Care Home: Caer Gwent Care Home with Nursing

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What the care home does well The home finds out about the needs of people before they move in. This means the home can take any necessary action to ensure they can meet the individuals needs. Residents have access to community based health professionals as required. Records are completed accurately when medication enters the home, promoting residents safety. Staff treat residents in a respectful but caring and friendly way. Residents can participate in a range of activities if they wish. Visitors are made to feel very welcome in the home. The home provides well balanced and healthy meals. Residents are confident that their complaints will be listened to, taken seriously and acted upon. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. Recruitment practises offer safeguards to residents. What has improved since the last inspection? Since our last inspection medication audits have been implemented and the home has changed pharmacy suppliers. New complaints documentation has been introduced to record complaints and review how they are dealt with. The residents kitchen, some bedrooms and a communal bathroom have been decorated. A washing machine and a dryer have been replaced. New carpets have been fitted when rooms have become vacant. What the care home could do better: A record must be maintained of all care given to residents especially those at risk of dehydration or pressure areas in order that their needs can be monitored safely. Guidelines for the use of `as required` medication must be implemented for consistency. Records must be maintained that confirm staff receive training in all areas needed to support residents safely. Key inspection report Care homes for older people Name: Address: Caer Gwent Care Home with Nursing Downview Road Worthing West Sussex BN11 4TA     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: Lesley Webb     Date: 0 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Caer Gwent Care Home with Nursing Downview Road Worthing West Sussex BN11 4TA 01903536649 01903535526 caergwent@guildcare.org www.guildcare.org Guild Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Srijit Duffadar Type of registration: Number of places registered: care home 61 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 who can be accommodated is: 61 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 Caer Gwent is registered to provide accommodation for up to sixty-one residents over the age of sixty-five years. All sixty-one could have personal or nursing care needs. The home combines a smaller old converted building and a large purpose built building. Accommodation for the residents is provided on two floors, in single, en-suite bedrooms. There is a large amount of varied communal space including three dining areas, four lounges of varied sizes and a conservatory. A hairdressing salon, small Care Homes for Older People Page 4 of 33 Over 65 61 0 Brief description of the care home kitchen for residents and visitors use and a reception area, with seating, are also available. A third floor provides staff changing, refreshment and training areas. There is a large visitors car park to the front of the building and an enclosed garden to the rear. The garden is well-maintained and accessible to residents, with some having patio doors from their bedrooms. The fees range between £646.00 and £931.70 per week. Care Homes for Older People Page 5 of 33 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: We visited this home on Thursday 1st April 2010, arriving at 10.00 am and staying until 5.30 pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. Since our last key inspection in April 2007 a new manager has been registered with us. The registered manager was present during this inspection and offered assistance by supplying documentation and answering questions we raised. During our visit to the home we examined the records of three residents and the recruitment records of four staff. We also looked at other documentation such as training records, medication records, minutes of meetings and quality audits. While at the home we also spoke with six residents and five staff. We also indirectly observed care practises and sat and ate lunch with some service users in one of the Care Homes for Older People Page 6 of 33 dining rooms. Prior to our visit the home supplied us with copy of its Annual Quality Assurance Assessment (AQAA). This document gives the home the opportunity to say what it does well and provide evidence of that. It also gives them the opportunity to say what they feel they could do better and what their future plans are, how it dealt with any complaints and concerns, any changes to how the home is run, the providers view of how well they care for people, the views of the people who use the service, their relatives and staff who work for the service. Before we visited the home we received eight residents and four staff questionnaires. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people receive from the home. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: A record must be maintained of all care given to residents especially those at risk of dehydration or pressure areas in order that their needs can be monitored safely. Guidelines for the use of as required medication must be implemented for consistency. Records must be maintained that confirm staff receive training in all areas needed to support residents safely. Care Homes for Older People Page 8 of 33 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents needs are assessed before they move into the home. This means the home is aware of new residents needs before they move in and can take any necessary action to ensure they can meet individuals needs. Evidence: Prior to our inspection the home sent us its Annual Quality Assurance Assessment AQAA. With regard to assessment processes it states An outcome focused pre admission assessment is carried out on all the residents. We try and keep all of our admissions as planned. This comprises of an initial visit, a period for residents to either decide whether to be admitted or compare with other homes, a planned pre admission assessment with a relative or friend present and finally admission. The pre admission assessments are always carried out even if the period between the initial enquiry and the admission is