Care Home: Calway House

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What the care home does well The home carries out comprehensive assessments to ensure that it will be able to meet the needs of people before they move in to the home. A health professional told us the home "settles new residents well" and "works well with Adult Social Care". A relative told us their relative had been well supported throughout their move. People who live at the home told us that they are well looked after. One person who had moved to the home after being in hospital told us "I feel so much better, the staff have supported me and I am more independent now". Health professionals told us about the home "excellent at recognising the person and their needs/wants/wishes. Very client centred approach", "provide a consistent and caring service", "the home appears calm and effective in care provision. Relatives commented "I am very happy with the care my relative receives" and "keep me in touch with reports of health issues in a caring and understanding way". People speak very highly of the staff at the home. People who live at the home comments` included "carer is one in a million", "staff are excellent, they fall over backwards for you". Relatives told us there are "caring and helpful, considerate staff", "I have nothing but praise for this home and the staff at all levels who show care and compassion for my relative looking after all daily needs" and "the staff at Calway House are wonderful, dedicating and caring. I know my relative is happy, safe and in the absolutely best place". Health professionals told us "the staff are without exception pleasant, cheerful and helpful" and "they explain things to them in a way they can understand and "this is a well run home with friendly and helpful staff, the standard of .. care is high". The home is purpose built and the environment is excellent. The home is well maintained, nicely decorated and clean. The gardens are attractive and provide pleasant seating areas for people who live at the home. One person who lives at the home told us "I have been to a few places and I have really felt at home here. It is a lovely atmosphere.. It`s nice to be able to treat the rooms as my home". What has improved since the last inspection? The home`s service user guide is now available in braille and large print. The home has employed a gardener who supports people who live at the home to take part in gardening and planting. The home has a comprehensive form which includes confirmation that concerns or complaints are followed up and that the complainant is happy with the outcome. More staff have received training in dementia care and care planning. Accidents are audited so that the home is able to identify any patterns and minimise the risk of further incidents. What the care home could do better: The home should ensure that people are turned in accordance with their care plan and that this is documented. This is to ensure that the people are turned to prevent pressure sores. Arrangements must be made to ensure that all medicines are stored within the correct temperature range. The home should review it`s medication audit, so that it monitors all areas of recording, storage, and administration, and that action is taken where necessary. This is so that the home`s medicine procedures will protect the people who live at the home. People commented that they would like more outings and day trips. The home is currently raising funds to buy a minibus for the people who live at the home. People who live at the home and relatives told us that this will enhance the choice of activities/outings and they hope that it will not take too long to obtain. The registered manager should ensure that when employment gaps are explored with staff, they are then documented. The registered manager should review and monitor staffing levels to ensure that peoples` social needs continue to be met. Information relating to people who live at the home displayed on noticeboards at nurses` stations should be stored securely to maintain peoples` confidentiality. The home must ensure that cleaning chemicals are stored securely under the COSHH guidelines and are not accessible to people who live at the home, as there is a possible risk of ingestion. (The registered manager locked two cupboards during the inspection). Key inspection report Care homes for older people Name: Address: Calway House Calway Road Taunton Somerset TA1 3EQ     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: Alison Philpott     Date: 1 7 0 6 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 31 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 31 Information about the care home Name of care home: Address: Calway House Calway Road Taunton Somerset TA1 3EQ 01823333283 01823347930 verity.underhill@somersetcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Somerset Care Limited care home 83 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 83. The registered person may provide the following category of service only: Care home with nursing -Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE - maximum of 15 persons requiring personal care only Mental disorder, not including learning disability or dementia - Code MD- maximum of 1 person requiring personal care only Date of last inspection Brief description of the care home Calway House is a new purpose built home registered with the Commission for Social Care Inspection to accommodate up to 83 service users over the age of 65 years who require personal care by means of old age. The home is registered under the category of dementia for 15 service users with personal care and dementia care needs. The Care Homes for Older People Page 4 of 31 Over 65 0 0 83 15 1 0 Brief description of the