: Last year the manager told us she was going to produce information on the home in different formats such as large print or on tape, to make information more accessible for people. This has not been done as yet. The manager said she had not had the resources this year to do this but was now looking at how it could be done with their head office support. In the AQAA, the manager told us there had been improvements to the way preadmission assessments were carried out. She said, Comprehensive pre-admission procedure to ensure all specific needs are met and compile a care plan with as much involvement as possible from the resident. There have not been many people admitted to the home since our last inspection. The manager described how preadmission assessments can be carried out. She said they can carry out the assessments in peoples own homes or if people are in hospital. She also said that people thinking of moving in to the home can visit with their families as much as they like before making any decisions about moving in. The manager is aware of how to access community support resources such as specialist nursing services. This makes sure they have the right support to meet peoples needs properly. We looked at pre-admission assessment information for someone recently admitted to the home. We found that the manager had obtained assessments carried out through the care management process and then completed their own assessments of the persons needs. These assessments were completed before the person moved in to the home and then on the day of admission to get an up to date record of the persons needs. The assessments identified the persons needs well, in the main. However, the life history section had been left blank. Staff said this persons previous life history was important to know in terms of how they provided support for this person. Staff did however know the person and their background well and it was clear they used the persons past history when communicating with this person. Life history information would make the pre-admission assessments more person centred and individual to the people involved. We also looked at how people whos needs had changed were assessed. It was clear they had been monitored through the care planning process and referred to other agencies for support to meet their needs. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: People look well cared for clean, tidy and well groomed. Attention had been paid to detail. People had clean glasses and had their hair styled as they wished. Staff were patient, gentle and kind when interacting with people. They were discreet and respectful of peoples dignity when attending to any personal care needs. Most people who live at the home and their relatives said they were well looked after. Their comments included: Well looked after we are here Never have to rush Staff look after her well, no complaints at all Care Homes for Older People Page 14 of 35 Evidence: Care is given to individual needs Very accommodating to patient and families needs Look after me in all ways. People answered always or usually when asked if they received the care and support they needed. One person said they needed two people for their moving and handling needs but there was only ever one staff member available for them. When asked what the home does well, staff made the following comments: It takes good care of looking after all the residents Brigshaw house is a warm friendly home Staff do their best to care for all the residents needs and help them to keep their independence and dignity. However, some staff said they did not have enough staff to meet peoples needs properly at times. They said there are times when there are only two staff on duty and some people who live at the home need the assistance of two staff which then leaves others in the home unsupervised. We discussed this with the manager and staff. They said they try to organise peoples care support to minimise the times when this could happen. There was no evidence of any accidents or incidents having taken place at these times and most staff said it was manageable and that they could meet peoples needs well. Staffing levels must be reviewed to make sure peoples needs are properly met. We looked at care plan and risk assessment records for some people who live at the home. At our last visit to the home we said that care records should continue to be worked on in order to improve them. The manager has reviewed the way in which care plans are developed, however further improvements are still needed to make sure peoples needs are not missed or overlooked. Some plans had clear and detailed instruction on how the needs of people who use the service are to be met. There were however, some shortfalls with some care plans and risk management plans. Some plans did not give the detail of how care needs are carried out. Terms such as support of one carer and needs assistance do not tell staff how much support a person needs and could lead to needs being overlooked. Some risks such as falls and aggression had not been fully identified for some people and could again lead to their needs being missed. Care Homes for Older People Page 15 of 35 Evidence: We therefore, still recommend that care plans and risk management plans are reviewed to make sure people using the service have an up to date, detailed care plan. This will make sure that people receive person centred support that meets their needs. Most staff said they always or usually had enough information about the needs of the people who live in the home. They also said they found the care plans useful and if there was anything they needed to know that wasnt in the care plan, they could always ask. They said they found the manager and care co-ordinater very helpful in training them to meet peoples needs. Despite the gaps in care plan and risk management documentation, staff were familiar with peoples needs and could talk confidently about the