relatively short. Regardless of the length of period between the initial enquiry and admission, negotiations are made regarding the date and time of admission to allow us to prepare the staff and the room as per the needs Care Homes for Older People Page 11 of 33 Evidence: of the residents. On admission a thorough assessment is completed with the resident and/or the family. Trained staff are able to manage this. During our visit to the home we looked at the pre admission documentation for three residents, including the newest person to move into the home and spoke with the registered manager. Evidence from these sources supports the contents of the homes AQAA. For example admission documentation for all three residents had been completed in full detailing their individual needs with regard to health and personal care. The AQAA informs us of improvements made over the last twelve months. For example it states We have changed our residents contracts to make them less ambiguous, we have introduced new pre admission assessment documents to make it more outcomes focused, we have researched and used IT to adapt the RCN tool for assessment to enable us to decide on levels of support swiftly. This was done with permission from the RCN. We have changed our website to make it more user friendly and all the important documents are now available to download and we have displayed all the necessary information in our reception for all visitors to read. Eight residents completed questionnaires and returned them to us before our inspection. Some of these had been completed with assistance from relatives. Seven state they received enough information about the home before they moved in, which helped them decide if it would be the right place for them. One person stated dont know to this question. The registered manager informed us that Caer Gwent does not offer intermediate care. Care Homes for Older People Page 12 of 33 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 home is not always following its own recording procedures for monitoring specific health needs of residents. Medication systems in the main offer protection to residents. Residents rights to privacy and respect are promoted. Evidence: With regard to health and personal care the homes AQAA states We draw up care plans based on a pre admission assessment and further assessments post admission. Among others these assessments include risks of falls, pressure sore, malnutrition and general safety. We keep residents and/or relatives involved during the care planning process. A copy of the care plan is provided to the residents. The care plans are person specific. Where appropriate our care plans are aimed at enabling residents to remain as independent as they wish or are capable of. Reviews of these documents are carried out on a regular basis, at least once a month and when changes occur. Based on reviews preventative equipment such as pressure relieving mattresses are provided as appropriate. We have regular visits from a GP. The residents are able to stay with a GP of their choice. When necessary we also access services from other professionals such as Nutritionist, Multiple Sclerosis Nurse, Macmillan Nurse from a Care Homes for Older People Page 13 of 33 Evidence: Local Hospice, St Barnabas. We have an in house Physiotherapy service. We work closely with the District Nurses, West Sussex Primary Care Trust, and Adult Services to provide safe and advised care. We have visiting optician, dentist and Chiropodist. We keep residents and families involved in all our initiatives for the care of the residents. Residents have regular exercise classes either held by the Activities co ordinators or the Physiotherapists. Evidence gained through our inspection process in the main supports the above statement. For example as at the previous inspection records show that residents have access to community based health professionals as required. For example visits by professionals such as a general practitioner and chiropodist are noted and any advice or treatment recorded. We looked at the care documentation for three residents. For one catheter care was recorded as an identified need, with fluids to be encouraged and output monitored. A care plan was in place regarding this. The home uses a form titled Daily care progress for recording pressure area care, food/fluid intake and outtake, bowel movements and personal care given. For this individual the monitoring form was not completed in full on all days with regard to fluids given, output and personal care. For example on one day staff have recorded that 770ml of fluid was given and personal care received, the next day fluid given was recorded as 50ml and no personal care given and the day after this 120ml of fluid given and again no personal care recorded. On another day staff have not recorded the amount of fluid given but have recorded fluids as water and coffee. We discussed this residents needs with a nurse on duty. They confirmed they have to monitor fluids, stating they are prone to UTI (infection), we aim for 2 litres of fluid per day. The second resident records that we looked at state that the individual requires turning two hourly as part for pressure care management. No care plan was in place for this. We discussed this with a nurse on duty who informed us that the resident was new to the home. Records detail the individual moved to the home 9th March 2010 with a grade 3 pressure area. We asked the nurse on duty how staff are aware what care a resident requires if a care plan is not in place. They informed us that they ask the individual questions and look at the pre admission information obtained. The daily care progress records for this resident have not been completed in full and do not demonstrate that the individual is being turned two hourly or that fluids are being monitored as required. The nurse on duty informed us that they encourage Care Homes for Older People Page 14 of 33 Evidence: fluids for this person. For both of the above residents examination of other documents such as local authority review records, wound dressing changing records and general practitioner notes demonstrate that their care needs are being met by the home and that for one individual their health needs have improved since moving to the home. In line with NMC guidelines the home must record all care to be given in a plan and record when the care is then given. This