Care Home: Charlotte House Mental Nursing Home

Similar services:

• Townley Road, 2-3
• Foxley Lane (121a)
• Tudor Lodge
• Stacey Street Nursing Home
• Delrose House Ltd
• Clovelly House Residential Home Ltd
• Abbey Road [53]
• Cherry Tree House

What the care home does well Our satisfaction survey and conversation with visitors and people who use the service highlight the quality of care that is given to residents, as the aspect of the service that they are most pleased about. Four residents commented that the care that is provided is very good. Two people said that the support that residents receive from staff in meeting their healthcare needs is very good. They say that staff recognise any deterioration in residents` condition promptly and contact the relevant healthcare professional as required to ensure that residents are seen without delay. Our findings show that the home has a good staff team that works well together to provide a good atmosphere in the home and who on the whole understands the needs of older people with dementia care or with mental health needs. Staff in their questionnaires said that they all work as a team to make sure that they provide a high quality of care. One member of staff said that they were proud to be a part of the staff team. This is evident when we considered the length of time that some members of staff have worked in the home. Most of the nursing members of staff have worked in the home for many years and are familiar with the needs of the residents that are accommodated in the home. Recruitment procedures are adhered to as required and staff receive induction and training to make sure that they are able to do the job that they are employed for. People who are referred to Charlotte House have their needs assessed in a comprehensive manner and at an early stage to determine the service that they require. They and/or their representatives are provided with information about the home for them to understand the way that social care is delivered and for them to make informed choices. Residents receive a variety of nutritious meals and are able to exercise choice in choosing their meals, although the system to record the choices of meals needed to be made more consistent, as there were different systems on each floor. There were no negative comments about the meals that are provided in the home. The home has an effective management structure that ensures that the home is run appropriately. There is an adequate number of ancillary staff that supports care staff as required. It also has a quality assurance system that takes into consideration the views of residents and their representatives, to monitor the quality of the service that is provided. Health and safety issues are taken seriously and are addressed as required to make sue that checks and maintenance of equipment are carried out in a timely manner. What has improved since the last inspection? Two requirements were imposed during the last inspection. One was about updating the statement of purpose and service users` guide. We can confirm that these documents have been updated as the manager had to present these when she was registered earlier this year. The second requirement was about providing adjustable beds for residents according to their needs. Our tour of the premises and discussion with the manager and staff have shown that people who need an adjustable bed have been provided with one. This particularly relates to residents with poor mobility and to those with pressure ulcers or at risk of developing pressure ulcers. What the care home could do better: We imposed two immediate requirements on the home during the inspection. One was to address the standard of decoration of the environment and the other was to address the call bell system in the home. We found that there has not been any significant programme of decoration of the home since the last inspection. A plan for the ongoing redecoration and refurbishment of the home was also not available for inspection. As a result the home was starting to look in a poor state of decoration and therefore not providing as pleasant an environment as reasonably possible for residents. We also noted that the call bell system was not that effective when activated, in alerting staff that a resident was calling for help because the bell/sounder could not be heard or could only be heard faintly and only in some places. As a result the call bell system must be improved or replaced to make sure that it is suitable for use by residents. One comment from staff questionnaires mentioned that outdoor activities to the seaside and local gardens could be improved. Two comments were about improving the decor of the home and replacing furniture. Another comment mentioned communication. While we did not notice any issues with communication, a visitor mentioned that communication between trained nurses is good and that communication between trained nurses and carers and between carers and carers, is not so good. They say that very often they have to repeat instructions that they have given to one set of carers again to the other set of carers because the information has not been passed on. As the home accommodates residents that may have some cognitive impairment because of dementia care needs and mental health needs, we suggest that the home look at producing the service users` guide and statement of purpose in an easy to read format to improve residents` access to the information that is contained in these documents. While the home generally provides a variety of meals to meet the nutritional and cultural needs of residents according to their choices and likes and dislikes where these are expressed, the process to determine the choices that are made by residents was not consistent.The home should be consistent about the system that is used to record the choices of residents about their meals. The home generally provides appropriate staffing levels, but in cases where there is a shortage of staff because of sickness or absence, the home should consider the use of agency staff to maintain the numbers of staff that care for residents.We noted that at least one resident did not receive one medicine because that was not supplied with the monthly cycle. The home should review the supply of medicines to make sure that all residents receive their medicines, as prescribed. We found that the home was using lancing devices that were not suitable for professional use when testing blood glucose levels.The appropriate lancing devices must be used for drawing blood when testing for blood glucose levels to prevent