support they give. Staff were able to describe peoples preferred routines with regard to their personal care and what works well for people. In the AQAA, the manager said health care needs are now properly monitored and involve the person who uses the service and their relatives. They also work with the involvement of the community matron to monitor peoples on-going health needs. She said there was now better communication between health professionals and the home. She also said that new nutritional risk assessments were in place and monitored. Help and advice is sought from health care professionals to make sure that people get the special help they need to maintain their health. People can be escorted to appointments by staff at the home. However, the manager said she likes to encourage peoples relatives to do this, to keep them involved in peoples care. Some staff have been trained to meet the specific health needs of people who use the service, such as blood sugar monitoring and dementia awareness. However, last year, the manager told us that she was going to access training on skin care and diabetes to make sure staffs skills are up to date. This had been organised with a visiting health professional but had been cancelled due to their availablity. The manager said she would be re-organising this training. Staff spoke very highly of their dementia awareness training and how it had changed the way they worked with people. Their comments included: Its all about seeing the person as a person and not their behaviour and knowing their previous life We use re-direction techniques when people get upset Care Homes for Older People Page 16 of 35 Evidence: It has made me think more about why people may behave or react in certain ways Loved the training, made me want to learn more to help people with dementia So important to give people time to do things and say what they want. Most staff have received training in safe moving and handling. This is initially covered as part of staffs induction and carried out by the manager or care co-ordinater. Staff then go on to complete a course by an accredited trainer. The manager and care coordinater have not been trained to deliver moving and handling training. The manager said they are just passing on their knowledge to new staff and then this is backed up by the full training course. Staff however, are responsible for the safe moving and handling of people who use the service before they have completed the accredited training. This could leave the health and safety of people who use the service and staff at risk at times. Staff must receive moving and handling training to make sure they can meet peoples needs properly. The home has introduced a new monitored dosage, pre-packed system for medication. All staff who administer medication have been trained to use the system. We checked some medication administration records (MAR) sheets. These were found to be in good order. There are now good ordering and checking systems in place. A record is kept in the home of medication ordered. This is checked against medication delivered and recorded as correct before any medicines are dispensed. Medication that is returned to the pharmacy is now managed safely with the records to show how this is done being in place. The manager said she was very pleased with the new system and felt more confident that medication was being managed safely. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do not always have a reasonable range of activity and occupation available to them. Menus in the home provide people with a varied and healthy diet. Evidence: In the AQAA, the manager said they have a varying range of activities available to people in the home. However, most people who returned a survey said they only sometimes had activity arranged that they could take part in. One person said never. When we asked people what the home could do better, comments included: Provide activities for residents There is a list of daily activities on the wall at the home but these dont seem to be ever done More residents that you can converse with and take part in activities. Staff also commented on the lack of activity in the home. They said: Care Homes for Older People Page 18 of 35 Evidence: There is little or no activity for the residents even though there is a poster on the wall Could do better. Staff said they felt they had enough time to organise a decent level of activity, but that quite often it was difficult to motivate people to join in anything they organised. Staff said that as occupancy level in the home was low, there were not many people interested in activity other than watching television or playing bingo now and then. During the afternoon, there were three staff available, yet for a period of two hours, the people in the main lounge received hardly any stimulation or interaction from staff. On the day of our visit, people sat in the main lounge looked bored at times and were falling asleep. One person was offered a newspaper to read in the afternoon. There was not much social interaction from staff, yet it was clear that people welcomed a chat as when we spoke with people they became interested and said they had appreciated the conversation. One person said, Its been lovely talking to you, it has taken the monotony off. They then went on to say, Some days are awful long here, not enough to do, in fact nothing to do really other than the odd game of bingo. People in the small lounge said they were happy with watching television, reading and watching the afternoon film. One person also enjoyed a foot spa during the visit. Some people enjoyed visits from their families. Visitors told us they felt very welcome in the home. One told us how the home had put on a party to celebrate their wedding anniversary. An activity planner has been put together with suggestions for activity. This is displayed on the wall, but the staff and manager all agreed that most of these activities