would include those at risk of dehydration or with pressure areas at risk of breakdown or with actual wounds. That the home has chosen to use fluid and moving charts that they have not completed in full means their own recording procedures are not being followed. The third residents records that we looked at were completed in full, detailed and informative. For example the needs assessment identified areas requiring support. These had then been translated into a plan of care. As at our previous inspection risk assessments were seen to be in place for all three residents for areas including falls, moving and handling and nutrition. Eight residents completed questionnaires and returned them to us before our inspection. Three state they always receive the care and support they need, two that they do usually and three sometimes. Four state the home always make sure they get the medical care needed, two they do usually, one sometimes and one person did not respond to this question. We sampled a number of residents medication administration records, all of which were in good order and up to date. Records included medication entering the home, having been administered and those that had been returned to the pharmacy. A number of residents were seen to be prescribed as and when required medication (PRN). The care services manager and nurse on duty were not aware of any risk assessments, care plans or protocols being in place for these. Drug information sheets supplied by the dispensing pharmacy give information regarding what particular medication is used for, when it should be given and actions if a reaction to the medication occurs. However records currently maintained by the home do not demonstrate how decisions are arrived at when residents are given PRN medication. We found no evidence that residents had been placed at risk when given PRN medication, however the use of PRN medication should be included in individual Care Homes for Older People Page 15 of 33 Evidence: residents care plans in order that staff have enough information to promote safe practice. The registered manager agreed to ensure this was put in place for everyone. The storage and recording of controlled drugs were also seen to be appropriate with no discrepancies found for those sampled. Since our last inspection medication audits have been implemented and the home has changed pharmacy suppliers. Staff were observed speaking and assisting residents with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. As at our previous inspection staff were noted to treat the residents in a respectful but caring and friendly way. Residents were at ease with the staff and residents being nursed in their rooms looked comfortable. All the residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. Some were seen to be wearing make up and jewellery and many had their hair styled. Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can participate in a range of activities if they wish. Visitors are made to feel very welcome in the home. Residents are able to make choices and decisions about their lives. The home provides well balanced and healthy meals. Evidence: With regard to daily life and social activities the homes AQAA informs us We aim to provide the residents with experiences which meet their expectations. We emphasise on residents exercising their choices in all aspects of their daily life routines. We offer an activities programme to suit varied wishes, interests and capabilities. We arrange regular outings for residents with the activities co ordinators and volunteers. Guild Cares Carer driver arranges with residents and accompanies to go shopping or to have a coffee or lunch in local cafes and restaurants. We have a programme for special events throughout the year. Residents are able to enjoy these days with families and friends. Residents are able to go out with their families and friends whenever they wish to. A resident led Sunday service is held in addition to vicars visiting the home. The residents are given a weekly Activities list to make their choices and plan their weeks. Our visiting hours are unrestricted. Relatives and friends are able to visit at the convenience of the residents. We have a Fund raising Group who assist and organise public events which are participated by the local community. The funds raised are Care Homes for Older People Page 17 of 33 Evidence: used to finance entertainment and additional complimentary services. Evidence gained through our inspection process supports this statement. For example residents that we spoke with generally expressed satisfaction with activities offered. As one person explained, its nice to have a choice. There is a separate kitchen area for use by residents. One resident was observed ironing and told us, its nice to be able to do things for yourself like when living at home. You can do own washing, ironing, make cup tea or light meal, its wonderful. As at our previous inspection records evidence activities take place that include games, music and movement, exercise classes, individual activities, reminiscing activities, outings and shopping trips. On the day of our visit some residents were seen participating in an exercise class and others watching television. Residents meetings are held monthly and records of these detail activities and meals being discussed on a monthly basis. Eight residents completed questionnaires and returned them to us before our inspection. Five state the home always arrange activities they can participate in, three they usually do. When asked the question what does the home do well comments were recorded including plenty of activities are provided for those who need them and activities and open days. When asked the question what can the home do better comments were recorded of more coach outings. One resident that we spoke with informed us they were going on the homes mini bus that afternoon for a drive out. They said, its lovely but only happens once a week because we have to share the bus with other homes. We discussed the above comment with the registered manager who informed us that another member of staff was going to be able to drive the bus when assessed as competent and that this should increase the opportunity for residents to go out. The people living at the home who we spoke with told us that their visitors could come at Care Homes for Older People Page 18 of 33 Evidence: any time and