Care Home: Challoner House

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What the care home does well The home provides a pleasant well maintained environment that is decorated and furnished to a high standard. The home has a range of activities available with two activities coordinators employed to organise a programme of activities to meet the needs of the service users. The activities are managed well, providing opportunities for residents to join in activities both inside and outside the home. Good social histories are maintained for each service user to enable the activities to be tailored accordingly. The care plans are well documented and describe how service users would prefer their needs to be met. The care plans are signed by service users or relatives and reviewed appropriately. Staff were seen interacting well with service users in general and were observed to be giving them choices. Comments on the surveys received from service users, relatives and visiting professional were complimentary with comments such as: `The service treats people with respect,have many activities in place for a range of needs.The service give resident`s choices as much as possible`. `The staff are very kind and helpful. I am always feel welcome when I visit. I would like to thank the staff for that`. `The nursing staff and carers are very helpful, friendly, considerate and supportive`. `The staff are very easy to talk to and understanding`. `I am perfectly content and well looked after`. `The activities girls put a lot of effort into organising a variety of activities for everyone taste`. `I have never had to complain about the care I have received in this home`. What has improved since the last inspection? The management of medication and the storage of medicines and medical supplies has been improved and the home has put in place internal audits to ensure safe storage and handling of medication. The home now ensures that all documentation regarding recruitment procedures are received before staff commence employment. Staff recruitment files have been upgraded and made more uniform to ensure all necessary records are in place. There are now activities at week-ends. Many of the areas of the home have been refurbished. The home has purchased new profiling beds and a new hoist. What the care home could do better: The manager must address the large number of comments made about the response time in staff answering call bells.Service users commented `Sometimes you wait a long time for bells to be answered especially at night`. `Sometimes the staff null a call and do not return quickly because they are dealing with a back log`. `When staff are busy I have to wait`. `Sometimes they are a long time answering bells.They say it is because they are short of staff`. The manager should ensure that if medication is prescribed on an `as needed` basis abbreviations like `QDS or TDS` should not be recorded as such but should be recorded on the administration recording (MAR) sheet in full. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Challoner House 175 Winchester Road Chandlers Ford Eastleigh Hampshire SO53 2DU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Challoner House 175 Winchester Road Chandlers Ford Eastleigh Hampshire SO53 2DU 02380266036 02380265763 lorraine.dentmagnusson@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 49 Number of places (if applicable): Under 65 Over 65 49 0 old age, not falling within any other category physical disability Additional conditions: 0 49 The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Challoner House is a care home, providing nursing for up to forty-nine service users aged 65 years and over within the categories old age, physical disability. Challoner House is a purpose built home surrounded by well-maintained gardens that are accessible to service users. There are forty-three single bedrooms and three shared bedrooms. All bedrooms have en-suite facilities. There is a passenger lift to the second Care Homes for Older People Page 4 of 36 Brief description of the care home and third floor. The home is decorated to a high standard. Challoner House is situated in a residential area in Chandlers Ford, close to local amenities. Fees are betweem £560 being lowest and £949 the highest. These fees do not include personal items, newspapers, hairdressing or chiropody. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to Challoner House formed part of the process of the inspection of the service to measure the service against the key national minimum standards and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in February 2007. An unannounced visit to the home took place on the 26th February 2009. For this visit the inspector was assisted for part of the inspection by an Expert by Experience (this is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service). Care Homes for Older People Page 6 of 36 An Annual Quality Assurance (AQAA) had been completed in detail by the home following the last inspection visit and information from this and the last inspection report was also used to inform this report. Evidence for this report was obtained from reading and inspecting records, touring the home and from observing the interaction between staff and users of the service. During the visit the expert by experience spoke to a number of residents both in their bedrooms and in the communal areas, and also spoke to members of staff on duty at the time. In order to prepare for the visit, surveys were sent to the people living in the home, staff and other professionals involved with the home. Twenty six service users, thirteen staff and one visiting professionals surveys were returned and most comments were positive about the care and environment. The general issues raised in the surveys returned, are discussed in the main body of the report. There was positive feedback from the visiting health professional. The home is registered to provide support for 49 residents and at the time of the inspection there were 44 people in residence. The Registered Manager has left the home and the home is being managed by an operational manager for the area who has some years experience in managing a care home and is also a registered nurse. She assisted us throughout this visit. What the care home does well: What has improved since the last inspection? What they could do better: The manager must address the large number of comments made about the response time in staff answering call bells. Care Homes for Older People Page 8 of 36 Service users commented Sometimes you wait a long time for bells to be answered especially at night. Sometimes the staff null a call and do not return quickly because they are dealing with a back log. When staff are busy I have to wait. Sometimes they are a long time answering bells.They say it is because they are short of staff. The manager should ensure that if medication is prescribed on an as needed basis abbreviations like QDS or TDS should not be recorded as such but should be recorded on the administration recording (MAR) sheet in full. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 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. Service users needs are fully assessed prior to them being admitted to the home. Evidence: The AQAA states that the manager or senior qualified nurse always carries out a comprehensive pre-admission assessment of potential service users and care plans are initially generated from this tool. It states that potential service users and their relatives are invited into the home to participate in a meal time and look around the home prior to them making a decision about going to the home to live. Four service users pre admission assessment documents were viewed and these are contained with their personal care plans. These were comprehensive and contained information to cover all aspects of care. One of the service users was transferred from another care home and the transfer information was very detailed to ensure continuity Care Homes for Older People Page 11 of 36 Evidence: of care. Care plans are initially written from information in the pre-admission assessment and formalised following assessment at the time of admission. The expert by experience reported that she spoke to a number of service users about their choices of homes and service users said they had choices about moving to the home. One resident had spent a months trial in the home before making a decision and a residents daughter told us she had visited several homes before choosing Challoner House. Service user surveys returned to CSCI indicate that they did have information about the home before people made the decision and that mostly relatives were involved with the assessment and decision making. Comments on the surveys say: The home has a good reputation in the area so I knew of it before arriving. My son visited 6 homes and was shown around Challenor by a nurse and Challoner House seemed the best choice at the time.My daughter lives in Chandlers Ford so she chose Challoner House and was satisfied with what she saw when she visited. Intermediate care is not provided in this home. Care Homes for Older People Page 12 of 36 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. Service users health, personal and social care needs are set out in individual care plans and reviewed appropriately. Service users, where appropriate, are responsible for their own medication and are protected by the homes policies and procedures for management of medication. Service users privacy and dignity is respected, however this could be compromised by the slow response from staff to the service users request for assistance. Evidence: The AQAA states that each resident has a care plan which is reviewed monthly or when the residents needs change. The AQAA states that the care plans are comprehensive and individualised to reflect every aspect of each service users personal requirements. The care plans show evidence of the representatives input. A sample of four service users care plans were viewed. The care plans are formulated from information gathered pre admission and at the assessment on admission. Risk Care Homes for Older People Page 13 of 36 Evidence: assessments are in place for falls, moving and handling, tissue viability. Each service user has a risk assessment in place for the stairwells that are used as an emergency exit from the building. Nutritional profiles are undertaken on all service users and weights are monitored regularly. The care plans contain a personal profile for each service user, which describes their social history and past hobbies and interests and a record of the activities they enjoy. The care records also detail the service users wishes and plans following their death. The assessments and care plans were very detailed and gave information on how to support the service users with personal care, health and medical needs, communication, activities, social interaction, sexuality and behaviour. The care plans identify to staff the wishes of the service user of how they like things done.The care plans are regularly reviewed and a number had been signed by relatives as evidence that they had been consulted and involved with the plans. Twenty three service users surveys were returned to CSCI, some of which had been completed by their relatives on their behalf, these were very positive about the care the service users receive comments saying The care I receive has been so good.The nursing staff and carers are very helpful, friendly, considerate and supportive. However there were a number of comments on the surveys appertaining to staff being available to give the care and support service users need, that the length of time service users have to wait for a response from call bells is unacceptable. The expert by experience had the opportunity to speak to a number of service users and she reported that service users told her they were aware of their care plan and said that they were consulted about them through questionnaires when they first came to the home and at regular intervals subsequently. Trained nurses document in the care plans the service users record of the activity of their daily lives. Care workers spoken with told the inspector that they use the care plans to find out the care needed for service users although many of them are familiar with the needs of the service users. Surveys received from staff generally indicated that information was available and up to date but some staff said The information in the care plans is sometimes conflicting and not always clear. Not all staff are informed about the simple things about the residents needs that have just been admitted. Everybody tries their best to keep the care plans up to date. These are reviewed on a monthly