care home home is registered to provide nursing care for 37 service users. Calway House, is situated in a quiet residential area not far from Taunton town centre. The building is arranged over three floors with a shaft lift giving access to all floors. The home is fitted with appropriate aids and adaptations. The gardens have been professionally landscaped and provides safe and pleasant areas for service users to enjoy. Calway House in owned by Somerset Care Ltd which is a not for profit organisation. The registered manager is Verity Underhill and the responsible individual is Marion Osborn. The home has achieved the Somerset Social Services Quality Rating. The homes current fee range is between £680 and £850 per week. Fees charged are dependant on the individuals assessed needs and room to be occupied. Extra charges are met by service users for hairdressing, newspapers, magazines, chiropody and personal toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over one day (7 1/4 hrs) by regulation inspector Alison Philpott and pharmacist inspector Brian Brown. As part of the inspection process, CQC are using Experts by Experience to help inspectors get a picture of what it is like to live in a social care setting. The term Expert by Experience used in this report describes the people who also visited the home during the inspection and who have knowledge about social care. On the day of the inspection, 82 people were living at the home and 10 people were attending for day care. Verity Underhill, Registered Manager was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. We were able to meet with people using the Care Homes for Older People Page 6 of 31 service, staff and a visitor to the home. We carried out a random inspection on 17th September 2008 after receiving comments about staffing levels in surveys. People told us at the random inspection that they were generally happy with the level of staff and felt well cared for. The home completed its Annual Quality Assurance Assessment (AQAA) and this was received by the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. We received completed surveys as follows; seven from people who live at the home; seven from relatives, carers and advocates; four from staff who work at the home; and eight from social and health care professionals. Extracts have been included in this report where appropriate. The term we, used throughout this report, refers to we the Commission. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home should ensure that people are turned in accordance with their care plan and that this is documented. This is to ensure that the people are turned to prevent Care Homes for Older People Page 8 of 31 pressure sores. Arrangements must be made to ensure that all medicines are stored within the correct temperature range. The home should review its medication audit, so that it monitors all areas of recording, storage, and administration, and that action is taken where necessary. This is so that the homes medicine procedures will protect the people who live at the home. People commented that they would like more outings and day trips. The home is currently raising funds to buy a minibus for the people who live at the home. People who live at the home and relatives told us that this will enhance the choice of activities/outings and they hope that it will not take too long to obtain. The registered manager should ensure that when employment gaps are explored with staff, they are then documented. The registered manager should review and monitor staffing levels to ensure that peoples social needs continue to be met. Information relating to people who live at the home displayed on noticeboards at nurses stations should be stored securely to maintain peoples confidentiality. The home must ensure that cleaning chemicals are stored securely under the COSHH guidelines and are not accessible to people who live at the home, as there is a possible risk of ingestion. (The registered manager locked two cupboards during the inspection). 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive sufficient information so that they can make an informed decision about the home. The home carries out detailed assessments to ensure that it can meet the individual needs of people before they move in to the home. Evidence: The home told us on their AQAA we look carefully at the residents needs and make sure that the home can provide them with the level of care they require. We have an up to date service user guide. Our service user guides are now available in braille and large print. Three people who live at the home who completed surveys told us that they received enough information to help them decide that the home was the right place for them. A relative told us the home helped me move my relative in and get used to their new Care Homes for Older People Page 11 of 31 Evidence: surroundings, supplied information and help on services available and did a first class job in overcoming issues arising... We looked at care plans which contained detailed pre-admission assessments. A health professional told us the home settles new residents well and works well with Adult Social Care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal and healthcare support using a person centred approach. Medication and records relating to medicines are generally well managed. Staff treat people who live at the home with respect. Evidence: The home uses a computerised care planning system. A paper copy is also available. We looked at five care plans. Care plans are detailed and give advice and guidance for staff to follow to ensure that peoples individual needs are met appropriately. Peoples individual preferences are written within the plan. We also looked at information relating to