cross infection. The ironing and storage of residents` clothes in the wardrobes and drawers could be improved to ensure that clothes are less creased and that the wardrobes and drawers are kept tidy. Key inspection report Care homes for older people Name: Address: Charlotte House Mental Nursing Home Snowy Fielder Waye Isleworth Middlesex TW7 6AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 1 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 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 36 Information about the care home Name of care home: Address: Charlotte House Mental Nursing Home Snowy Fielder Waye Isleworth Middlesex TW7 6AE 02087580080 02087580054 manager.charlottehouse@careuk.com www.careuk.com Care UK Community Partnerships Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Agbani Doris Briggs Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Charlotte House is a purpose built care home that is owned by Care UK, a national provider of care services. The home is located next to West Middlesex University Hospital. It is accessible by buses and the underground. The bus stop is a few minutes walk away and the underground station is a short bus ride away or about 10-15 Care Homes for Older People Page 4 of 36 Over 65 0 0 60 60 Brief description of the care home minutes walk away. There are extensive parking facilities in front of the home. There are local amenities and shopping facilities in the streets not far from the home and access to more extensive shopping facilities is available in Hounslow High Street, a short bus or car ride away . There is a large secure garden to the rear of the building that can be accessed from the ground floor and that can be used by wheelchair users. Accommodation to residents is provided in four units that are organised into two teams of staff. The home has a passenger lift and features communal lounges and dining areas, communal bathrooms and toilets. In addition to these, all bedrooms are ensuite with toilet and wash hand basin. The home is registered to provide accommodation and nursing care to 60 older residents with mental health needs or with dementia care needs. There are 4 double bedrooms, that are now mostly used for single occupancy. As a result at any one time the home accommodates a maximum of 56 residents, unless there are people willing to share a bedroom. The home is managed by Doris Briggs. She is supported by a full complement of nursing, care and ancillary staff. At the time of the inspection there were 55 residents in the home. The home charges fees of 650-850 pounds weekly, depending on the needs of the residents. 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 unannounced inspection started at 10:15 to 18:30 on Monday 16th November 2009 and was carried out by Clare Henderson Roe and Ram Sooriah (lead inspector). Clare Henderson Roe visited the home again on the 19th November from 10:00 to 11:00 to complete the inspection. Our last visit to the home was an unannounced key inspection on the 11th January 2008 when the service was rated as providing excellent outcomes for people that use the service. This inspection also looked at the key national minimum standards for older people. During the course of this inspection we toured part of the premises, observed care practices and looked at a sample of records. We also talked to four visitors to the home, at least six residents and twelve members of staff. When we finished the inspection we gave feedback to Doris Briggs, the manager of the home. Care Homes for Older People Page 6 of 36 An Annual Quality Assurance Assessment (AQAA) was received in April of this year. We carried out a satisfaction survey as part of this inspection and we received ten questionnaires from staff, two from healthcare professionals and ten questionnaires from residents. Some of the residents were supported by their relatives to complete the questionnaires. We also had the input of Christine Cousins, an Expert by Experience, from Age UK the new force combining Help the Aged and Age Concern. Experts by Experience are people who have experience of using social care and help us with getting feedback about the service from residents, staff and visitors to the home. We would like to thank all the people who contributed and supported us during the inspection. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? Two requirements were imposed during the last inspection. One was about updating the statement of purpose and service users guide. We can confirm that these documents have been updated as the manager had to present these when she was Care Homes for Older People Page 8 of 36 registered earlier this year. The second requirement was about providing adjustable beds for residents according to their needs. Our tour of the premises and discussion with the manager and staff have shown that people who need an adjustable bed have been provided with one. This particularly relates to residents with poor mobility and to those with pressure ulcers or at risk of developing pressure ulcers. What they could do better: We imposed two immediate requirements on the home during the inspection. One was to address the standard of decoration of the environment and the other was to address the call bell system in the home. We found that there has not been any significant programme of decoration of the home since the last inspection. A plan for the ongoing redecoration and refurbishment of the home was also not available for inspection. As a result the home was starting to look in a poor state of decoration and therefore not providing as pleasant an environment as reasonably possible for residents. We also noted that the call bell system was not that effective when activated, in alerting staff that a resident was calling for help because the bell/sounder could not be heard or could only be heard faintly and only in some places. As a result the call bell system must be improved or replaced to make sure that it is suitable for use by residents. One comment from staff questionnaires mentioned that outdoor activities to the seaside and local gardens could be improved. Two comments were about improving the decor of the home and replacing furniture. Another comment mentioned communication. While we did not notice any issues with communication, a visitor mentioned that communication between trained nurses is good and that communication between trained nurses and carers and between carers and carers, is not so good. They say that very often they have to repeat instructions that they have given to one set of carers again to the other set of carers because