were made to feel welcome. One relative spoken with during our visit said that there are no restrictions about visiting and that they are made welcome. Eight residents completed questionnaires and returned them to us before our inspection. Two state they always like the meals provided, one that they usually do and five that they do sometimes. When asked the question what does the home do well a comment was recorded of food is good. When asked the question what can the home do better comments were recorded of make the lunches more appetising serve meals hot not cold or almost cold and less delay between meal courses. We discussed the comments with the registered manager who informed us that the menu has been altered as a result of comments raised by residents and that meals are now discussed in the monthly residents meeting in order that this area of service can be explored further. During our visit we sat and ate lunch with residents in the ground floor dining room. All those that we spoke with expressed satisfaction with the meal provided. Two choices were offered along with a range of hot and cold drinks. As at our previous inspection residents are able to have a cooked breakfast on a daily basis or a continental breakfast if they wish and fresh fruit is available in addition to the daily meals. Care Homes for Older People Page 19 of 33 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. Residents are confident that their complaints will be listened to, taken seriously and acted upon. In the main safeguarding procedures are always followed, which reduces any risks to residents. Evidence: With regards to complaints the homes AQAA states We follow Guild Cares complaints policy in dealing with our complaints. We encourage residents and relatives to participate and be involved in their care. The aim is to engage in a continuous dialogue to minimise having to resort to complaints. The residents and relatives are made aware of our policy and procedure through our welcome packs at the time of admission. This information is also available at our reception for all visitors to read. Our complaints procedure includes the CQC address. Complaints are received, recorded and dealt with as an opportunity to improve the service for our residents. We deal with complaints in an objective manner. Evidence gained from our inspection process supports this information. For example, as at our previous inspection we observed that a copy of the complaints procedure is displayed at the entrance to the home. We looked at the record of complaints and saw that complaints made had been responded to in the agreed timescales. Records evidence thorough investigations and Care Homes for Older People Page 20 of 33 Evidence: complainants being informed of outcomes. Eight residents completed questionnaires and returned them to us before our inspection. Seven state they know how to make a formal complaint and one that they do not. The AQAA also informs us of improvements made with regard to complaints, stating We have introduced a new complaints form which enables us to learn from complaints. The new forms enable us to record complaints easily and review how we deal with them. We have altered some systems of our day to day work as a result of the complaints we have received. E.g. how we allocate our staff, changed pharmacy for medication. We have introduced an IT based system to analyse our complaints. When looking at the homes complaints records we found two where the home should have made referrals to the local authorities safeguarding team. One related to potential theft and the other to potential neglect. The registered manager confirmed this had not happened for either. For both the commission should also have been informed in line with Regulation 37 of the Care Home Regulations 2001. Again the registered manager confirmed this had not happened. Since these two events, the home has reported correctly, other incidents that have occurred, to both the local authority safeguarding team and the commission. The homes AQAA informs us that four safeguarding referrals to the local authority have been made in the last twelve months and that as a result of these two safeguarding investigations have been undertaken. One was found to be inconclusive and the other is still being investigated. The investigation that is still ongoing relates to alleged conduct of a member of staff towards a resident. Training records confirm that the majority of staff employed at the home have undertaken safeguarding training in 2009. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. Evidence: With regard to the environment the homes AQAA states Caer Gwent is located in a quiet surrounding yet close to Worthing town centre and Goring road shops. The building is three storied with two storeys being used for residence. All attempts are made to keep the environment as the residents home. Guild Cares maintenance programme is on a rolling 10 year basis. Regular fire, gas, electricity and other maintenance are carried out as per statutory regulations. All parts of the building are connected to a central fire alarm system. On each floor there is a main lounge, a smaller lounge and a separate dining room. On the ground floor there is an additional large lounge and a conservatory. The lounges are used by residents for activities, meetings, religious services and for daily social gatherings. There are two large garden areas accessible to all the residents. Some residents are able to access these areas directly from their bedrooms. The furniture in the communal rooms are arranged as per the residents advice and approval. The smaller lounges are used by residents as a library and private area to entertain families and friends. All bedrooms bar one are en suite and 55 rooms have level access showers. There are assisted baths and additional toilets throughout the home. All parts of Caer Gwent are completely wheelchair accessible. There are three lifts to connect the two floors. There are grab rails in all Care Homes for Older People Page 22 of 33 Evidence: the corridors. In almost all the areas of the home the corridors are spacious enough to transport wheelchairs and hoists comfortably. Loop system and microphones are available in one of the lounges. Large Screen televisions are available in all the large lounges. The nurse call system is available either through call points, wired call buttons or neck pendants. A