did not take place. Peoples spiritual needs are met by a monthly visit from a Church of England vicar or by people going with their relatives to the church they previously attended. Some of the care plans we looked at showed that people would benefit from being occupied and stimulated. They did not appear to be having these needs met. One person sat for two hours in the afternoon without any interaction from staff or other people who live in the home. They looked bored and isolated. Staff said that people liked one to one activity such as hand massages or painting nails. Records showed that this happened occasionally for people. More consideration should be given to this. Care Homes for Older People Page 19 of 35 Evidence: The way in which activity is organised must be reviewed, to make sure peoples needs are met and they are not bored. This is a specialist service for people who have dementia yet there was no evidence to show how their specialist needs in terms of occupation and stimulation are being taken into consideration. People were very positive about the food and meals in the home. They said: We are very well fed Food is always nice and plenty of it Meals are very good Food is home cooked, home made cakes and buns. We observed the lunch time meal in the home. This looked appetising and well presented. We looked at menus at the home. These are planned around peoples likes and dislikes. People said they can always have an alternative to what is being cooked if people dont like it and drinks and snacks are readily available and offered regularly. The choice of foods available to people for snacks is varied and plentiful. Foods such as fruit and vegetables were fresh and stored properly. People are now weighed regularly so that their weight is monitored properly. Anyone who is nutritionally at risk is supported to maintain a healthy diet and the manager makes sure professionals such as dieticians or general practitioners are referred to for advice. The atmosphere in the home is relaxed. Everyone we spoke to said it felt like home. People said they can get up and go to bed when they want. People are free to move about the home as they wish and are able to have their things around them. Staff gave good examples of how they encourage people to make choices on a daily basis such as choosing their own clothing, choosing when to have a bath or what to eat. The manager told us that they have an annual meeting for people who use the service and their relatives where they can comment on aspects of the service. She said people who use the service had decided on the frequency of the meetings and had clearly stated they only wanted one per year. She also said that people meet with their keyworkers monthly when reviewing care plans and anything they want to discuss can be addressed then too. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: People we spoke to said they knew what to do if they were unhappy about anything and knew how to complain. They said they would speak to the staff, manager or their relatives. It was clear from staffs interactions with people that the people who live at the home seemed confident to raise their wishes or concerns. A relative said they had been given information on how to complain if she needed to. The complaints procedure is displayed on noticeboards around the home and in the bedrooms of people who live at the home. All staff said they knew what to do if anyone shared concerns about the home with them and that they would report any issues to the management team. We looked at complaints records and saw that one complaint had been received this year. It had been investigated and responded to properly. The manager said she has still to produce the complaints procedure in alternative formats such as large print or tape. This would make it easier to access for some people. Staff have received training in safeguarding adults. The manager initially does this with staff on their induction and then makes sure they attend a course run by an Care Homes for Older People Page 21 of 35 Evidence: accredited trainer. We suggested to the manager that she apply to be trained to deliver this training herself, which would then qualify her to deliver the training. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. All staff were clear on their responsibility to report abuse or allegations of abuse. One staff member described what they had done recently when they needed to report alleged bad practice. Staff were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. They also knew how to do this and who to contact. The manager is familiar with the local authority safeguarding referral system. This means people are properly protected. There has been one safeguarding issue at the home this year. This was addressed properly and referred to the right people for investigation. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people live in a reasonably comfortable and safe environment. Evidence: A tour of the building was carried out. Communal areas, bathrooms and bedrooms were visited. The home was clean, tidy and homely in most areas. In the AQAA the manager said they provide a clean and homely environment that is odour free. She also said they provide protective clothing for staff and a clean kitchen. She said they had received 3 out of 5 stars from their last environmental health visit which was an improvement on the previous 2 star rating. We discussed the advice the manager had been given from their most recent visit and saw that this had been acted upon to further improve food hygiene and infection control. When asked what they could do better she said, Refurbishment of home, provide new lounge chairs, tables and chairs etc. She also said in the AQAA that a number of improvements had been made to the environment. These included: Many rooms re-decorated and carpetted. Entrance hall and staircase decorated. A summer house in the garden. Car park re-surfaced. New curtains in