wound care and turning people to prevent pressure sores. One persons care plan stated that they should be turned four hourly. The records viewed showed that on different nights the person was turned once, twice, three and four times. The home should ensure that the person is turned in accordance with their care plan and that this is documented. This is to ensure that the person is turned to prevent pressure sores. Care plans had been reviewed every month. Care Homes for Older People Page 13 of 31 Evidence: People who live at the home told us that they are well looked after. One person who had moved to the home after being in hospital told us I feel so much better, the staff have supported me and I am more independent now. The Expert by Experience said that the staff were spoken of very highly - nothing is too much trouble and one person could not praise them enough, as they had been brought in in a very frail state, not eating and they had managed to get them walking again so that they hoped eventually to be able to return to their own house. Relatives told us there are caring and helpful, considerate staff, I am very happy with the care my relative receives and keep me in touch with reports of health issues in a caring and understanding way. Health professionals who completed surveys told us about the home excellent at recognising the person and their needs/wants/wishes. Very client centred approach, provide a consistent and caring service, the carers are always cheerful and treat the clients with concern and good humour. They explain things to them in a way they can understand. The clients are always clean and appear content, this is a well run home with friendly and helpful staff, the standard of .. care is high, the home appears calm and effective in care provision, feedback from residents and families is very positive. We looked at records that showed that people have access to a range of health professionals. Two health professionals commented that communication with them could be more timely. We looked at the homes medication and records. We checked the stocks of Controlled Drugs and found these to balance. However we found that on one unit the cupboard used to store these medicines did not comply with current regulations and the medicines from this unit were moved to another cupboard where they could be stored in accordance with current regulations. On one unit we found that in the front of the Medication Administration Record folders there was a missing signature audit chart but we found on other units that post it notes were fixed on the Medication Administration Record (MAR)charts to identify gaps. They appeared to ask staff to sign the gap. The manager confirmed that this is not acceptable and staff should record on the back of the chart to indicate that they have failed to sign. There was no current record made of these as part of the audit process. One hand written MAR chart had two signatures but was not dated. There were numbers across the top of the chart but no reference to the actual month and year to which it refers. Where people had been prescribed a Care Homes for Older People Page 14 of 31 Evidence: variable dose of medicines the actual dose administered was recorded. The use of nutritional supplements is recorded. One persons records had clear information so that staff knew when to give as required medicine including expected outcome and follow up action after administration. Two peoples records relating to the administration of as required medicines had information available but this was generic and not personalised for the individual person. One person had been prescribed medicine, 1 to be taken at night as required. There is no protocol so that staff know when to give this but it is recorded as administered each night for over a week. Where a person wishes to self medicate, appropriate risk assessments were present for external medicines. There is a Homely Remedy agreement in place. We checked the homely remedy stock and records. Stock balances were correct. There was an inappropriate stock of a prescription only medicine stored in the homely remedy stock. For one person who is prescribed insulin, there were clear records present regarding administration. Information from the GP was in place explaining how the dose to be administered is to be worked out in regard to the blood sugar level. All lancets used are appropriate for use by care staff. The actual doses of insulin given on each occasion are recorded. Blood glucose levels are recorded on a chart in the Nurses office. The home had obtained information from the surgery relating to the warfarin dose to be administered to one person after testing. The next test date was recorded and the actual dose administered was recorded. Medicines are labelled and dated on opening. In use eye drops are dated when opened and seen to be stored appropriately. We found some medicines that were still in use after their labelled discard date and others that had a discard date added that was longer than that indicated by the manufacturer. We found blood bottles and urine testing sticks that had passed their expiry date. Medication rooms temperatures are well controlled. We observed that one of the fridges that is used to store medication had been running at 1C for over a week. Insulin was being stored in the fridge. We found an unopened bottle of eye drops in one of the medicine cupboards which needs to be stored in the fridge. The manager agreed to order replacement supply of insulin and any eye drops that may have been affected by the temperature storage. The home carries out regular audits of medication. The manager confirmed that the current audit would not have picked up on the temperature control of the fridges. Also Care Homes for Older People Page 15 of 31 Evidence: the Audit only picks up that products have been dated when opened not that the correct discard date has been recorded. We observed staff knocking on peoples bedroom doors before entering. People who live at the home told us that staff treat them with respect. A Health professional told us that staff at the home respect the dignity of their clients. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for people who live at the home. This will be further enhanced once the home has obtained a minibus to take people on outings. The meals at the home are balanced and nutritious. People are generally very happy with the quality and choice of food available. Evidence: The home employs three activities organisers. On the day of inspection, one activities organiser was working due to the others being on leave. People who live at the home told us they receive an activities programme every week so that they can plan how they wish to spend their time. A health professional commented meals served on same floor as bedrooms gives sense of community now aware of lots of activities. A relative commented the house has a full range of daily activities which is of great interest and use . They told us that they felt the service could improve the amount Care Homes for Older People Page 17 of 31 Evidence: of physical exercise e.g. walking, exercise classes, dance etc. . Another relative commented the service could improve with just a little more one to one time, to sit, chat, look through a magazine together, go into the garden, do an activity. The Expert by Experience said I was able to speak at some length to eight residents, some in their rooms and some in the lounges, and got a clear picture of their opinions of the Home. The first people were quite happy but complained that there was nothing to do and no activities were on offer. They would have liked to be able to visit the shops but seemed uncertain about how this could be achieved. The Home has no mini-bus and is currently fund-raising to buy one. Speaking later to other residents I got a completely different picture: there were lists of activities in bedrooms and several spoke appreciatively of what was on offer. The home is currently raising funds to buy a minibus for the people who live at the home. People who live at the home and relatives told us that this will enhance the choice of activities/outings and they hope that it will not take too long to obtain. The Expert by Experience observed that there was general approval of the food which certainly looked very appetising. I was able to see what happened at lunch-time and I noted that staff seemed to know peoples individual likes and dislikes, and that food was served from heated trolleys in manageable portions. There was little waste. Although there were two choices for main course and dessert I gathered that if neither was suitable an alternative would be provided. This was confirmed when I visited the kitchen which again was clean and fresh-looking. People who live at the home told us that they had been asked by the chef what foods they would like to eat before new menus were introduced. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints policy. People are confident that they will be listened to and any concerns will be acted upon. The homes policies and procedures protect people who live there from the risk of abuse. Evidence: The home has a complaints policy. The home told us on their AQAA that they are confident that residents and their families will be listened to .. and .. look at complaints as an opportunity to improve. People who live at the home and relatives told us that they would know how to make a complaint if they needed to. The home had received three complaints since the last inspection. These had been investigated and action had been taken where necessary. There was evidence that the manager had followed the complaint up by checking the complainant was satisfied with the outcome. The home has policies relating to whistleblowing and abuse. Staff spoken with knew what to do if they had any concerns. Staff do not start work at the home until the appropriate checks have been carried out to prevent the risk of harm to people who Care Homes for Older People Page 19 of 31 Evidence: live there. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained, decorated to a high standard and provides a comfortable and homely environment for the people who live there. There is wide range of up to date specialist equipment and adaptations to meet individuals needs. Evidence: We viewed all communal areas of the home and a number of bedrooms. The home is divided into units providing nursing care, dementia care, and residential care. Each unit has its own communal lounge and dining room. The day care unit is a good size with a pleasant lounge and dining area. All areas of the home are nicely decorated and well maintained. The home has its own hairdressing salon and small shop. A trolley shop goes around the home once a week. A health professional commented that the home provides a safe and happy environment for residents to live and nice building, very clean. and it is a light and attractive environment. There is always someone to greet visitors on arrival. The Expert by Experience told us my first impression was very favourable. The outside of the building blends well with the surrounding residential area and great care has been taken to provide attractive grounds with a variety of seating areas. Care Homes for Older People Page 21 of 31 Evidence: Everything looked extremely well maintained. Two people who live at the home to whom I spoke were anxious to show me their rooms on the ground floor which had French doors opening onto a private patio area with two chairs. They