basis and relatives are involved as well.There are usually good hand overs between staff, however the care plans are often not up to date. The home has the services of a number of local GPs, one GP who visits the home twice a week routinely, and the primary health team who, the acting manager reported, are Care Homes for Older People Page 14 of 36 Evidence: prepared to give advise on specialist needs such as tissue viability. Service users spoken with told the inspector that they see a GP promptly if they are unwell. The responses from the surveys returned generally reported that the service users consider their health care needs are always met. One service user commenting I had an occasion to see the doctor and was admitted to hospital and the process worked well for me due to the close liaison between the home and my son. The care plans contained a record of all visiting health professionals that have been visited. The home has a visiting physiotherapist that visits the home weekly to assess service users mobility and moving and handling profiles and will document in care plans for prescribed care. The home has medication policies and procedures in place. One service user was choosing to self-medicate and the inspector viewed an assessment and risk assessment of the service users ability to manage her own medication. The medication is checked monthly by the nurse in charge of medication ordering to monitor compliance with prescribed medication. Lockable storage areas are available in each room. The clinical room that houses the medication trolleys was visited and was tidy and well organised.The home had a requirement made from the previous inspection to ensure better stock rotation of as needed drugs was required and the general tidiness and organisation of the room should be improved . The home uses the monitored dosage system for the administration of medication and is delivered by the pharmacy monthly. A senior nurse coordinates the ordering, receiving, returns and administration of medication. Records were viewed and in order. The system the nurse has instigated is thorough and all prescriptions are seen before they are sent to the pharmacist to avoid any unwanted medication being delivered. The cupboards did evidence large stocks of topical creams and skin washes which stated stock.The nurse told us that these are used regularly and the a large number of service users have these prescribed so,following discussion with the pharmacist it was decided that a label with stock on it be delivered and the persons name be stated on it as it was needed. The Medication Administration Records (MAR) sheets for individuals had the prescribed medications stated. This form of delivery of stock drugs also applied to the medication that was prescribed on an as needed basis. This was cross referenced to the MAR sheets and it was observed that the instruction for use were abbreviated to QDS or PRN and should be written in full with detailed instructions for their use for each person they have been prescribed for. The controlled cupboard was viewed and the stock balance of the controlled drugs in Care Homes for Older People Page 15 of 36 Evidence: use were in agreement with the balances stated in the controlled drug record register.The records are audited monthly by the senior nurse and there was evidence of her signature in the records of when she had undertaken this. The room accommodated a medication fridge and it was noted that medication being stored in the fridge stated the date the medication was opened. Temperatures of the fridge were being recorded daily. The senior nurse told us that one service user repeatedly refused medication and a risk assessment had been undertaken for the consequences of his not taking the medication, the GP had been consulted and advised to keep trying to persuade the person to take the medication. Reasons for his not taking medication were documented in the MAR sheets.The inspector viewed the MAR sheets and these had been recorded appropriately. No covert administration of medication is taking place in the home currently. A service user survey returned to CSCI told us that Drug rounds are timely and prompt and normally all drugs are delivered. The doctor visits twice a week and prescriptions usually come through quickly. The AQAA says the home has a privacy and dignity policy which all staff are made aware of and this subject is covered in the induction programme. The home has only 3 double rooms and all rooms have en suite facilities and house screens that give privacy. The inspector observed the practises throughout the day and staff were observed to be interacting well with service users and giving them choices. The inspector could not detect any difficulties in communication and staff were speaking and treating service users with respect. The expert by experience reported that most residents preferred to have their doors open when in their room but doors were closed when the rooms were unoccupied.When residents were being attended to by staff the door were closed and staff were observed to knock on doors prior to entering, with the exception of one carer who entered an opened door unannounced. Because the majority of accommodation in the home is single en-suite rooms, service users are able to retain their privacy in their rooms is they wish to do so. One service user reported that she enjoyed staying in her room to read quietly and this was respected. Care Homes for Older People Page 16 of 36 Evidence: A number of service users made comments on the surveys returned to CSCI about the length of time they have to wait for call bells to be responded to. Some saying sometimes I have to wait when the staff are busy but they come as soon as possible. There have been occasions when it may take upto 45 minutes for the buzzer to be answered.Sometimes there is a long wait for the bells to be answered.I do have to wait sometimes to go to the toilet after lunch because of lack of staff.You sometimes have to wait a long time for the buzzer to be answered at night. The issue of the time taken to answer call bells is causing the service users privacy and dignity to be compromised and the issue should be investigated by the manager. At the time of this visit the home was busy and call bells were being used but were being responded to appropriately. The expert by experience reported that it was observed that