variety of stand aids and hoists are available to suit individual needs and capabilities. Where possible the slings are restricted to use for single residents. All the bedrooms are single rooms with living space either meeting or exceeding the statutory requirements. Couples are able to convert two bedrooms into a bedroom and sitting room. Residents are able to bring items to personalise their room. All the bedrooms are furnished with a bed, chest of drawers, a lockable bedside cabinet and chairs. Residents can bring their own furniture provided the health and safety of themselves and the staff are not affected. The lighting in the rooms are on a dimmer switch with additional reading light. The main door to each bedroom is lockable should the resident wish to. Except for a few manually adjusted beds all our beds are electric profiling beds. The bedrooms are centrally heated with facility to adjust the room temperature in each room. The bedroom either looks onto a garden or the main drive. The emergency lighting is connected to the fire alarm system. The rooms are checked regularly for cleanliness and safety, including the water temperatures. All rooms are fitted with blending valves for water supply. Evidence gained through our inspection process supports this statement. For example when we looked around the home we saw that people living in the home have personalised their rooms, with some bringing items of personal furniture as well as other personal affects. All areas of the home viewed were decorated and maintained to a high standard and no health and safety issues were identified. The homes AQAA informs us of improvements that have been made over the last twelve months. These include decoration of the residents kitchen and a communal bathroom and replacement of a washing machine and a dryer. In addition to this some bedrooms have been redecorated and new carpets fitted when rooms have become vacant. Eight residents completed questionnaires and returned them to us before our inspection. Seven state the home is always fresh and clean and one that it is usually. With regard to infection control the homes AQAA informs us A regular housekeeping routine keeps the home clean and odour free. Staff are monitored in the use of Care Homes for Older People Page 23 of 33 Evidence: personal protective equipment and hygiene practises. Clinical waste is handled by care staff only and household by housekeepers. Laundry facilities are in a secluded area of the home to accommodate appropriate handling of clean and dirty laundry. Laundry staff are instructed to use a variety of temperatures depending on the state of the linen and personal garments of the residents. Different bags are used to identify soiled items to prevent direct contact with them in the laundry. We contact the Health Protection Agency and Environmental Health Officer to seek guidance on infection control. On the day of our inspection no odours were apparent when we walked around the home. The homes AQAA also states that two staff have received infection control training. The registered manager confirmed this information as correct and informed us this was an area that had been identified by the home needing improvement. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practises offer safeguards to residents. Staff receive training in order that they can fulfil their roles and responsibilities, however improvements to some records would evidence this further. Evidence: The registered manager informed us that staffing levels consist of six staff including one nurse upstairs on the nursing floor for twenty five residents and five staff downstairs on the residential floor. In addition to this kitchen and domestic staff are allocated to each day shift. Previously the nursing floor had two nurses on each shift. The registered manager informed us that the new staffing levels have been introduced to make individual staff more accountable. The registered manager also said that staffing levels are based on numbers of residents and their assessed needs. Eight residents completed questionnaires and returned them to us before our inspection. One states staff are always available when needed, three that they are usually and four that they are sometimes. Of the eight residents surveys two state staff always listen to and act on what they say, four that they usually do and two that they do sometimes. When asked the question what can the home do better comments have been Care Homes for Older People Page 25 of 33 Evidence: recorded of provide more care staff get more people to take residents out shopping because at present we have one lady employed who goes around all the homes, she cannot take out everybody, residents like what she does but the turns take too long and more staff needed so I can get to the commode when needed, more quickly. When asked the question what does the home do well comments have been recorded of staff are caring and good staff. Four staff also completed questionnaires and returned them to us before we visited the home. All confirmed they received an induction and that they are given training to enable them to undertake their roles and responsibilities. When asked the question what does the home do well comments have been recorded of well run and friendly takes care of people who live there very well, and gives staff and residents all the support they need and want, has good activities for residents and the vast majority of the staff who are employed at Caer Gwent are very committed to the home and the residents, the nursing and care staff are excellent. When asked the question what could the home do better comments have been recorded of sometimes not enough staff be more prepared if different staff are off ill as it is more pressure for everybody else and have longer shifts instead of six hours daily and to ensure the home runs smoothly all staff are extremely busy with their different roles. It would be nice to have a little more time available in order to be able to just chat to the residents, who I personally find to be very interesting. We discussed the contents of the surveys with the registered manager who said he would monitor and review the situation if needed. We spoke with five members of staff and indirectly observed care practises. In the main staff demonstrated understanding of their roles and responsibilities. We examined the recruitment records for the four newest