obviously appreciated the opportunity this gave them to sit outside but still close to their room. During my visit I was able to see a number of bedrooms on other floors (there are three) all of which had very pleasant views of the gardens, although one person liked the fact that their room overlooked the car park so that they could see people coming and going. The rooms were all ensuite with shower and WC (there were also a number of bathrooms) and were equipped with the same furniture throughout, although where there was room it was possible for a small piece of their own furniture to be included and, of course, there was the usual collection of photographs, ornaments and in one room a positive menagerie of soft toys! Everywhere looked clean and tidy, and well cared for. The Home is arranged in the same pattern on each floor, ie a residents lounge and dining room. I could see that this might make for a more companionable atmosphere, but I did wonder whether it could also mean that each group stayed together all the time However, on the ground floor there is also one large lounge which can be used for activities and I was told that residents liked meeting up there as it was viewed as an extra facility. Television is available throughout but there were also a number of games, eg Scrabble, cards. Another room which is very much appreciated is a well-equipped hairdressing salon on the ground floor. Bedrooms are nicely personalised to show the interests of the person living there. People told us that they are very happy with their rooms. Some people had brought small pieces of furniture and treasured possessions with them when they moved in to the home. One person who lives at the home told us I have been to a few places and I have really felt at home here. It is a lovely atmosphere.. Its nice to be able to treat the rooms as my home. The home has made good use of signage and symbols in the Sycamore Unit to help orientate the people who live there who have dementia. The home has involved the people that live there in the decoration of the unit. Peoples artwork is displayed on the walls. Each bedroom has a cabinet on the wall next to the bedroom door. People have chosen memorabilia which is meaningful to them and reflects their history and interests to be placed in the cabinet. The Expert by Experience observed I was very impressed by what I saw. An effort had been made to re-create a home with a small H by including a traditional fire place in the lounge, and lots of pictures, ornaments, etc - a slightly less tidy setting but designed I would imagine to prompt memories. There was also a resident cat who looked extremely happy and well-fed! Care had been taken to protect the residents in this section by a controlled entry door. Care Homes for Older People Page 22 of 31 Evidence: A number of the ground floor bedrooms have french doors with direct access to the garden. The gardens are well maintained with seating areas, bird boxes and attractive flowers and shrubs. The home employs a gardener. People who live at the home are able to assist with gardening if they wish to. The home plans to further improve the garden by purchasing a gazebo for the summer. The home has a good range of adaptations and equipment in place to assist the people who live there. People benefit from stairs and a lift which accesses all levels. People who live at the home told us that it is always clean and fresh. We observed that the home was clean and fresh. The home employs a housekeeper to manage the domestic staff. We spoke with one of the domestic staff who told us they carry out regular deep cleaning of each room as well as routine cleaning to ensure that standards are maintained. The home also employs laundry staff. The laundry contains a range of commercial washing machines. We observed that liquid soap and paper towels were available in all bathrooms and toilets. We observed staff wearing gloves and aprons to minimise the risk of spread of infection. Alcohol gel is available throughout the home. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet the care needs of people who live at the home. Some people would like more time with staff to meet their social needs. People who live at the home benefit from having caring, skilled and trained staff. The homes recruitment procedures protect people from risk of harm. Evidence: The manager confirmed that the home is almost fully staffed. People who live at the home commented on the staff at the home. my key worker is good, staff are very good, my carer is one in a million, staff are excellent, they fall over backwards for you. A health professional commented the staff are without exception pleasant, cheerful and helpful. Relatives commented I have nothing but praise for this home and the staff at all levels who show care and compassion for my relative looking after all daily needs and the staff at Calway House are wonderful, dedicating and caring. I know my relative is happy, safe and in the absolutely best place. Seven people who live at the home and completed surveys told us that staff are always or usually available when they need them. One person commented that they Care Homes for Older People Page 24 of 31 Evidence: could do more if there was more staff. Two people who live at the home told us there is not always enough staff on duty to meet everyones needs. Three staff told us that there had been staff shortages on occasions recently but peoples care needs had been met. The Expert by Experience was told by people that they had the impression there were always enough staff on duty to attend to them, day or night, and to answer their calls promptly. A relative commented there is little time for staff to provide quality attention. On the day of inspection, the homes staffing levels