many rooms. Care Homes for Older People Page 23 of 35 Evidence: Most people said the home was always clean and fresh. When asked what the home does well, one person said, Keeps nice homely roomsnot clinical- this IS A HOME. Despite the improvements made to the environment, many areas of the home are looking tired and worn in terms of the decor and furnishings and should be made more comfortable for people who use the service. For example, the downstairs bathroom does not look to be a pleasant environment for people. The seals around the bath and toilet are in need of replacement and it is bare and stark with no decorative features. The dining room furniture is old and worn looking and many areas of the home have chipped paintwork. Some carpets are in need of replacement as they are looking stained and worn. However, the home is clean and homely and people are happy with their rooms. The manager is aware of what needs to be done to improve the homes environment further, and has been prioritising work. Last time we visited, we said they must replace one of the upstairs baths as it was chipped and could injure someone. The bath has been bought but has not yet been fitted. The manager said the chipped bath was not in use though and no-one was therefore at risk from injury. The homes handyman visits daily to attend to any jobs that need doing. Staff said that minor repairs were always attended to promptly. Some more signage to help people with memory loss has been put up to help people find their way round better. This is an area that could be further developed to meet the specialist needs of people with dementia and memory loss better. For example, the home has a number of highly patterned carpets which may not help people in terms of their orientation and wandering. They should also consider colour contrasting to help people find their way around more easily. The kitchen was clean, well organised and proper procedures were being followed to promote safe food hygiene practices. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. However, uncovered toilet rolls were being stored at the back of the toilets. This is not Care Homes for Older People Page 24 of 35 Evidence: hygienic and there is a risk of the spread of infection. The manager agreed to remove them during the visit. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, staff in the home are trained, skilled but may not be in sufficient numbers to support people who use the service and to support the smooth running of the home. Evidence: In the main, people who live at the home and their relatives spoke highly of the staff. Their comments included: Staff are very helpful, although there doesnt always appear enough of them Very friendly staff we know well, some have been here as long as four and a half years Most of the carers do a really good job. Most people said staff usually listened to them and acted upon what they say. They also said staff were usually available when they needed them. In the AQAA, the manager said she had improved the home in the areas of recruitment, staff training, staff induction and staffing levels. Care Homes for Older People Page 26 of 35 Evidence: We looked at rotas and saw that there are three staff on duty during the day, two staff in the evenings and two at night. The manager is also available through the day Monday to Friday and occasionally works an evening or weekend shift to monitor the home. Most staff said they usually or sometimes had enough staff to meet peoples needs properly. One said they did not have enough staff to provide people with adequate supervision and support to be more independent. As mentioned in the health and personal care section of this report, staffing levels must be reviewed to make sure peoples needs are properly met. There has been a high turnover of staff at the home. Ten out of seventeen staff have left in the last 12 months. The manager has worked hard to recruit new staff. She said she tries to involve people who use the service by introducing candidates to them on the day they are interviewed. She said she would then consider any feedback they had given her as part of the recruitment process. It would be good practice to record this to show how people who live at the home have a say in choosing staff. We looked at the recruitment process for people working at the home. The files had the relevant information to confirm these recruitment processes were properly managed. This included application forms, three references and CRB (criminal records bureau) checks. The manager said she also checks some references by telephone to further protect the interests of people who live at the home. This is good practice. We recommend that the manager also records when she has done this. We looked at staff training and induction records. The manager has now developed a training overview which clearly shows who has done what training and when updates are due. The availability of training for staff has improved. In the last year a number of training events have taken place. These have included; moving and handling, safeguarding adults, health and safety, fire, food hygiene, dementia awareness, medication and first aid. The manager is aware that some staffs training and induction training is a little behind schedule and had discussed this with the homes director. She said she was confident that further training courses would be booked as needed, especially as more new staff were recruited. As mentioned in the health and personal care section of this report, all staff must receive moving and handling training to make sure they can meet peoples needs properly. We also recommend that the manager records more information in staffs induction records to show evidence of the training that has been given. Staffs views on their training were mixed. Most said their induction had covered what they needed to know. Two staff said it hadnt. Most staff were satisfied with their training and said it equipped them for their job. Two people were not. Care Homes for Older People Page 27 of 35 Evidence: There is a committment from the home for staff to complete an NVQ (National Vocational Qualification) in care in level 2 or above. This is good practice and means the home keeps staff who are qualified to carry out their job. Over half of the staff team have achieved this. One staff member said they were about to now start their NVQ level 3. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is well managed. The interests of people who use the service are seen as important to the manager and staff and are, in the main, safeguarded and respected. Evidence: The home has an experienced manager who also works alongside staff at times, to demonstrate good practice. Staff said she was a good manager and very approachable. Their comments included: I feel that since new manager has been here the home is so much better place to work She sets good standards, wants things done right all the time If theres a problem she deals with it Care Homes for Older People Page 29 of 35 Evidence: Can ask her about anything and she will try to help New manager is there for her staff no matter what the problem is. Most staff said they regularly were given support and opportunity to discuss how they were getting on in their job. They also said they received great, fantastic and the best support from the manager and management team. Two staff, however, said they didnt feel valued or supported, they did not say why they felt this way. Records showed that most staff were receiving regular supervision as either 1-1 meetings or supervised by senior staff while working. The manager said she receives good support from the provider, and that she visits the home regularly to carry out monitoring visits, to make sure the home is running well. The manager is currently in the process of applying for registration with the CQC. This will make sure there is someone accountable for the running of the home. The manager has not yet started the Registered Managers Award, but has gained an NVQ level 4 in management. She said she has also completed a supervisory management course and a 12 week course in dementia awareness. She should now complete the Registered Managers Award. This will make sure she is qualified to manage the home. We received the homes AQAA (Annual Quality Assurrance Assessment) when we asked for it. It had been fairly well completed and had identified some improvements the manager has made to the service. However, there was not a great deal of detail on the affects of the improvements made or how future improvements are going to be made. The manager said that low occupancy in the home had affected the way improvements could be made. She said there was a financial and business plan in place for the coming year and the home has remained cost effective through negotiation of contracts such as suppliers. The manager now sends out annual questionnaires to people who live at the home, relatives of people who live at the home and health professionals, asking for their views on any improvements that could be made. Some of these had been returned to the home. They were, in the main, positive about the service. Some comments on food and lack of activity had been made. The manager said that in response to this they had introduced new menus with more choice at lunchtime. The manager has not yet addressed issues regarding more variety of activity. Arrangements are in place to make sure of safe working practices. The home has a range of health and safety policies and procedures in place. In the AQAA, the manager said that all policies were reviewed and up to date. She also said that all equipment Care Homes for Older People Page 30 of 35 Evidence: used in the home has been serviced or tested as recommended by the manufacturer or other regulatory body. For example, the hoist and gas safety. We saw the homes electrical wiring certificate was up to date. However, the electrical wiring check had only been completed this month which meant it had been a year out of date. This had put peoples safety at risk. Systems must be introduced to make sure essential safety checks are carried out at the time they are needed. This will ensure everyones safety. Staff said they received health and safety training from the manager during their induction. Accident or incident reports are completed and kept in the home. These have now been forwarded to the CQC when necessary. The manager analyses these every month to see if there are any patterns or trends or ways of avoiding future accidents. This makes sure that the health, safety and welfare of people who use the service is protected properly. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 The way in which activity is 31/12/2009 organised must be reviewed. This will make sure peoples social needs are met and they are not bored. 2 27 18 Staffing levels must be reviewed. This will make sure peoples needs are properly met. 31/12/2009 3 30 18 All staff must receive moving and handling training. This will make sure they can meet peoples needs properly and safely. 30/01/2010 4 38 23 Systems must be introduced 30/11/2009 to make sure essential safety checks are carried out at the time they are needed. This will ensure everyones safety. Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will make sure they receive person centred support that meets their needs fully. Some serious consideration should be given to the refurbishment of the home, to make it more comfortable for people and to consider the specialist needs of people with dementia and memory loss. More information should be recorded in staffs induction records to show evidence of the training that has been given. The manager should complete the Registered Managers Award. This will make sure she is qualified to manage the home. 2 19 3 28 4 31 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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