the information has not been passed on. As the home accommodates residents that may have some cognitive impairment because of dementia care needs and mental health needs, we suggest that the home look at producing the service users guide and statement of purpose in an easy to read format to improve residents access to the information that is contained in these documents. While the home generally provides a variety of meals to meet the nutritional and cultural needs of residents according to their choices and likes and dislikes where these are expressed, the process to determine the choices that are made by residents was not consistent.The home should be consistent about the system that is used to record the choices of residents about their meals. The home generally provides appropriate staffing levels, but in cases where there is a shortage of staff because of sickness or absence, the home should consider the use of agency staff to maintain the numbers of staff that care for residents. Care Homes for Older People Page 9 of 36 We noted that at least one resident did not receive one medicine because that was not supplied with the monthly cycle. The home should review the supply of medicines to make sure that all residents receive their medicines, as prescribed. We found that the home was using lancing devices that were not suitable for professional use when testing blood glucose levels.The appropriate lancing devices must be used for drawing blood when testing for blood glucose levels to prevent cross infection. The ironing and storage of residents clothes in the wardrobes and drawers could be improved to ensure that clothes are less creased and that the wardrobes and drawers are kept tidy. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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. Residents and their representatives receive enough information for them to decide if they would like to use the service that the home provides. The needs of prospective residents are assessed to make sure that the home would be able to meet their needs once they admitted to the home. Evidence: When the manager was registered in August 2009 the service users guide (SUG) and the statement of purpose (SoP) were reviewed as part of this process. A copy of the SUG was kindly provided to us. We noted that this document was appropriately completed and contained all the necessary information as required by legislation. We discussed whether the SUG and the SoP were available in other formats for residents such as in easy to read format or in large fonts. As the home admits residents with mental health needs and dementia care needs, having these documents in different formats might be useful to residents for them to understand the service Care Homes for Older People Page 12 of 36 Evidence: that is provided by the home. Six out of ten residents who responded to our survey said that they had received enough information about the service prior to moving in. The rest said that they had not or were not sure. The manager confirmed that all residents needs are assessed prior to them being offered a place in the home. We also saw preadmission assessments of the needs of residents in the care records of the residents. These were normally carried out by senior staff in the home and were on the whole appropriately completed. Most residents come from the Middlesex hospital that is within walking distance from the home and therefore it is relatively easy for the homes staff to assess the needs of residents. We talked to visitors and they said that they had the opportunity to visit the home to find out more about the service that is offered before deciding to use the services of the home for the resident. The manager said that she always welcome visits from prospective residents or from their representatives for them to find out more about the home and to answer their questions. We looked at whether residents that are admitted to the home receive a contract/ statement of terms and conditions. The records for a a privately funded resident showed that a contract was in place. This was clear and stated what services are included in the fees charged. This had been signed by the residents representative and also on behalf of the home. For residents being funded by Hounslow Social Services there is a contract signed up between the home and Social Services. We also saw copies of the homes terms and conditions document in the files of residents that are placed by Social Services or the Primary Care Trust. Our survey showed that five out of the ten residents who responded, have not received or were not sure whether they had received a contract/statement of terms and conditions. This is a significant number of people (50 ) and the home should therefore check to ensure that all residents do have a contract in place. Care Homes for Older People Page 13 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. Residents needs are addressed in care plans that are drawn up with their involvement or their representatives. The care plans are kept up to date and reviewed at least monthly or when the needs of residents change. Staff in the home support residents in meeting their individual health and personal care needs as required and ensure that residents privacy and dignity are respected. A few issues was noted with the management of medicines that needed to be addressed to fully ensure the safety of residents. Residents on the whole receive an appropriate standard of end of life care. Evidence: The home uses a computerised system for the residents care plans. We viewed six residents plans, some in detail and others specifically to look at wound care management. Care plans were in place for each identified need, which also identify the effect of cognitive impairment in each area of care. There was evidence of monthly reviews taking place and the review comments were meaningful and provided a good picture of the care that the resident received. Risk assessments for falls were in place and information regarding falls was clearly recorded. The daily record information was Care Homes for Older People Page 14 of 36 Evidence: clear, providing a good picture of what had happened to the resident throughout the 24 hour period. We saw some hard copies of care plans that had been signed by the residents representatives. Some of the reviews with the representatives were a long time ago, and we were told that there are situations when representatives do not visit often, making it more difficult to review documentation. We viewed wound care documentation. The care plans provided a clear