staff to commence working at the home. They included an enhanced criminal records bureau disclosure (CRB), two references, induction and evidence of training undertaken. We did note that for one person their records did not include two forms of identification and for another their application form was not on file. The registered manager informed us that some staff have been recruited using the on line application process. We informed the registered manager that regardless of how someone is recruited evidence of a full application form having being completed Care Homes for Older People Page 26 of 33 Evidence: should be on file. With regard to staff training the homes AQAA states Guild Care has a separate Training Department who provide and monitor the training of the staff. All staff undergo an induction programme during their probation period. When visiting the home we sampled a number of staff training records and these indicate that the majority of staff have received training in moving and handling and safeguarding. As mentioned earlier in this report only two people employed at the home have received infection control training. A training report we viewed details 158 staff employed at the home. This includes 25 registered nurses and 78 care staff. Of the 158 staff 63 have undertaken training in food hygiene and 71 in health and safety. No staff are recorded as having undertaken training in first aid or fire. We were informed staff have received training in these areas but that this information is not included on the homes training monitoring forms Care Homes for Older People Page 27 of 33 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. Management practises in the home have not ensured that staff record all care given to residents and that complete and accurate records are maintained with regard to staff training. This will impact on monitoring systems for promoting the health and welfare of individuals. Staff are supported to fulfil their roles and responsibilities. Evidence: Since we last inspected the home a new manager has become registered with us. The registered manager has worked for Guild Care for over three years and has previously been the registered manager of another establishment owned by Guild Care. The registered manager holds a number of qualifications including the Registered Managers Award and being a registered nurse. As detailed in other sections of this report further work must be undertaken with regard to ensuring full and accurate records are maintained, specifically with regard to the care that residents receive and staff training. Care Homes for Older People Page 28 of 33 Evidence: As at our previous inspection the home has a quality assurance system in place that includes a survey seeking the views of residents and relatives. We saw evidence that surveys were last distributed in 2009. The registered manager informed us that the findings now need to be analysed and an action plan implemented. With regard to quality monitoring the homes AQAA states meetings are held with all the staff. The manager personally conducts meetings with the residents to review their experiences and communicate about initiatives in the home. The manager follows an open door policy for all residents and staff and communicates with them on a daily basis. The staff are encouraged to follow a problem solving rather than problem stating approach. Actions are taken promptly on residents requests and communicated to them. The complaints are monitored by the manager and deals with them at most times. Complaints are used as a measure of the performance of the home and progress made to make the residents experiences better. An annual survey is carried out encompassing all aspects of life in Caer Gwent. Regular Operations audits are carried out to highlight areas that need attention. Residents and staff are encouraged to complete surveys from the CQC independently. Guild Cares customer services officer meets with the residents regularly The manager monitors expenses and completes a variance report for Guild Cares Senior Management team on a monthly basis. This is also discussed with the Operations Director. When we were visiting the home we found evidence to support the above statement. For example a number of audits are undertaken including those for medication, health and safety, staffing and care records. In addition to this a representative of the organisation visits the home on a monthly basis, producing a report of their findings. The home sent us its AQAA when requested. The contents of this are detailed, informative and demonstrate quality monitoring and reviews undertaken by the home. Records indicate that staff receive both formal one to one supervision and group supervision in the form of staff meetings. Records that we looked at indicate that the frequency of one to one supervisions varies from person to person. The registered manager acknowledged that improvements could be made in this area, informing us that this had already been identified within the homes own quality monitoring systems. Information within the homes AQAA states that checks on services and equipment have been undertaken within recommended timescales. We sampled a number of health and safety records, finding all to be in good order and up to date. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 8 15 The registered person must 01/05/2010 ensure a record is maintained of all care given, particularly with regards to pressure care and dehydration. This must happen to ensure residents health needs are met safely and consistently. 2 9 13 The registered person must ensure care plans are in place for the use of PRN medication, that include guidelines for use and evaluation of effect. This must happen to ensure consistency and safety. 01/05/2010 3 30 18 The registered person must ensure that records maintained in the home demonstrate that suitable numbers of staff have received training in all required areas. This must include infection control, 01/05/2010 Care Homes for Older People Page 31 of 33 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 food hygiene, first aid, fire and health and safety. This must happen in order that residents are supported by suitably qualified staff at all times. 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 32 of 33 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. 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