all residents had their buzzers close at hand in their rooms, one resident saying that the response time to the buzzers was fairly quick. One survey was received from a visiting health professional who commented that the service treat people with respect, have good activities for a range of needs, lay the dining tables beautifully and give residents choices as far as possible. Care Homes for Older People Page 17 of 36 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. Service users find the lifestyle in the home matches their expectations and meets their social, religious and recreational needs. Service users are supported to continue to maintain contact with the local community, their families and friends who are welcome at the home. Service users are supported to make choices in how they wish to live their daily lives. The home provides service users with a wholesome balanced diet which can be taken in pleasant surroundings of their choice. However, there is a variation in the standard of food from head chef to assistant chef. Evidence: The home endeavours to obtain a social history of the service user and their past recreational hobbies and preferences, at the time of assessment and try to gain as much information about them from relatives if service users are unable to communicate this to the staff. The profiles were evidenced in the care plan plans. The activities co ordinators say that this information is taken into account when considering appropriate activities for service users and to ascertain their level of being able to participate and what activities would be appropriate. Care Homes for Older People Page 18 of 36 Evidence: The home employs two activities co ordinators who between them work six days of the week. Each service user has a copy of the programme of the activities taking place each morning and afternoon for the following week and this is delivered to their rooms each week for them to consider what they wish to participate in. A copy of this is also displayed on the notice board in the reception area. The activities programme seen demonstrated that a variety of activities are offered such as weekly whist, which some of the service users are very keen on, scrabble, knit and natter sessions weekly, art and crafts, clothes sales twice a year and at the festive times of the year the school children attend the home to sing. The home also holds special themed days throughout the year. A mobile library attends the home monthly and a lady attends the home to swop the books for the service users. Other outside entertainers also attend the home. A resident told the expert by experience that a lady attends the home and brings her dog to visit the service users. The activities team were spoken with. One told us that she has been working at the home as an activities organiser for some time and really enjoys the role. It was observed that the co ordinators have a good rapport with the service users when interacting with them. The expert by experience observed the activities of the day and spoke to service users about what activities they participate in and how varied the programme was to meet their needs. The service users told her that the two activities ladies were excellent and they work hard. On the day of this visit there was a quiz in progress for about 15 residents who were observed to be enjoying taking part, one resident saying she could not linger to talk as she might miss the start of the quiz. Later in the morning sherry was offered to the service users before lunch in the downstairs lounge where residents gather before lunch is served. Those who were confined to their rooms or choosing to stay in their rooms were also offered pre lunch drinks. Later in the day a church service was being held which several residents told us they were attending. It was noted that services for other religious denominations are also held monthly. For those service users who are too frail to participate in activities or who are isolated by a lack of relatives or friends able to visit, the activities team make a point of visiting them in their rooms once every two days for a chat.The home now produces a monthly newsletter that is delivered to all service users. 23 service users surveys returned to the CSCI were complimentary about the activities provided at the home with comments saying. We are given information every week but I just participate in what I can. My mother is bedridden but 2 entertainment staff drop in to see her on a regular basis. Plenty of activities on offer. I enjoy the activities very much and I think staff work very hard to organise them. Activities are Care Homes for Older People Page 19 of 36 Evidence: good and the staff involved are caring coming up with activities that I enjoy. The two activities organisers are enthusiastic and efficient. I feel every effort is made to arrange a variety of activities for everyones taste. The records are well maintained of all activities that take place, who has attended and their level of participation. The activities organiser told us that she attends the residents meetings to support the residents if they are unable or reluctant to raise issues. One service user spoken with told us that she attends a day centre twice a week. Other service users go out with relatives whilst others go out with escort to lunch at a restaurant occasionally. It was observed that residents had the use of satellite TV in their rooms and also some had their private telephone lines installed. Service users are given autonomy over how they wish to spend their days and their preferences of how they like to undertake their routines of daily living are documented in the care plans. One resident telling the expert by experience that You can do anything you like here. You can stay in bed all day if you want and if you have any complaints you can air them.The expert by experience observed that bedroom doors had a number and the name of the resident on them with their preferred name stated. The home has a visitors book that was observed to be well recorded and demonstrated that the home has many visitors throughout the day. The home welcomes visitors and they are invited to stay for a meal and participate in events if they wish. One gentleman, who lives locally, visits the home daily to have lunch with service users. The kitchen was observed to be clean and well organised, although the