picture of the condition of the wound, the dressing regime to be followed and the progress of the wound. They also include the pressure relieving equipment in use for each resident. Photographs of wounds were available, and a written record of dressing changes. Pressure sore risk assessments were in place and with one exception were up to date, with one being updated at the time of inspection. Assessments in place included continence, moving and handling, nutrition, care needs, dependency and cognition. Care plans had been formulated to reflect any needs identified in these assessments. Moving and handling assessments seen identified the equipment to be used for each resident and also the number of staff to be present when carrying out any moving and handling procedures. Residents are routinely weighed monthly, however where a nutritional risk is identified then weight checks are carried out every 1-2 weeks, depending on the severity of the concern, and a referral is made to the dietician. There was evidence of several residents being on nutritional supplements. We saw written risk assessments for bedrail use, and we were told that these are now used for very few residents, as the home now has mainly high- low beds, that can be lowered to near the ground, and if needed, a mattress can be place by the bed if the resident is at risk of rolling out. There was evidence of residents receiving input from healthcare professionals such as the GP, tissue viability nurse, dietician, chiropodist and physiotherapist. The relatives of one resident commented in a satisfaction questionnaire that the home gets medical support for residents as soon as this is required. Another said that residents receive exceptional medical care. A visitor during the inspection mentioned that staff always act quickly when residents condition change. Nine our of the ten residents who responded to our survey said that they always receive the care and support that they need. Eight out of ten members of staff said that they are given up to date information about the needs of residents so that they are able to care for residents appropriately. The two healthcare professionals who sent us questionnaires were also satisfied that staff always act in a prompt manner when concerns about the health of residents are noted. Care Homes for Older People Page 15 of 36 Evidence: The home was generally free of odours but the inspection team noted odours in a few areas. On one occasion we noted an odour that we traced back to a resident. We understood that the resident had not been toileted/changed. We also observed that residents sat from about 10:45 to lunch time without being changed or moved to relieve pressure from their sacral area. We were informed that these issues are normally addressed after lunch. We discussed these observations with the manager to ensure that these are addressed when required. One resident mentioned in a satisfaction questionnaire that residents could be checked and changed more often. We observed staff interacting and engaging appropriately with residents. In one case we noted that staff were able to calm a resident when the latter became aggressive by moving away and not responding to the aggressive behaviour of the resident and the things that the latter said. There were many occasions when there were informal and appropriate interactions between staff and residents, such as comments that were exchanged and gentle touches. We also observed that staff fed residents appropriately according to the pace set by the residents and not rushing residents despite the number of residents that require support with feeding. Our tour of the premises showed that the clothing of residents was at times not ironed appropriately and not placed appropriately in the drawers and wardrobes of residents. Clothing of another resident was found in the wardrobe of one resident. This issue must be addressed to ensure that the laundering of residents clothes is carried out to a good standard. Information is available regarding the wishes of residents and their families in respect of end of life care. Some of the information is quite general and we discussed this with one of the registered nurses. She explained that they do endeavour to get information for each resident, and prioritise those with certain conditions, for example cardiac problems, so that the wishes of the resident and their families are known in the event of health deterioration, plus this is discussed with the GP. If there is no instructions in place for health deterioration and end of life care then the resident would always be sent to hospital in an emergency situation. We checked the management of medicines on each floor. The home was starting a new cycle of medicines on the day of the inspection and staff were busy sorting out some of the medicines. We noted that three residents had not received a supply of some medicines for the current cycle. As a result one of the resident did not receive a medicine in the morning, one resident had to rely on some medicines that remained from the last cycle and the third residents medicine was due for the night and we were informed that the medicine will be supplied later during the day. Staff stated that Care Homes for Older People Page 16 of 36 Evidence: the medicines supply come on the Friday and that they check the medicines over the weekend. As the chemist is closed on Sunday, they say that they do not get a chance to resolve any anomalies before the start of the medicines cycle. This explains why the three residents were not supplied some of the medicines. As a result the home must review the process for the supply of medicines to make sure that residents always receive their medicines in a timely manner. We looked at the medicines charts for the previous cycle as the current charts were practically empty because of the beginning of the new medicines cycle. Medicines were on the whole signed when administered or a code was used to explain the reason if the medicines had not been administered. The amount of medicines received in the home or brought forward was also recorded on the medicines records chart. One one occasion however the amount of medicines that was in place did not balance with the amount that should have been in place taking into consideration the amount that had been carried forward and the amount that had been administered. This could be because the medicine had not been administered as prescribed. We noted that relevant blood tests were being carried out in cases where the level of medicines in the blood needed to be monitored. The manager explained that two of the registered nurses are trained to carry out these blood tests. We discussed the inclusion of nutritional supplements on the MAR to include any enteral feeding regimes. In cases where medicines were disguised to give to residents, we noted that the relevant risk assessments were in place. The temperature of the medicines fridges and of the clinical rooms were monitored and recorded. The clinical rooms were airconditioned to make sure that the temperature remained constant. The home has a number of diabetic residents and we noted that the wrong lancing device was in use for blood sugar testing. A device for self-use was in place, albeit each resident had their own device, but as staff were using these devices and not the residents themselves, a device for professional use should have been in place. We also noted that control solutions were not in place to calibrate the meters that are used to measure the blood sugar levels. 