were as follows; a supervisor, shift leader and two care staff on each residential unit; one RGN and ten care staff on the nursing unit. The Registered Manager was also on duty. In addition, there was one activities worker, and domestic and kitchen staff on duty. People told us that things had improved since the home had reduced the use of agency staff. We looked at three staff recruitment files. All of the required information was complete. One file did not provide a ten year employment history for the staff member. We discussed this with the manager who was able to evidence that she had explored this. It was not documented within the file. Staff who completed surveys told us that they receive training that is relevant to their role, helps them to understand and meet the individual needs of people, and keeps them up to date with new ways of working. New staff undertake a comprehensive induction which links to the Skills for Care Common Induction Standards. The home has a comprehensive training programme which includes health & safety; health & hygiene; fire; manual handling; abuse; end of life; first aid; medication; dementia and person centred care. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home benefit from a well managed service and an open and inclusive atmosphere. Effective quality assurance systems are in place. The homes health & safety policies and procedures generally protect peoples health, safety and welfare. Evidence: Verity Underhill is the Registered Manager. She is supported by two deputy managers, one has clinical lead on the nursing unit and one has responsibility for the residential units. Staff told us that they feel well supported. A health professional told us the management of the service are open minded and happy to try and work together to provide an appropriate response. A relative commented communication to me about my relatives wellbeing from all staff, carers, section managers and the home manager has been excellent. Care Homes for Older People Page 26 of 31 Evidence: The home has a quality assurance system in place. There is a suggestion box with paper slips in the entrance to the home. Residents meetings are held on a regular basis. The home told us that a copy of the minutes is given to people who live at the home. Surveys were given to people who live at the home, families and friends in December 2008. When completed, the surveys are sent to Somerset Care head office. The manager is responsible for following up where any action is needed. The area manager undertakes regular visits to the home to monitor quality by speaking to people and viewing the home. Records relating to these visits were viewed at inspection. The home carries out regular audits to check that the National Minimum Standards are being met. The home keeps small amounts of personal monies for some of the people who live there. These are stored individually. We checked the records and balance of monies for two people who live at the home. Records are signed by two people to safeguard people and the balances were found to be correct. We observed lists posted on noticeboards at two of the nursing stations. These related to baths and showers for people who live at the home. We discussed this with the manager at the inspection. We viewed up to date maintenance and servicing records relating to; Fire systems; Portable appliance testing; Electrical installation; Lifts. Further to a recent visit from Environmental Health, the kitchen has been awarded a 5 star rating. We found that two cupboards containing cleaning chemicals were unlocked. We discussed this with the manager and these were then locked during the inspection. Accidents are recorded. The home carries out an audit of accidents and falls each month. This is to identify patterns and minimise the risk of further incidents and injury to people. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 12(1)(a)(b) The home must ensure that substances hazardous to health are stored securely under the COSHH guidelines and are not accessible to residents as there is a possible risk of ingestion. (This requirement was made at the previous key inspection on 20th June 2007, and has not been fully met). 31/07/2009 Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made to ensure that all medicines are stored within the temperature range as specified by the manufacturer This is to ensure that people receive medicines without their efficacy having been compromised 31/07/2009 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 8 The home should ensure that people are turned in accordance with their care plan and that this is documented. This is to ensure that the people are turned to prevent pressure sores. The home need to review the storage of Controlled drugs and establish if they need to replace the cupboard that is not compliant with current regulations. The home should review its medication audit, so that it monitors all areas of recording, storage, and administration, and that action is taken where necessary. Page 29 of 31 2 9 3 9 Care Homes for Older People 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 This is so that the homes medicine procedures will protect the people who live at the home. 4 27 The registered manager should review and monitor staffing levels to ensure that peoples social needs continue to be met. The registered manager should ensure that when employment gaps are explored with staff, they are then documented. Information relating to people who live at the home displayed on noticeboards at nurses stations should be stored securely to maintain peoples confidentiality. 5 29 6 37 Care Homes for Older People Page 30 of 31 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. 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