inspector did not look at this in detail. The responses received from the twenty three CSCI surveys returned were mixed. The majority commented that they usually like the meals they receive. The comments written by service users were of mixed opinion such as. When the head cook is on duty it is always very nice but when the second chef is standing in it is not good and I have complained about this several times. Breakfast and supper is generally good. The lunchtime main course is variable, the meat is sometimes tough and bland and for residents eating in their rooms it is often cold. Dessert is generally good. The meals are generally good but maybe residents could be asked to nominate their favourites. I find the meals very dry and I would enjoy having some gravy. Breakfast is my favourite meal, lunch and supper puddings are usually good. However the choices for the main lunch meal needs reviewing and the meat is always tough and not cut into Care Homes for Older People Page 20 of 36 Evidence: slices. There is restricted choice of sandwiches at supper time and Sunday lunch has no choice it is always roast lunch. Barchester need to improve the choice. The mid morning and afternoon tea trolley are timely and staff are caring. A choice of menu is offered to residents in the morning on the day before for all three meals. The inspector observed the lunchtime meal. The dining room is very pleasant and the tables looked attractive. The service users lunches were being presented well and the meal looked appetising. The menu was displayed and it demonstrated choices at each mealtime. The expert by experience reported that observing the lunch time meal there was a choice of two alternatives and service users told us the desserts are good and the chef makes a lovely cake. The expert by experience also observed that during the meal time there was positive social interaction between staff and residents with one member of staff listening patiently and caringly to the domestic concerns of a gentleman that attends the home for lunch. Another carer was helping a resident with her food and was chatting with her as well as helping, but not rushing. The expert by experience spoke to a number of residents about the food. A few residents told us that the food is better when the main chef is on duty. The assistant cook will cook things in a different way and could do with some cooking lessons. The food can be a bit stodgy and you cannot tell what it is. Again some residents told the expert by experience that the meat was chewy and on the day of this visit some residents were making comment about the meat being chewy and difficult to digest. Other residents spoken with said their lunch was very good. The operational manager told us that it is planned for the second cook to go on a training course as soon as possible. Portion sizes were observed not to be big but this had been a decision made at a residents meeting by the residents and it was observed that as a consequence there was little food wastage after lunch. A visitor spoke to the expert by experience and said she did not think the food was as good as it should be and that perhaps a nutritionist input was necessary. Their was evidence in the care plans that all service users have a nutritional risk assessment undertaken and weights are recorded regularly. The GP would be consulted if a risk was identified. The AQAA states that the home will continue to hold regular menu meetings and review the menus according to the service users changing needs and wishes. Care Homes for Older People Page 21 of 36 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 complaint process in the home is satisfactory and relatives views are listened to. The home has the adult protection policy and procedures in place,which have been followed effectively. All staff receive training on abuse and have an awareness of procedures to follow for the safeguarding of vulnerable adults. Evidence: The home has a complaints policy which is displayed on the reception area wall. It also forms part of the information that service users and relatives received about the home before they come to live at the home.The home has a complaints book and suggestion book that is kept next to the visitors book and people are welcome to made comments or complaints in this book which is audited regularly and any complaints or suggestions are actioned. This book was viewed. Most of the complaints were of a minor nature and dealt with by the manager. The book documented how the complaint was resolved. There were general compliments documented bout the home. The AQAA reports that the home have received 10 complaints in the last year with 90 resolved in 28 days and 2 of which was upheld and one waiting for an outcome. There have been 6 adult protection referrals made to the appropriate authority and investigated. At the time of this AQAA being completed there remained one adult Care Homes for Older People Page 22 of 36 Evidence: protection (safeguarding) issue in the process of being resolved. The home had followed the safeguarding procedures and Eastleigh Adult protection team were fully involved as the investigating agency. The AQAA told us that as a consequence of contact with Social Services on safeguarding issues that have had to be investigated by them, the home has gained a mutual understanding of the roles each agency play in following the safeguarding procedures. All staff undertake the Protection of Vulnerable Adults (POVA) training at induction and yearly updates, which are mandatory and provided and funded by the organisation. Training files evidenced that training sessions are held three monthly to enable staff to attend at least once annually. Staff have also undertaken the customer care course and this was evidenced in the training file. The organisation is providing person centred care courses for all staff which is delivered via the computer programme. Elements of this training contains how to deal with abuse and policies and procedures to follow. The service users responses to the survey identified that generally they would know who to go to if they wished to complain or to discuss an issue with the manager, one service user saying I have no need to complain. The current acting manager was observed to have a great rapport with the service users on the walk around the building and she took time in listening to one service