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. The home provides recreational and leisure activities to meet residents needs in these areas, although the home would benefit from a review of activities and resources to provide activities to make sure that everything possible is being done to ensure quality activities for residents. The meals that are provided in the home are varied and nutritious and meet residents nutritional needs. Evidence: The home has two activities coordinators: one for each floor. They each work a total of 35 hours weekly. The shifts are arranged so that there is an activities coordinator on duty on Saturdays. On the day of the inspection one of the activities coordinator was on leave and there was only one on duty. She coordinated activities on the day to include residents from each floor. A progamme of activities was available in the home. On the day of the inspection there was a flower arranging session in the morning. This was carried out in the activities room (that doubles up as the hairdressing room), but feedback about this room suggests that it is too small to accommodate the number of residents that are willing to take part in activities. In addition to that there are many residents that use Care Homes for Older People Page 18 of 36 Evidence: specialised chairs. These tend to be quite bulky and take a lot of room and would not fit or would fit with difficulty in the activities room. They were therefore automatically ruled out of the activities room. There was also some issues about the resources that are allocated for activities. For example the session for flower arranging could have been more engaging and innovative. Residents were observed arranging plastic flowers in a flower pot, but apparently the flower pot was too small. While some clearly enjoyed the session, this activity could have been made more interesting by the use of more appropriate resources and material. Examples of other activities include pet therapy, exercise sessions, physiotherapy sessions and bread making. There are entertainers that visit the home monthly. The activities programme also contains information about outings. Apparently these are arranged every week, depending on the weather. The home does not have a minibus and uses the Dial-a-Ride service. We were informed that residents are also taken in their wheelchairs to the local places of interests such as the parks and the riverside. Feedback from staff about what could be improved included a comment about improving outings for residents. The residents satisfaction questionnaires showed that four residents were always satisfied with the activities, four were usually satisfied and two did not respond to that section. There was evidence that people who were able to make choices had their decisions respected by staff. For example there were residents that did not want to do activities. These decisions were respected. We were informed that representatives of the main churches regularly visit residents in the home. Residents therefore have the opportunity to have communion and spiritual support according to their needs and wishes. Most of the residents in the home are from the main churches but there are a few residents (about 3 according to the AQAA) from ethnic minorities. We were informed that in these cases the home supports the residents whenever possible to meet their cultural and spiritual needs. The care records have a section to record the assessment of the social and recreational needs of residents. These were on the whole appropriately completed and care plans were in placed to address these needs. We noted a number of visitors to the home and they were all greeted appropriately by staff. Two of them who talked to us about this matter, told us that they are always welcomed and offered refreshments when they come into the home. Care Homes for Older People Page 19 of 36 Evidence: We had the opportunity to observe lunch being served in the home. The home has a four weekly menu that on the whole looked comprehensive. On the day of the inspection there was vegetable briyani, sausages and gravy, mashed potatoes, broccoli, peas and sweetcorn. The chef said that he prepares other meals if residents request these. One relative said that the chef is very good and will prepare food for residents even if this is not on the menu. We noted that the chef visited residents during meal times to ask them about the meals. The chef also told us that he speaks with relatives about the choices of residents and that he has recently drawn up a new menu with feedback from residents and relatives. On one floor we were informed that residents are asked about their choices the evening before and that the choices are recorded on a sheet that is sent to kitchen. When we asked for the sheet on one floor during lunchtime, we were told that the sheet was in the kitchen. We were therefore not clear how staff would know the choices that residents made without the choices sheet. On another floor we were informed that residents are asked about their choices when the meals are being served. The procedure for finding out resident choices about meals did not seem to be consistently applied. One one floor we noted that meals were dished out for residents only when staff were ready to support them with their meals so that the food did not get cold. On another floor, this was not the case. We visited the kitchen and noted that the kitchen has been awarded Five Stars by the Local Environmental Health Department. All records as required were kept in the kitchen and we were informed that all items of equipment were working appropriately. The kitchen