Care Home: Carisbrooke Nursing Home

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What the care home does well People who use the service and their relatives have the information they need to decide whether Carisbrooke Nursing Home is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. People receive a good standard of personal and nursing care. One person wrote "Its an excellent nursing home it could not be better". Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. Medicines are generally well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are generally good and means that staff know how to care for someone in a safe and consistent way that meets their individual needs and preferences. People have access to a good programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home. People tell us that the food is excellent at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognise signs of abuse and know how to report any suspicions or poor practice. Carisbrooke Nursing Home is a safe and pleasant place to live and work. The matron and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. Pre employment checks are performed on staff to show they are suitable to work with vulnerable adults. The home is well managed by the owner and the RGN in charge. What has improved since the last inspection? No requirements were made at the last inspection, however the owner continues to make improvements and involves the people that live at Carisbrooke in these decisions. What the care home could do better: One requirement has been made in respect of the recording of administration of medication. This needs to be improved to keep people safe at all times. Key inspection report Care homes for older people Name: Address: Carisbrooke Nursing Home 50 Teignmouth Road Torquay Devon TQ1 4ET     The quality rating for this care home is:   three star excellent 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: Caroline Rowland-Lapwood     Date: 1 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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 27 Information about the care home Name of care home: Address: Carisbrooke Nursing Home 50 Teignmouth Road Torquay Devon TQ1 4ET 01803326409 01803313368 carisbrookecare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Betty Delicia Miller care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The Home is registered as a Care Home with Nursing for a maximum of 25 Service Users in the categories of PD 25, TI 25 Date of last inspection Brief description of the care home Mrs Betty Miller, the proprietor and Matron, established Carisbrooke Nursing Home in 1971. It is located in the Torre area of Torquay, close to local amenities. The home is registered to provide general nursing care within 18 single rooms (14 of which have en-suite facilities), and 3 double rooms. It provides nursing care for long and shortterm admissions for physically disabled, palliative care and post- operative care (convalescence). The home is arranged on 3 floors with access via a passenger lift and a small stair lift to 3 double rooms on the top floor. The garden is well kept and accessible to Service Users. There is a variety of equipment to support physically disabled Service Users needs and specialist equipment is available following an assessment of need. Care Homes for Older People Page 4 of 27 Over 65 0 25 Brief description of the care home A registered nurse is on duty at all times supported by a team of Health care assistants, administration, catering, domestic and maintenance staff. The fees charged range from five hundred and ninteen pounds to six hundred pounds per week. People requiring continuing care have their fees negotiated by the placing authority on an individual basis. The latest inspection report is displayed in the entrance foyer and the manager was advised that the Statement of Purpose should be updated to include information about where people can access the latest report if they do not have access to the internet. The contracts issued include name and date of admission and who pays the fee, how the fee is broken down and the total fee, plus the homes terms and conditions of residency. Care Homes for Older People Page 5 of 27 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This key unannounced inspection consisted of a visit to the home on Thursday 10th and Friday 11th December 2009. One inspector performed this inspection. During this time we spoke to the owner/matron, Mrs Miller she is the person with day to day responsibility for the service, the Registered Nurses and many other members of care and ancillary staff on duty. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. Care Homes for Older People Page 6 of 27 We looked at three staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Carisbrooke Nursing Home. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 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 27 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 27 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. The home provides good information to people, which enable them to make a choice about whether the home will suit their needs. Good systems are in place to ensure that peoples needs are assessed and can be met prior to moving into the home. Evidence: There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. People returning CQC surveys told us they had received enough information about this home before they moved in, helping to ensure it was the right place for them. People spoken with during this visit told us they were happy living at the home, one said, Its exceptional here. The home uses an assessment as a way of getting information about peoples needs Care Homes for Older People Page 11 of 27 Evidence: and preferences before they move to the home. This helps to ensure that individual needs can be met. We looked at three assessments, all gave good information about peoples abilities, needs, usual routines and preferences to enable staff to plan and deliver care appropriately. Social care professionals told us in surveys that assessment arrangements always ensure that accurate information is gathered and that the right service is planned and given. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 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 has a good care planning system, which provides the staff team with the information needed to enable them to support people in a way they prefer. Peoples health needs are well met and the management of medication is satisfactory. People feel they are treated with respect and that their privacy is upheld by caring staff. Evidence: People responding to CQC surveys told us they always received the care and support needed. One wrote, the overall quality of care and nursing is really good . During our visit people told us they were happy with the care they received, comments included, The staff come when I call I dont have to wait very long at all, Staff are kind and nothing is too much trouble for them, and the owner is a marvel!. Each person has a plan of care, these detail his or her individual care needs, wishes and preferences. Staff were aware of peoples needs and could describe the care Care Homes for Older People Page 13 of 27 Evidence: delivered. Risk assessments were in place and generally reflected behavior or situations, which may cause harm to people, for example poor mobility, falls, aggression and the use of equipment. Moving and handling assessments and plans, skin care and continence assessments were in place and generally provided staff with the instructions needed to deliver care. Staff were observed to assist people with manual handling needs in a competent and sensitive manner, using the correct equipment and giving gentle instructions and reassurance to people as needed. Staff were given information at shift handovers about some peoples particular needs any changes to their needs, who was to be offered a bath, or needed encouragement with drinks or food. Staff surveys showed they were always given up to date information about peoples needs, one wrote, The care offered to the patients and their relatives is excellent. Peoples personal care was well attended to; people were smartly dressed, and well groomed. Everyone spoken to advised that they rose and retired at a time of their own choice. People told us their medical needs were always met; Health professionals responding with CQC surveys told us the home always sought advice and acted on advice. Health professionals felt that peoples health care needs were always met. Their comments included; It is excellent all round, The staff are friendly, caring and respectful and The home has good communication and a positive attitude. Records show that people have access to a variety of health professionals including GP, district nurses, optician and other specialists and out patient clinics. We looked at the way the home stores and administers medicines. Medicines at the home are managed safely. Medicines are stored and disposed of safely. The fridge used to store medicines is lockable and temperatures of the fridge are kept. Other storage was satisfactory, including the arrangements for storing of controlled medicines. Daily records were complete, however there were some gaps in administration records. During our visit staff were seen and heard to be polite and friendly when delivering care or assisting people with their daily activities. Staff were heard to address people in a respectful manner and their approach was pleasant and caring. Care Homes for Older People Page 14 of 27 Evidence: The service is highly efficient when caring for people who are terminally ill or dying. The wishes of individuals about dying and terminal care, and the arrangements they want after death are discussed and recorded.Staff work to a very high consistent standard and constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. Facilities are available to allow relatives and friends to stay with the person if they would like to. The home works closely with external professionals and specialists for advice and support to help the person their family and the homes; staff. Care Homes for Older People Page 15 of 27 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. Routines are flexible and people are supported to exercise control over their daily lives. Social activities meet peoples expectations and preferences and people benefit from contact with their family and friends, which is encouraged and supported by the home. Meals at the home are excellent and provide a nutritious variety. Evidence: A tour of the home showed some people in their rooms watching appropriate TV programmes, listening to the radio or reading. Communal space includes a conservatory, where most of the activities take place, and a dining room, part of which can be used as a quiet seating area. There is level access to well laid gardens where seating is available for people to use. An activity programme is in place, information about what is scheduled is displayed within the home. These include movement to music and crafts with a recreational therapist, these are well attended. Outings and trips are arranged on an individual basis. There is a monthly Holy Communion session held in the home. On the day of the inspection a pet therapist was visiting an several people were enjoying stroking and holding the different animals. Care Homes for Older People Page 16 of 27 Evidence: The menus are very varied and alternatives are always available. The menu has stated on it that always available are cold meats, fresh fruit, cheese and biscuits, a selection of yoghurts, beverages and mineral water. All of the people spoken to said that the meals are exceptional, many of the completed staff surveys indicated that the meals served are excellent. The matron takes great care to ensure meals are served attractively and with the amount the person wants. Trays are laid, the meal is served and individually taken to peoples rooms by the care staff. This process was seen during the inspection and ensured that peoples was hot enough when delivered to them and that the staff member could make the Service User comfortable for their meal and give any assistance as required. The Christmas 2009 menu was seen, this was well presented and included 3 days menus, all varied and specially created for the season. House wines were included on the menu. Staff were seen assisting Service Users at a mealtime. We were told the pureed meals are served individually and look appetising and appealing. Specialist diets are catered for. Information about the people requiring these was available in the kitchen for the catering staff to refer to. People can eat in their rooms or in the dining room, wherever they choose. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. Evidence: People responding with CQC surveys knew how to make a complaint and knew who to speak with should they have any concerns. People felt Mrs Miller, the owner/matron, and the staff were approachable and would listen to them and always act on what they say. Relatives were also aware of how to make a complaint and told us that concerns were responded to. Outside professionals were confident that complaints or concerns were responded to appropriately. The Commission has received no complaints about this service since the last inspection Training records showed that staff receive adult protection training to ensure they are aware of the issues and know who to raise any concerns with. Staff spoken with said they had attended training and had a good understanding of adult protection matters and understood their personal responsibility to report incidents of concern. People spoken with confirmed that they were happy living at the home and all said they felt safe at the home. Care Homes for Older People Page 18 of 27 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 safe and well maintained and clean and hygienic ensuring people live in a pleasant environment. Evidence: A tour of the home showed that peoples contain personal items including furniture, ornaments and pictures. The home appeared well equipped to meet the needs of people identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses and cushions and adjustable beds were seen in place for those people requiring them. There is new call bell system throughout the home, people seen in their rooms all had the bell placed within their reach. There is a conservatory and a dining room on the ground floor. The decoration and furniture was domestic in nature was of good quality. There are no televisions in the communal areas. All rooms benefit from their own TV. The matron has replaced all recently with wall mounted flat screen televisions. There is a shaft lift and a stair lift for access to a 3 double rooms with steps leading to them. The home has a well - laid and maintained garden with seating available for people to use. Many rooms benefit from views over the gardens. Care Homes for Older People Page 19 of 27 Evidence: Hand washing facilities were seen throughout the home as were protective gloves and aprons. The laundry has one washing machine, with a disinfecting sluice cycle, and a large tumble dryer. The kitchen appeared well equipped and although small it is organised in such a way that the catering staff can manage the meals required for the number of people living in the home. The matron/proprietor has an ongoing plan for refurbishment and redecoration as she takes a great pride in the appearance of the home and the quality of the fixtures and fittings. During the inspection the home was clean and tidy. Care Homes for Older People Page 20 of 27 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. Staffing levels are sufficient to ensure that peoples needs are met in a timely way and experienced and friendly staff support people well. People are protected by the robust recruitment practice followed at the home. Evidence: People living at the home spoke highly of the staff. Their comments included,They are caring and work hard and They are great. Relatives responding with surveys felt that the home gave the support required and could meet the different needs of people living there. People responding with CQC surveys told us staff were always available when needed. All staff told us there was always enough staff to met peoples needs. During our visit peoples needs were attended to in a timely and unhurried way. We looked at the recruitment practice within the home to ensure people are protected. All staff returning surveys told us that employment checks such as Criminal Record Bureau (CRB) check and references had been undertaken. We looked at three staff recruitment files. All the required checks had been obtained before staff started working at the home. Staff told us they had good training opportunities and good support from the Care Homes for Older People Page 21 of 27 Evidence: management. All staff responding with surveys said they had received induction training, which helps them to understand how to work safely and respectfully with people. Many of the care staff have achieved a nationally recognised care qualification (NVQ 2 or above), which helps to ensure that staff are competent to meet peoples general care needs. Other training, including mandatory training is well addressed. One staff member told us, We have a lot of training, its good Records showed that staff had undertaken training such as adult protection, medication, dementia, and Liverpool Care Pathway. Care Homes for Older People Page 22 of 27 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 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 well managed, with good systems in place to ensure that peoples views are sought and acted upon. Health and safety within the home is promoted meaning people live in a safe environment. Evidence: The matron /proprietor of this home is a 1st level registered nurse who has a Registered Managers Award. She established the home in 1971. She shows strong leadership qualities and expects high standards from her staff. The completed staff surveys indicate that her management style is respected and staff are clear about what she expects from them. She believes in providing good quality care, meals and environment and ensuring people are treated with kindness and dignity. She measures this by visiting the people regularly to assess the level of service they are receiving and has satisfaction surveys given/ sent to people and/or their representatives for feedback. Any actions required as a result of these is discussed at staff meetings and is documented in the minutes. Care Homes for Older People Page 23 of 27 Evidence: There are clearly defined roles amongst the staff with trained nurses having responsibility for specific areas such as medicines ordering and induction training. The home looks after some peoples monies, these were checked and were accurate and kept securely. Staff told us they received regular supervision and support to help them do their jobs well. One staff member told us, The matron is excellent, firm but fair. Health and safety at the home is managed well. The records we looked at showed that staff have received training and regular updates on all health and safety related topics. Records showed that staff had undertaken fire safety, first aid, manual handling, food hygiene, infection control, and health and safety training to ensure people work safely. The kitchen was organised and well equipped. Fridge and freezer temperatures are recorded regular to ensure that food is stored safely. The fridges in the kitchen were clean and food stored had been labelled and dated. Records showed that maintenance of equipment and systems, such as water, gas and electrical systems were up-to-date. Care Homes for Older People Page 24 of 27 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 25 of 27 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 All medication must be signed for when administered. This will ensure peoples safety. 31/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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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