Care Home: Cheneys

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What the care home does well The home provides a safe comfortable environment that is maintained to a good standard of cleanliness and decoration. There are no obvious unpleasant odours. Residents generally speak positively about the home and their experiences of it; they like the staff and find them friendly and kind. Residents like the quality of the meals they receive and feel able to express their views about food quality. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Residents told us that they like the range and frequency of the activities and that they are kept informed weekly about what is happening each week. Residents enjoy accessing the gardens. Resident`s benefit from improvements to the recruitment procedure, the impact of agency staff usage is minimised by ensuring only specific staff are routinely used. A rolling programme of training ensures staff` mandatory training is kept updated, specialist training is provided to ensure staff` have the necessary knowledge and skills to meet changing needs of people in the home. People living at the home tell us they feel listened to and kept informed of changes. The home is welcoming to visitors. Residents told us that: "Most aspects of the home seem to be satisfactory" "I`m happy here and it suits my needs" "Very good as nursing homes go" Relatives tell us: "They keep relatives well informed as to resident`s welfare" What has improved since the last inspection? Since the last inspection the service has addressed all outstanding requirements, and implemented most of the recommendations made. The number of agency staff has been reduced. Improvements are ongoing to the implementation of more person centred support plans. A pain management tool has been implemented. As a result of feedback from people living in the home: Several bedrooms have been redecorated and new flooring laid in another. Some bedside cabinets and chest of drawers have been purchased for some rooms. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 The TV is now turned off at mealtimes. Infra red heaters have been installed in a bathroom on cedar floor and in the wet room in response to requests for more heating in these areas. Menus have been redeveloped. The shop trolley run by friends of Cheneys committee members has been reinstated. Changes have been made to scheduled entertainment. What the care home could do better: When we spoke with some people they reported that at key times of the day there are not enough staff available to help with routine toileting routines, when we examined personal care records we found that the frequency of pad changes for some people varied with some people experiencing unacceptable delays and we have issued a requirement for this to be more closely monitored. An examination of staff recruitment and training records highlighted that induction appropriate to the role applicants are employed for is not routinely evidenced as being provided, we also found that evidence of mandatory training for staff also employed elsewhere is not robustly pursued; we have issued a requirement for this. In addition we have made some good practice recommendations that: Individual PRN medication guidelines are reviewed to provide greater clarity for why and when they should be used. Staff will benefit from access to agreed behaviour guidelines on how to work with individual residents. There is a need for the call bell system to be replaced to ensure calls cannot be overridden, and the management team can monitor response times better. With increasing dependencies of people living in the home there is a need for staffing levels to be reviewed. Although people in the home feel listened to and able to influence some service development, there is a need for the implementation of a formal quality assurance monitoring programme. Key inspection report CARE HOMES FOR OLDER PEOPLE Cheneys Links Road Seaford East Sussex BN25 4HY Lead Inspector Michele Etherton Key Unannounced Inspection 11th August 2009 09:50 DS0000028541.V377151.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 2 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 Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheneys Address Links Road Seaford East Sussex BN25 4HY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01323 893373 01323 491480 cheneys@btconnect.com www.sxhousing.org.uk Sussex Housing and Care Mrs Tina Hewitt Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 51. Date of last inspection 19th August 2008 Brief Description of the Service: Cheney’s is situated in a quiet residential area of Seaford a short walk from the seafront and approximately half a mile from the town centre with its access to bus and rail routes. The home is registered to accommodate up to 51 older people, some of whom may be in receipt of nursing care. The registered owners are Sussex Housing and Care. The home is part purpose built and part converted with accommodation over two floors. The home comprises of 51 single bedrooms (26 of which have ensuite facilities) three bedrooms are larger previously being used as doubles (all 3 of which have en-suite facilities). There are additional toilet and bathroom facilities throughout the home. Rooms are located over two floors, accessible by two passenger shaft lifts. The home has a number of specialist equipment in use such as mobility aids, specialist nursing beds and bath and moving/handling hoists. There are extensive attractive gardens to the rear of the property that are accessible to residents. There are car-parking facilities to the front of the premises. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged (at the time of this report) is £345 - £660 per week, Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 5 with additional charges made for newspapers, hairdressing, toiletries and chiropody. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. A key unannounced inspection of this service has been undertaken, this has taken account of information received from the service and about the service by the Commission since the last inspection, including an Annual quality assurance assessment (AQAA) completed by the manager. Adult safeguarding information and an anonymous complaint made to the commission. The AQAA has been completed to a reasonable standard and provides us with most of the information we need. The document fails to reflect on how the service has addressed outstanding requirements issued at the last inspection, and would be improved by inclusion of additional detail to illustrate day to day operations and to support statements made. The inspection has included an unannounced site visit to the home on 11/09/09 during which we visited communal and private bedrooms with the permission of people living in the home. We met with the manager, RGN, and health assistant staff, in addition to speaking with a number of people who live in the home. The views and comments received during the site visit and from survey responses have been influential in the compilation of this report. All key standards have been inspected some in more depth than others; and we have tested out some of the allegations made within the anonymous complaint by examining records and discussion with residents and staff. A range of documentation has also been examined including care plans, risk assessments, menus, Medication administration records, staff recruitment, training, complaints and accident reports. What the service does well: The home provides a safe comfortable environment that is maintained to a good standard of cleanliness and decoration. There are no obvious unpleasant odours. Residents generally speak positively about the home and their experiences of it; they like the staff and find them friendly and kind. Residents like the quality of the meals they receive and feel able to express their views about food quality. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 7 Residents told us that they like the range and frequency of the activities and that they are kept informed weekly about what is happening each week. Residents enjoy accessing the gardens. Resident’s benefit from improvements to the recruitment procedure, the impact of agency staff usage is minimised by ensuring only specific staff are routinely used. A rolling programme of training ensures staff’ mandatory training is kept updated, specialist training is provided to ensure staff’ have the necessary knowledge and skills to meet changing needs of people in the home. People living at the home tell us they feel listened to and kept informed of changes. The home is welcoming to visitors. Residents told us that: “Most aspects of the home seem to be satisfactory” “I’m happy here and it suits my needs” “Very good as nursing homes go” Relatives tell us: “They keep relatives well informed as to resident’s welfare” What has improved since the last inspection? Since the last inspection the service has addressed all outstanding requirements, and implemented most of the recommendations made. The number of agency staff has been reduced. Improvements are ongoing to the implementation of more person centred support plans. A pain management tool has been implemented. As a result of feedback from people living in the home: Several bedrooms have been redecorated and new flooring laid in another. Some bedside cabinets and chest of drawers have been purchased for some rooms. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 8 The TV is now turned off at mealtimes. Infra red heaters have been installed in a bathroom on cedar floor and in the wet room in response to requests for more heating in these areas. Menus have been redeveloped. The shop trolley run by friends of Cheneys committee members has been reinstated. Changes have been made to scheduled entertainment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 9 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. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive an assessment of need to inform the homes decision making and are afforded opportunities to visit prior to formal admission. Increased dependency of residents needs to be fully reflected in information provided to prospective residents. In order to continue to meet the needs of all people living at the home staffing resources should be routinely reviewed. EVIDENCE: Information supplied to us by the home informs us that in the last twelve months there have been a few service breakdowns owing to the increasing needs of the residents concerned and up to 30 new people admitted over this period. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 12 From our examination of records and discussion with the manager we are satisfied that new residents are only admitted following an assessment of need usually undertaken by the manager during a visit to meet the prospective resident. The content of assessment documentation is of a reasonable level and informs the development of a draft care plan, from our examination of records and discussion with the manager and some of the present residents there would seem to be a trend of prospective residents being admitted with much higher dependencies than previously. This has resulted in a growth in the homes population of people with dementia type conditions. As a consequence of increasing numbers of higher dependency residents, more able residents we spoke with and staff survey feedback indicates that staff time is often stretched. Specific identified pinch points being around meal times when a number of staff are involved in helping with ‘feeds’ , other residents who need help with toileting tell us they sometimes have to wait for some time before support is forthcoming. Whilst all residents spoke positively about the home and the care staff they admitted they do have “niggles” about there not always being enough staff available at key times. A staff member reports that: “Head office is trying to run it like another residential home and not realise we need extra resources”. It is important that the home ensures they have enough staff resources to cater for the higher dependency residents with undue impact on the daily routines of other residents and we therefore recommended elsewhere in the report that a further review of staffing levels at key times is undertaken. The service does not provide an intermediate care service although can provide respite for short periods when long term vacancies arise. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 personal and health care needs of people living in the home are generally well supported, although closer monitoring is needed to ensure residents support is consistent. Arrangements for the storage, administration and recording of medication have improved to better safeguard people in the home. EVIDENCE: When we spoke with people who live in the home they told us they enjoy living at the home, and are very happy with the support they receive, they commented that: I am happy here and it suits my needs Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 14 very good as nursing homes go Relatives commented through survey information that: keep relatives well infromed as to residents welfare Most aspects of the home seem to be satisfactory We looked at four support plans and noted that one out of four had not been updated although detailed risk information had been. Care plans had some good detail but are not person centred, the manager reports that new person centred support plan formats are being rolled out and we saw some examples of these. Views amongst people living in the home were mixed as to whether the support they received was in keeping with their own preferences, most said they were happy, and found staff friendly and very kind, they had no real concerns just a few niggles from time to time. Only one of the plans viewed provided evidence that it had been discussed with the individual concerned and their family, other people who we spoke with at the home indicated that they had previously been involved in disussing their support plan but not for some time now. When we spoke with a relative they reported that whilst they found the home to be better than most in the area, they felt the keywork system could be more effective than it currently is, citing examples of where a keyworker had not known important information about the person they were supporting. From this discussion and others with some of the people in the home there is a need for staff to respond more proactively to ensuring that residents are kept hydrated and that those who are predominently in bed receive adequate mouth care if they are unable to attend to this themselves. A pain management tool has now been introduced. Each resident living at the home has a personal care file in their bedroom in which staff record what and when personal care has been provided. People we spoke with indicated mixed expereinces in regard to frequencies of some personal care routines. One out of three personal care files we looked at indicated that the individual concerned was experiencing unacceptably long periods between pad changes, in discussion with some residents it also Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 15 became clear that at times residents are left for long periods in their wheelchairs during the day, before being offered a rest late afternoon. When we spoke to people about this they said they liked sitting in their wheelchairs and the manager confirmed they are supplied with air cushions to minimise risk of pressure areas developing. Comments from some residents suggests that at key times of the day it is difficult to get staff attention to help with routine toileting as they are engaged elsewhere. We have discussed these shortfalls with the manager and have issued a requirement for the registered manager to implement systems to ensure that personal care needs are being attended to, in keeping with the preferences of the individuals concerned and at the agreed frequencies. Examination of records indicate the weights of people in the home are recorded regularly and they tell us this is undertaken in the privacy of their rooms. We have addressed concerns regarding the call bell system elsewhere in the report. The RGN staff undertake mininmental state assessments of people admitted to the home to determine their capacity to manage their own medication etc, only two people currently undertake their own medication, and their capacity to do so is reassessed from time to time. Capacity decisions should routinely be reviewed particularly where someone has been admitted when they are unwell, and have subsequently experienced improvements to their health and cognition. The service maintains good records in regard to routine and specialist health care interventions and appointments, all the support plans viewed indicated the people concerned had good contacts with health professionals. Discussion with RGN staff indicates they are proactive in discussing health and medication issues with respective GPs on behalf of individual people at the home about whom they may have concerns or seek medication review. Residents we spoke with conformed they are weighed regularly in the privacy of their room, and records of weights are maintained Previous shortfalls in medication arrangements have been addressed and arrangements for the storage, recording and administration of medications are satisfactory. We have recommended that PRN guidelines developed since the last inspection are reviewed to provide greater clarity for staff about why and when they should be offered. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of activities is in place about which people in the home are consulted and can influence, there is a need to ensure that the programme does not aim to offer a ‘one size fits all’ approach and other abilities and interests are catered for. People in the home value the facilities offered to meet and eat with their relatives and friends and enjoy a generally nutritious and varied diet. EVIDENCE: During our visit to the service we had opportunities to speak to peole living in the home and to observe what they were doing during the day. We spent some time in the main lounge speaking with some of the people who like to sit there and also observing. Some of the people we spoke with commented that they are provided with a weekly activity plan, they said they liked this because they know whats on Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 17 each week and can decide to attend or not. Residents said they felt listened to about activities and changes are made in accordance with their feedback, this is confirmed in AQAA information which makes clear where people living at the home have been influential in changes to the activity programme. All the residents we spoke with commented positively on attending the AGM which they look forward to particularly because of the lunch,some said they did speak up at the meeting if they needed to. One person said they were on the residents committee and makes a point of asking other residents if