was on the whole clean and in a good state of repair except for the flooring that was torn in one place. We were informed that quotes have been received to repair the flooring in the kitchen. Care Homes for Older People Page 20 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 home takes complaints and allegations and suspicions of abuse seriously and makes sure that these are appropriately addressed. Evidence: The AQAA informed us that the home has had one complaint during the past year. There has also been one referral to the safeguarding adult team of the Local Borough. The complaint was on the whole appropriately addressed and responded to. Feedback from visitors suggest that they would speak to the manager or senior staff on the floors if they had any concerns or complaints. One person said that staff in charge of the units are always approachable and address all the concerns that they may have and as a result they say that they do not have to resort to the complaints procedure. Seven out of ten people who responded to the residents survey said that they were aware of the complaints procedure and nine said that they knew who to speak to if they were not happy about the service that they were receiving. Training records show that most staff have had training on safeguarding adults. We also spoke to staff about residents complaints and what to do if they witness or suspect that residents are being abused. They knew that they had to report complaints and any concerns that they have about the safety of residents to senior staff in the home. Care Homes for Older People Page 21 of 36 Evidence: Three members of staff that we spoke to about safeguarding adults understood the whistleblowing procedure. All ten members of staff who returned their questionnaires said that they know what to do if they have concerns about the home. A copy of the complaints procedure was available in the service users guide and in the foyer of the home. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the decor of the home suggests that there needs to be a programme of redecoration with appropriate timescales to make sure that the environment of the home continues to be suitable for residents that live in the home. Evidence: The home is located in a residential area of Isleworth a few minutes walk from the West Middlesex hospital. There is a car park in front of the home that was tidy and maintained. The grounds at the back of the home are also maintained and consist of patio areas, walkways, lawns and bushes and shrubs. These are accessible to wheelchair users and we noted that there were adequate facilities for residents to sit outside when the weather is nice. The reception area of the home is pleasantly decorated and looks inviting. We noted that some areas of the home were looking tired and needing redecoration. Many members of staff have been in the home for a long time and a few said that there has not had any significant redecoration for 4-5 years. The paint on bedrooms doors and door frames, and the hand rails has come off in places and there were many areas where the wall needed repainting. The radiator in a few bedrooms looked in need of repair or replacing. We also noted that at least three windows were broken which were letting in the draught, as it was quite windy on the day of the inspection. Care Homes for Older People Page 23 of 36 Evidence: We asked to see a redecoration plan and noted that one was not available for inspection. We were therefore not sure when the issues with regards to redecoration and maintenance of the environment would be addressed. As a result we imposed an immediate requirement asking the home to provide a redecoration plan to address all areas of the home so that the quality of the environment does not deteriorate any further, but improves. The home also had a call bell system that when activated could barely be heard in places. The sounder/bell were located in a few places and were rather low. Staff and us could hardly hear the call bell when we were in the office or at the far end of the corridors. This is particularly concerning at night as there are less staff and if a resident needs help, the bell might not be heard as staff might be busy in a bedroom attending to other residents. As a result we also imposed an immediate requirement on the home to address this matter. Some of the bedrooms of residents were in an acceptable state of decor and personalised with the possessions of residents, that have been brought in. However, a few bedrooms were also observed not to have personal possessions and looked quite bare except for the standard items of furniture that is provided in residents rooms. There is therefore room for progress to be made in this area. The standard of cleanliness was on the whole good. Residents and visitors praised the standard of cleanliness both in questionnaires and when giving direct feedback to us. We however noted a slight odour on the second floor but think that this might have been related to a management of incontinence issue for one particular resident rather than an inherent characteristic of the home. There was evidence that attention is given to infection control issues and that staff receive training in infection control. There were sanitising handrub in various areas of the home available to staff, visitors and residents as a measure to prevent cross infection. Care Homes for Older People Page 24 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 home provides appropriate staffing levels to make sure that the needs of residents are appropriately met. The recruitment procedures are adhered to robustly, to ensure thorough vetting of people that apply to work in the home. Staff in the home receive supervision and adequate training to make sure that they are competent to care for residents. Evidence: Although the home has four units, it is run as two units as the staff group is divided into two teams, one for each floor. There is a senior nurse, another nurse and five carers in the morning for each floor. In the afternoon there are two trained nurses and four carers for each floor and at night there is a trained nurse and two carers for each floor. Where residents have been assessed as requiring one to one supervision and care, additional staff is provided as required. There are ancillary staff in sufficient number to address other areas in the home such as cleaning, catering and laundry. Six out of ten residents who sent satisfaction questionnaires said that staff are always available when they need them and that staff always listen and act on what the residents