user who had a suggestion for the home and was quite anxious not to make a fuss. 13 staff surveys were returned to CSCI and all of them indicated or commented that they would know how to guide a service user if they had a complaint and the procedures and who to go to if they had concerns about the service users safety. There was evidence in the personnel files that staff are checked with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults register POVA before commencing employment. Care Homes for Older People Page 23 of 36 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. Service users live in a clean well maintained home that provides a homely comfortable environment. Evidence: The AQAA states that the internal and external building is maintained and furnished to a high standard. The surrounding grounds are also well maintained. The home has made improvements over the last year and stated as Air conditioning has been installed in the kitchen. The bathrooms have been redecorated. The care park has been relined and more parking spaces created. Eight bedrooms have been redecorated. Three new profiling beds purchased. New washing machine. The dining room has been decorated and seating upgraded. Two communal lounges have been upgraded Replaced light fittings in most bedrooms affording service users a brighter light. The AQAA documents that the home has a plan for the coming year to continue to maintain and undertake further improvements to the environment. The inspector toured the home and visited most rooms. It was observed that rooms are personalised and equipped to meet residents needs whilst providing a homely Care Homes for Older People Page 24 of 36 Evidence: environment that has been decorated and refurbished to a high standard for them. There is a mixture of beds supplied to meet needs and assist staff in their caring. Where bed rails are needed for those people who have been identified as at risk of falling, a risk assessment has been undertaken and agreement sought from them or their relatives for the use of the bed rails. The inspector observed that there were adequate assisted baths and showers. The manager identified that one bath has been moved around to give optimum space for residents. The AQAA states that the internal and external building is maintained and furnished to a high standard. The surrounding grounds are also well maintained. The home has made improvements over the last year and stated as, Air conditioning has been installed in the kitchen. The bathrooms have been redecorated. The care park has been relined and more parking spaces created. Eight bedrooms have been redecorated. Three new profiling beds purchased. New washing machine. The dining room has been decorated and seating upgraded. Two communal lounges have been upgraded Replaced light fittings in most bedrooms affording service users a brighter light. The AQAA documents that the home has a plan for the coming year to continue to maintain and undertake further improvements to the environment. The inspector toured the home and visited most rooms. It was observed that rooms are personalised and equipped to meet residents needs whilst providing a homely environment that has been decorated and refurbished to a high standard for them. There is a mixture of beds supplied to meet needs and assist staff in their caring. Where bed rails are needed for those people who have been identified as at risk of falling, a risk assessment has been undertaken and agreement sought from them or their relatives for the use of the bed rails. The inspector observed that there were adequate assisted baths and showers. The manager identified that one bath has been moved around to give optimum space for residents. The home has had a large conservatory built which has been fully furnished to a good standard and looks out over the well maintained surrounding gardens with easy access for all residents. This is used as a quiet area for service users to take their visitors or used for family parties to celebrate special occasions. The service users surveys returned to CSCI gave praise for the cleanliness of the home and included in their responses to the survey comments such as The cleaning staff are regular and always helpful. Peters room is untidy at times. Public areas are always clean sometimes residents rooms could be improved. The environment of the home is very good including the garden which has some exotic trees planted. The home is Care Homes for Older People Page 25 of 36 Evidence: fresh and clean and the laundry is done well. There are no unpleasant odours. There were no negative comments about the environment received from the service users and relatives spoken with. The acting manager told us that an extra cleaner has been employed to ensure all areas of the home are cleaned each day. On the day of this visit there were four cleaners and one laundry lady on duty. The home was observed to be clean and hygienic. The AQAA records that 38 staff have received specific infection control training with all staff receiving the principles of infection control as part of their health and safety training.The training records was evidenced on the training records. The inspector observed that there were numerous hand washing facilities around the home. Gloves and aprons were being worn by staff. The expert by experience walked around the home independently and reported that there were no unpleasant odours detected in the home. The home was clean and well lit and pleasantly decorated with many books and pictures on display. One resident told her that the cleaner comes in every day, another said the cleaners are very good indeed. It was observed by the expert by experience that the reception rooms were pleasantly decorated with with plenty of seating and a pretty outlook. Some residents have their own bird tables and feeders and enjoy looking out observing the birds and squirrels. The expert by experience reported that the dining room was smart with tables laid nicely and residents enjoying the social intercourse of having a meal together. The residents told us that they are pleased with the laundry service and is very efficient one commenting They bring the laundry back every morning they are very good. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing would seem to meet the needs of the residents currently in residence. Staff training is provided, however there are mixed views on if the training provided is meeting staffs training needs. Service users are protected by the homes recruitment policies and procedures. Evidence: The AQAA stated that staffing levels and skill mix of the staff is sufficient to meet the needs of service users who are cared for by qualified staff who carry out their roles competently.The home only uses agency staff in the event of permanent staff being unable to cover absences. The staff rotas demonstrated that 9 carers are on the rota for duty in the morning and 6 in the afternoon. 3 carers cover night shifts. 2 trained nurses are on duty in the home over the 24 hour period. These rota figures do not include the acting manager and the homes trainer who are in the home for five days of the week. A separate housekeeping staff are on duty during the day that consist of 4 housekeepers, a laundry person, chef, kitchen assistant, hostess who serves beverages and prepars the dining room for meals, 2 activities organisers, a maintenance man and the receptionist and administrate are also in the home. At the time of this visit the home was accommodating forty four residents, two of whom were in hospital, and employed a Care Homes for Older People Page 27 of 36 Evidence: workforce of mixed gender who were from various cultural backgrounds. Observations throughout the day evidenced that the call bells were being answered within an acceptable timescale, people were not rushing about the home and there appeared to be sufficient staff on duty to meet the current service users needs. The expert by experience recorded that she overheard behind closed doors two carers moving a service user who was obviously in pain, their voices were friendly, reassuring and calm. There was positive interaction and care from staff towards the residents. A resident said the staff are all very good and very caring. I have no complaints. Another resident told the expert by experience that the staff give care with courtesy. The staff are attentive the moment you ask for something. The male carers are lovely. One resident did mention to the expert by experience that when there is agency staff they may try to get you to bed earlier. The acting manager was very much in touch the home and knew her residents and staff well, despite only being at the home for four weeks. Staff surveys returned to CSCI have opinions on the numbers of staff needed saying. Mornings are worse but there has not been enough staff on the middle floor to attend to the service users needs. Some people have to wait for at least half an hour to be seen. The service users needs are sometimes not met like responding to call bells in time, this is due to the fact the sometimes we have to work short staffed especially when someone phones in sick and the manager is unable to get some one to cover the shift, but we try our best. There are enough staff usually to meet the basic needs of washing and dressing and feeding but not much more. The work priorities can sometimes compromise other needs of the service user. We have enough staff but sometimes the individual needs of the residents require more, some are very disabled. There are times when we could do with a few more staff but this could change with the new manager coming into post. The information on the AQAA indicated that at the time of completion only 30 of care staff employed at that time had achieved their NVQ level 2 and above. Training was discussed with the acting manager and she informed us that three carers were doing the NVQ level 3 and another was currently on the NVQ level 2 course. The manager told the inspector the home assists staff in applying for an NVQ qualification with the Barchesters training forum, which is suitable for them and offers support in the home with two qualified NVQ assessors in post and they wish to facilitate and encourage more carers to do the NVQ level 2 & level 3 if they wish. The AQAA says that the home could improve the supervision programme for care staff which has suffered as key staff have been off sick or left the home. Care Homes for Older People Page 28 of 36 Evidence: The acting manager is undertaking reorganisation of the staff supervision and appraisal programme and will ensure that training plans are in place for all the staff. Since being in post the acting manager has endeavoured to undertake a supervision with all staff and has organised training for registered nursed and senior carers in appraisal and supervision to enable them to supervise their junior team of staff. The acting manager is in the process of identifying training needs and arranging training to meet the staffs needs. Staff surveys returned to us had some mixed opinions on training needs being met and the training that has been on offer in the past. About 50 of the surveys returned indicated a level of satisfaction and that staff had received appropriate training to carry out their roles. Other comments on surveys from staff were stated as, The home tries to give as much training as possible to staff. Nearly all the training you get at this home is the mandatory training. Care staff are not encouraged to better themselves. I am still waiting for some training for a role I undertake twice a week. Any new ways of working are taught to me as needed. We do get some form of training but it is not enough to equip us with the expertise that is required. We are hoping that in future we will be getting more training. The moving and handling training I received was poor there was no practical training and I received this from another carer before the training was run. The home has appointed a trainer who is co ordinating the training for the coming year and maintains training records and undertakes the induction training. She showed us the training matrix as evidence of the training that has taken place and the planned training for the coming year. At the time of this visit the fire training person was attending the home to undertake fire training. This was attended by most of the staff and the acting manager commented that more staff had turned up to do the training than expected and that staff are motivated to undertake the training. Another care worker was in the training computer room undertaking part of infection control training via the CD Rom. The AQAA states that the home has a robust recruitment procedure and all appropriate checks such as