they want to raise issues. Most residents we spoke with said they decided what they wanted to do each day,and some like to make use of the garden if its sunny. One person who has been a resident for a long time commented that they were no longer interested in the activities on offer and felt they had deteriorated over the years, she felt some of this was due to the higher dependency of people now coming to live at the home and their inability to participate in some types of activities, this is not strictly the case as two successful outings have recently taken place one involving an evening concert and the other country tour with cream tea .However, there is a need for the service to establish a programme of activities that has something to suit everyone but not necessarily at the same time. People we spoke with reported that they have regular family visits, and particularly valued and were appreciative of the facility provided for them to lunch in private with their families in the sun lounge; that younger children who they enjoy seeing can also be safely catered for in this area. When we visited people in their rooms we noted these were personalised with some of their own possessions enabling them to settle better into the home, inventories of possessions are maintained. All the people we spoke with were generally happy with the standard and variety of food offered to them particularly lunches. Those spoken with confirmed they could have alternatives if they wanted and informed staff in good time. A relative reported that whilst lunches were very good, they sometimes found some of the combinations of foods less than satisfactory particulalry for those less able residents who are unable to express their views and need feeding, the relative further commented on an over reliance on packet soups and the nutritional benefits of introducing more home made soups. The manager should ensure systems are in place to monitor food intake for less able residents to ensure they receive a good varied and imaginative diet at all times. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 18 Records examined evidence that nutritional asessments are routinely undertaken and where concerns are highlighted food supplements provided through the GP. Special diets are catered for. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home feel listened to and able to influence some aspects of service development important to them. Improvements to some of the procedures operated within the home better safeguard residents. Staff would benefit from guidelines about how to work consistently with behaviours exhibited by some residents. EVIDENCE: The service has informed us within AQAA information provided that they have received 2 new complaints within the last 12 months. The Commission has also received one anonymous complaint expressing concerns about a number of areas which we have looked at during the course of our inspection. The AQAA tells us that there are lots of ways in which people living in the home can express their views about the service and can influence some areas of service development e.g. activities, menus, minor environmental improvements, when we spoke with people who live at the home they generally felt listened to, and felt that action is taken to address issues they have raised, they also felt they were kept informed. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 20 The AQAA data set informs us that approximately 8 adult safeguarding alerts have been made in the last twelve months and this includes some issues highlighted at the last inspection, since that time the home has acted decisively in referring any incidents that fall within this area and investigations have taken place, with some ongoing at this time. We are advised that all alerts are now closed and feedback from social services staff indicates that they are satisfied with the manner in which the home is now reporting and acting upon alerts. The service has implemented a programme of Adult safeguarding training for staff, and a refresher course was in progress during the course of our visit. Policies and procedures relating to the management of personal finances of people living in the home have been reviewed as a result of a recent alert From reading AQAA information, and discussion with the manager we have been made aware that some people living at the home experience behaviour issues. When we looked at their files we noted within daily records instances where behaviour had been recorded, we found no guidance within the support plan to inform staff how to manage behaviours in a consistent manner. Some more senior staff indicated this would be helpful as sometimes behaviours escalate unnecessarily because staff’ lack confidence or knowledge in how to deal with it. We noted that some behaviour happens during personal care routines, the development of more person centred information about routines residents find acceptable will benefit all staff in working consistently with individuals. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 live in a clean safe and well maintained environment. Some thought should be given to revising the layout of communal spaces for the enjoyment of all residents, and the progression of plans to replace the present call bell system EVIDENCE: Some people we spoke with commented that call bells are sometimes not responded to for long periods, this is mainly at key times although one person indicated this has sometimes been a problem for her at night. She reported that: Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 22 night times sometimes long delay in coming. In a recent anonymous letter we received we are informed that call bells can be turned off at the main box. Whilst the registered manager refutes that this happens she has confirmed that the facilitiy does exist. We are informed that the organisation are currently considering the purchase of a new system as a result of pressure from the manager and others, and we would recommend this is progressed. The home is maintained to a good level of decorative order and cleanliness. Separate ancillary staff’ are available to ensure cleaning and other domestic tasks are provided. When we visited there were no unpleasant odours in the main communal areas although some individual bedrooms had some underlying odours which will need monitoring. We noted equipment had been serviced and the AQAA advises us that all equipment has been serviced including that for fire detection. During our visit we noted that most people tend to congregate in the main lounge or are taken there by staff. This area is somewhat overcrowded with some residents sitting in their wheel chairs behind others. When we discussed this with some of the residents they said they liked to be in that lounge because it was warmer in the winter and because the sun came into it through the conservatory roof and windows. They also liked to listen to the music, as at the time this was competing with the television, some thought needs to be given to making better use of this and the other communal spaces. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing resources are under pressure from the increased dependency of some residents and this can at key times impact on the quality of support provided to people in the home. Improvements have been made to the recruitment procedure and staff training programme to better safeguard residents, but evidence of induction is still not consistent for all staff and the quality of some recruitment documentation accepted needs review. EVIDENCE: We have received an anonymous complaint that alleges that in 2008 some staff were working 14 out of 15 days without a break, in discussion with the management team there was acknowledgement that whilst this did happen on at least one occasion, this is no longer the case with those staff who have signed to work more than 48 hours per week prevented from working more than 60 hours in total, the manager reports this has not been well received by some staff. We would remind the registered manager that even staff who have worked no more than 60 hours at the home should be monitored to ensure they have had adequate rest breaks and are competent to undertake their Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 24 role, this is particularly important where some staff are known to have a second job. The manager and deputy manager work between 7.30 am and 5.00 pm Monday to Friday, in their absence the RGN on duty are in charge. Out of hours cover is provided by the manager and deputy, with occasionally input from the Care manager. The AQAA informs us that in order to minimise disruption to people living at the home by receiving support from a number of different agency staff, the home has negotiated with an agency to only supply the same workers, when we spoke with some of the people at the home they initially reported they find agency use not good bcause these staff do not understand their needs, but later acknowledged that the home is trying to limit the number of agency staff used to ensure better continuity for people living at the home. Discussion with people living at the home and some survey feedback received from staff, indicates pinch points throughout the day usually around meal times when there are insufficient staff available, staff report this is because of the number of people who need help with feeding. People at the home have also informed us that they sometimes find it hard to get a staff member to answer a call or take them to the toilet at key times. We noted in some personal care records that frequencies of pad changes for some people is variable and at times unacceptable and we have issued a requirement elsewhere for this. Staff survey feedback informs us that the increasing need of some residents means that it can be stressful for staff who are experiencing pressure on their time. People living at the home generally spoke positively of the care staff and the care they provide, feeling that there are not enough of them and that they work hard, it is a concern that this and the availability of staff at times may influence their decision to remain in their wheelchairs for the majority of the day rather than sit in armchairs although most made clear this was by choice. Another resident who commented that they sometimes refused to get changed and lay down late afternoon did so because she was concerned staff may not respond to her calls to get up for some time, she said they cant always be short staffed. Whilst she could not think of a time when this had happened this is clearly a source of concern to the resident. There is a need for the service to ensure that if they are taking residents with more compex needs they have adequate staffing to support them without undue impact on other residents. We would recommend a review of staffing arrangements within the home with a view to ensuring there are satisfactory numbers of staff available at those times during the day when residents are Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 25 most in need of support. We looked at three new staff recruitment files. Whilst the AQAA information has not specifically addressed the shortfalls identified previously, examination of staff records indicates these to be much improved with evidence that vetting and checks are being conducted and file contents mostly conmplaint with schedule 2 of the care homes regulations 2001.The registered manager has been reminded that only in exceptional circumstances should staff be commencing employment without all checks being in place, and only where their close supervision can be clearly evidenced at all times. We have also discussed the importance of the organisation not encouraging the employment of groups of relatives within individual homes as this can be disruptive. We found one employment reference to be of poor quality and have asked the registered manager to look into this as it is important that references are only accepted from individuals authorised to provide references in another service. Whilst most employment histories were detailed we discussed some gaps with the registered manager and the need to ensure that only full employment histories are accepted. Interview records were only noted in one file viewed as was evidence of induction, the registered manager has been reminded of the need to ensure new staff are provided with appropriate induction for the role they are undertaking and a requirement has been issued for this. There is a rolling programme of staff mandatory and specialist training to meet the changing needs of the people in the home. We found one file of a staff member where no evidence of training is recorded, in discussion we are informed that this staff member works elsewhere and has completed all necessary mandatory training with their other employer, but there is no evidence of certificates to confirm training has been completed or is up to date and we have addressed this also within the requirement issued. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 health, safety and welfare of residents are generally well supported, the management of the service is stable and there is a continuing drive for improvement. Communication between staff is an area for further development. Residents feel listened to and their views influence some aspects of service development, but a programme for the quality audit of the service and its systems needs development EVIDENCE: We received the AQAA when we asked for it; it has been completed to a Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 27 reasonable standard but, fails to reflect specifically how the service has addressed outstanding requirements issued at the last inspection. This documentation would benefit from improved detail to illustrate how the service operates on a day to day level as regards the National minimum standards and plans for the future. Since the last inspection we are advised that all required policy and procedure documentation has been reviewed and updated. A recent anonymous complaint indicated that some overseas staff may lack confidence in the whistleblowing procedure and implies feelings of victimisation amongst some groups of overseas staff. When we spoke with some staff from the identified group they reported they felt supported and understood the whistleblowing process and safeguarding, they indicated that they understood the feelings of some people but may not necessarily share them. We have been made aware through feedback we have received that communication issues exist between the different layers of staff within the home. A relative we spoke with also commented on the lack of communication between RGN and health care assistant staff. Currently there are no mechanisms in place to enable both groups of staff to work more closely through shared shift handovers. In discussion the management team express an awareness of staff dynamics within the home and are making some efforts to resolve matters by holding meetings with individual staff groups to discuss concerns. Clearly this separation in care responsibilities needs to be reviewed with RGN staff taking a more active role in the oversight and monitoring of overall care giving. When we spoke with people living at the home during our visit, they told us that they are generally very happy living there, but admitted that there are occasional niggles that need to be addressed. Feedback suggests people feel comfortable about raising issues with staff and are provided with a number of opportunities and forums to do so. They mostly feel listened to with odd exceptions, and feel action is taken to address issues they raise. They feel informed about what happens in the home A previous requirement for provider visits to be undertaken and reported on has been met; we discussed some possible improvements in the level of recording within these. There are a number of stand alone audits undertaken by the staff but no formal programme of quality assurance for the internal audit and review of the service. We would recommend that the service implements such a programme to ensure internal review and audit of systems and service quality can be used Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 28 to inform an annual quality assurance report and that this can evidence consultation with people living in the service AQAA dataset information informs us that all health and safety checks and servicing have been updated, and we noted updated servicing of hoists, parker bath and fire extinguishers have been updated within suggested timescales. We looked at accident records for the period 3/5/09 to 10/8/09 and found that whilst there had been a number of falls, only two residents were shown to have experienced repeat falls, and action has been taken to reduce these. Falls monitring is taking place and the service is acting promptly to check people experiencing falls for UTIs or other possible health or medication related causes. The home has been notifying the commission appropriately of events that happen in the home but were unaware they needed to inform for some events and this was discussed, the manager now has a clearer understanding of the range of events that should be notified to the commission and or other agencies. Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 x 3 3 x 3 Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered manager to implement systems to ensure that personal care needs are being attended to in keeping with the preferences of the individuals concerned and at the agreed frequencies. The Registered manager must ensure that staff records can evidence clearly that new staff have received induction appropriate to their role and also familiarises them with the workings of the home. Evidence that staff have completed mandatory training must be retained in staff records. Timescale for action 11/09/09 2. OP30 18 11/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP18 Good Practice Recommendations PRN guidelines need clarity to inform staff why and when medication should be offered Care staff would benefit from the development of DS0000028541.V377151.R01.S.doc Version 5.2 Page 31 Cheneys 3. 4. OP19 OP27 5. OP33 individualised behaviour guidelines to help work consistently with those people who exhibit behaviours The call bell system needs replacement to ensure bells cannot be turned off without staff attending callers, and to enable closer monitoring of response times A review is needed of how RGN and health care assistant time is utilised, and whether current staffing levels needed to support increasing dependencies of people in the home are sufficient. The registered manager should implement a system of quality assurance to undertake the internal audit and review of systems and procedures, this should include evidence of consultation with people using the service and an annual report or quality assurance findings should be available for inspection Cheneys DS0000028541.V377151.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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