say. Three residents said usually to the above and one said sometimes. Five Care Homes for Older People Page 25 of 36 Evidence: out of ten members of staff said that there are always enough staff on duty, three said usu sally and two said sometimes. There is therefore an indication that on a few occasions there has not been enough staff on duty. On the day of the inspection, there was a shortage of a carer on one unit and we were informed that it was not possible to find a replacement. The manager clarified that the home does not use agency and staff also said that the home does not use agency when there is a shortage. Staff also said that at times it can get very busy because of the needs of the residents that live in the home. We think that the home should consider using agency staff whenever there are shortages to ensure that there are always adequate numbers of staff on duty. We viewed three sets of staff employment records. These contained the necessary information as required under Schedule 2 of the Care Homes Regulations 2001. The manager explained that for staff working on a student visa she does contact the college to ensure the staff only work the number of hours allowed in line with the visa. She also explained that for one employee this was their first place of work, hence the references were from college tutors. We recommended that the letters received from the colleges be kept on the individuals file for ease of access, plus a written record be kept of any additional information provided by members of staff. Copies of signed contracts for staff were available and provided clear information. The manager kindly provided the training records. We noted that staff received a range of training. Most staff were up to date with mandatory training that included health and safety, manual handling, fire training and food hygiene. There was evidence that staff also received customer care training and abuse training. Training in many subjects was provided in house using a computer training package, but some training such as manual handling training and fire training was provided by the homes or companys trainers. We asked whether staff receive training in understanding dementia and the mental health of residents. We were informed that staff generally received training that consists of an introduction in these areas and that is provided in-house. There are many types of training that is provided by reputable organisations such as the Alzheimers society about dementia care. Many members of staff, including nurses stated that they would have liked to attend more in-depth courses in mental health or dementia care. As the home specialises in the provision of care to meet the dementia care and mental health needs of people, the home must review the provision of training in these specialised areas. Care Homes for Older People Page 26 of 36 Evidence: The figures provided in the AQAA show that the home does not yet have 50 of its care staff trained to NVQ level 2 in care or above. There are fifteen out of thirty-five care staff with at least an NVQ level 2 qualification in care. The home keeps supervision records for all care and nursing staff. These show that most staff have received supervision, some more regularly than others as not all have had supervision every two months or at least six times every year. The manager stated that she would hold an annual appraisal for staff. Care Homes for Older People Page 27 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 has an appropriate management structure to ensure that the aims and objectives of the service are met. There is a quality assurance system in place to address the quality of the service that is provided. Residents personal money is appropriately managed by the home to prevent the financial abuse of residents. Most health and safety issues in the home are addressed appropriately to ensure the safety of people that use the premises. Evidence: The home has a registered manager. She has now been working in the home for slightly more than one year. She has a social work qualification, the NVQ level 4 in care and the Registered Managers Award. As she is not a trained nurse, the deputy manager assumes the clinical lead responsibility in the home. From our discussions with the manager, we gathered that she has a good understanding of dementia care and mental health care. Care Homes for Older People Page 28 of 36 Evidence: The manager should consider one of the findings of the staff satisfaction survey that we conducted and take action as required. The findings relates to the question whether the manager gives you enough support and meet you to discuss how you are working. Five members of staff said regularly, one said sometimes and four(40 ) said never. This may very well be because the unit managers have direct line management responsibility for all staff. We did not receive any negative feedback about the manager during the inspection or in questionnaires but it would be useful to explore this matter. There was evidence of relatives and staff meetings which were held at intervals of three to four months. Minutes were available for inspection and on each floors. We also noted that the managers office is near the reception area and that she keeps her door opened. Therefore she is easily accessible to people who would like to see her and talk to her. Care UK has a quality assurance procedure and system that are in place in the home. There are monthly audits according to themes that are sent by the head office. These can cover subjects such as communication, infection control, food hygiene and care plans. There is also an annual audit that looks at all areas of the service that is provided by the home. A copy of the report following the last satisfaction survey that was carried out in November 2008, was available for inspection. A copy is also available to all stakeholders. The manager said that an action plan has been formulated to address areas that did not score as well as other areas. We are however not clear why the quality management system has not identified the need to have a redecoration plan. We also noted that the internal medicines audit did not seem to be consistently used. Each floor used it differently. For example on one floor there was a count of tablets daily and on the other floor this was carried out weekly. The management of the personal money of residents was inspected. The home holds personal monies on behalf of some residents. Written records of all income and expenditure are maintained and clearly identify what expenditure is being made on behalf of