the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) are taken up and verified. These are returned and with two written references being received before the staff member can commence employment. A sample of three recruitment files was viewed by us. The files are kept secure in the administration office and the administrator maintains and updates these and is providing a uniform structure to all personnel files. The electronic staff auditing system Care Homes for Older People Page 29 of 36 Evidence: updates the administrator and flags up nurse registration renewal dates and CRB renewal dates. The AQAA states that all staff have undertaken an induction programme that is based on the Skills for Care induction standards. Evidence of these were in personnel files. Staff surveys returned, indicated that the induction covered everything that staff needed to know to do the job when they first started. Other comments on surveys included. Most of the initial training was done in terms of hands on training. I was supernumerary but staff went sick and you just got stuck in. More recently staff seem to have faired better with being supernumerary before caring. Induction did cover almost everything but one still needs support during performance of duties, one should not be expected to know everything just because you have been inducted. Induction is given as a long practised routine not tailored to individual learne. I got on going training whilst at work. Everything was made clear and covered on my induction. The induction programme has improved since I started. Care Homes for Older People Page 30 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is without a registered manager currently but is being managed temporarily by a person who it fit to be in charge and is able to discharge her responsibilities fully. The home has a quality control system to ensure the home is run in the best interests of the service users. The health, safety and welfare of service users and staff are protected by the systems and staff training in place to ensure this. Evidence: The AQAA confirms that the manager is qualified for her post. Subsequently the registered manager has left her post and the home is being temporarily managed by the operational manager for Barchester in this area. The acting manager is a registered nurse and has had some years experience in managing a care home and as Care Homes for Older People Page 31 of 36 Evidence: operational manager for a corporate group of homes. The deputy manager has also left the homes employment. The operational manager, referred to in this report as the acting manager, told us that Barchester have appointed a new manager who would be taking up post within the following weeks once their CRB clearance is received and he would then be applying for registration with CSCI. The acting manager intends staying at the home until the new manager has completed his induction programme. Staff spoken to at the time of this visit say that they feel very supported by the acting manager and that she has given them confidence to undertake further training and they feel they are more confident in their roles. Comments on survey returned from the staff indicate that generally they feel they get the right support, but some staff felt that until recently they had not had the support they needed. Observing the interaction between the service users, staff and the acting manager would suggest that the acting manager is respected and thought highly of with some service users saying they wished she would stay at the home for always. The home has a corporate quality assurance system in place. The organisation has a quality control system which is undertaken on a monthly auditing programme. This is set out from an organisational directive. The audit programme covers a different area of the home each month and covers health and safety, including recording of accidents, nutrition, infection control, medication. activities, documentation, personal care and professional practises. The manager returns the results monthly to head office. The results of the audits, their outcomes and action plans are kept in the audit file and were seen. Residents and relatives meetings are held and minutes of these meetings are recorded. The AQAA states that the home wishes to improve the attendance of these meetings by holding them at different times of the day and giving plenty of notice of when they to take place. The home is visited monthly by the organisations representative and a report is undertaken on all aspects of the home and the management, a copy of which is left in the home and was seen by us. The response time taken to answer call bells has been recorded as an issue. These are now recorded and the records are audited regularly to ensure the call bells are being responded to within acceptable timescales and the acting manager can monitor these and discuss with staff any unexplained delays. Care Homes for Older People Page 32 of 36 Evidence: The home does not look after any monies for residents. Families or representatives such as a solicitor are invoiced for any extra expenses incurred by the resident. The home does keep a record of any valuable belongings that service user wish to bring with them. A sample of servicing certificates were viewed for systems and equipment and these were seen to be up to date. The fire log was viewed and recorded testing of the fire system and alarms at appropriate intervals. Records of monthly hot water testing was seen. The home has a fire risk assessment in place and an environmental risk assessments are in place for safe working practises. The home holds quarterly health and safety meetings involving staff from all departments of the home and minutes of these meetings are maintained. Mandatory health and safety training takes place annually and the training matrix evidenced that staff have attended this and includes fire, infection control, first aid, POVA and all kitchen staff have received training in Food Handling Hygiene. The chef is about to undertake his advance certificate in this. Care Homes for Older People Page 33 of 36 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 34 of 36 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 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 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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