residents. Monies for each resident are kept in individual wallets and we audited the amounts for three residents. The records and actual amounts tallied and there was evidence that the monies are audited every 1-2 months by the operations manager or by head office staff. Receipts are given for all income received on behalf Care Homes for Older People Page 29 of 36 Evidence: of residents, and receipts for residents expenditure are also retained. We looked at the records regarding the management of health and safety and the maintenance of equipment in the home. There was a gas safety certificate for the kitchen equipment and boiler equipment. We did not see a gas safety certificate for the laundry dryers that use gas. An electrical wiring certificate and a portable appliance test certificate were available for inspection and were up to date. A certificate was also available to show that the water system was being maintained for the prevention of Legionnaires disease. There were records of the monitoring of the water temperature at water outlets in the bedrooms of residents, but we noted that the water temperature was not being monitored in the bath and the wash hand basins in the toilets to which residents also have access to. There were records of fire detector tests but these were not always carried out weekly. There were also no records of in-house emergency lights test. We were informed that wheelchairs were checked regularly and maintained but we did not see a record of that. We would recommend that a record be kept. We noted that the fire risk assessment had not recently been updated. This must be kept updated, signed and dated. The health and safety risk assessment was partly up to date, as a risk assessment about the maintenance areas had not recently been updated. During a tour of the premises we noted that a kettle was available in the kitchenette in the dining area and accessible to residents. The health and safety risk assessment must therefore be updated and must consider all significant risks to people that use the premises. Care Homes for Older People Page 30 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 31 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 1 19 23 Residents must have access to an effective call bell system that they can use to summon help if that is required. An action plan to address the upgrading or replacement of the call bell system is required. To ensure that the call bell system can be easily heard when it is activated. 24/12/2009 2 19 23 The home must review the 24/11/2009 standard of decoration of the environment of the home and prepare a comprehensive redecoration plan with timescales addressing all identified areas. To make sure that residents live in a well maintained and decorated environment. 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 The home must ensure that the appropriate lancing devices are used to draw blood when carrying out blood sugar testing. Standard solutions must be 20/01/2010 Care Homes for Older People Page 32 of 36 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 in place to calibrate blood sugar machines. To prevent cross infection of blood borne diseases. To ensure that the meters to monitor blood glucose levels are appropriately calibrated. 2 9 13 The home must ensure that 20/01/2010 there is always an adequate supply of medicines to make sure that residents do not run out of medicines. If necessary arrangements for the supply of medicines must be reviewed. To make sure that residents always receive their medicines in a timely manner. 3 9 13 All medicines must be administered as prescribed. To ensure that residents receive the full benefits of their medication regime. 4 10 12 The clothing of residents 20/01/2010 must be appropriately ironed and placed in the wardrobes and drawers of residents. To ensure that residents benefit from high quality of laundering 20/01/2010 Care Homes for Older People Page 33 of 36 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 5 30 18 The home must consider 23/01/2010 providing more in-depth training in dementia care and mental health care to all staff, including nursing staff. To ensure that staff are fully trained to care for the residents that use the service. 6 38 13 The temperature of the hot 08/01/2010 water must be monitored not only in the bedrooms of residents but at all hot water outlets to which residents have access to, including bathrooms and wash hand basins in toilets. To reduce the risk of residents getting scalded to a minimum. 7 38 13 There must be weekly fire 19/01/2010 detector tests and in -house emergency lights tests according to a frequency that is identified in the health and safety and maintenance procedure of the home. The fire risk assessment must be reviewed yearly and must be signed and dated. To ensure the health and safety of all people that use the premises Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The home should consider providing the service users guide in other formats such as in an easy to read format for residents that may have a cognitive impairment. The manager and her staff should review residents toileting patterns and make sure that residents are toileted and changed as required to promote the comfort and the dignity of residents. The home should review the resources available in the home for the provision of activities, as feedback about the provision of activities suggests that there is room for improvement. Meals for residents that need support with feeding, should only be dished out when a member of staff is available to feed the resident, to ensure that the meal does not get cold. The home should use a consistent method to record the choices that are made by residents for their meals to make sure that this is always carried out. The home should consider using agency staff whenever there are shortages to ensure that the adequate numbers of staff are on duty. The home must have 50 of its care staff trained to NVQ level 2 or above as soon as possible. We recommend the review of the quality management system to make sure that it is useful and effective in improving the quality of the service that is provided by the home. The audit for the management of medicines in the home should be consistently used for it to be effective. The home should review all items of equipment that use gas and make sure that there are gas safety certificates in place for these items of equipment. We recommend that a record be kept of the monthly maintenance of wheelchairs. 2 8 3 12 4 15 5 15 6 27 7 8 28 33 9 38 10 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!