Care Home: Chestnut Park Care Home

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What the care home does well People who want to live at the service have their needs fully assessed so they can be assured that these will be met at the service. People have their personal care needs assessed and met in a way which protects their personal dignity People have a flexible and varied lifestyle, the social and recreational activities provided meet their needs and expectations. People`s complaints are responded to and investigated, they are safeguarded by staff who have been trained and who are committed to their protection. The accommodation is comfortable and provides a pleasant place for people to live. People are supported by trained staff who have been safely recruited. What has improved since the last inspection? Care plans have been completely reformatted and rewritten to provide more information and person centred detail to offer better guidance to staff on how to meet needs. A new call alarm system has been installed to make sure people can get help from the staff when they need it. An advisor on Health and Safety has been appointed to advise and guide the owners and the acting manager on improvements. New policies and procedures have been written and these have all been read and signed by the staff. This offers clear and up to date guidance to them. New electrical circuits have been installed throughout the building. New fire equipment has been purchased to make sure people are safe in the event of a fire. New fencing has been provided in the garden and a ramp has been installed to enable people easier access into the garden in nice weather. More trips out have been provided to offer entertainment for people who live at the service. Medication storage and administration have improved and are now more secure. Staff files have been audited and contain the necessary information and documentation to ensure people are suitable to work with vulnerable people. What the care home could do better: When a review of a care plan or risk assessment indicates there have been changes, the care plan must be updated to reflect the current needs of the person and ensure that the staff meet these effectively. Care plans should have a more rational format so that all of the key information about each need is kept together for staff to read, digest and understand. Health care plans and risk assessments must clearly highlight the condition, the key symptoms and the actions staff need to take to meet people`s needs to maximise their health and wellbeing Regular weekly audits must be carried out to check physical quantities of medication against the running balances recorded. To make sure people receive their medication as their Doctor prescribed. People must not be woken up if this is not their wish to accommodate the needs of staff. People who live at the service must be given choices in terms of their lifestyle and these must be respected unless there are valid, recorded reasons to do otherwise. Decisions about resuscitation must be made by the person concerned where they have been assessed as having capacity. Where the assessment shows this is not the case, the Resuscitation Council Guidelines must be followed. To ensure people have the right to life saving treatment where this is their wish. Find alternative ways of advising people who live at the service of their right to formally complain and how to do this to ensure their concerns are heard and responded to. Appropriate locks must be fitted to bedroom and bathroom doors to allow people privacy and maintain their dignity whilst offering staff access in an emergency. Review the deployment of staff to make sure that people receive help promptly and when they need it. The areas for development highlighted in this report must be addressed to ensure the service is well managed and operates in the best interests of the people living there. Key inspection report Care homes for older people Name: Address: Chestnut Park Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE     The quality rating for this care home is:   one star adequate 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: Linda Hirst     Date: 1 1 0 5 2 0 1 0 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Chestnut Park Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE 01159608935 01159602791 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chestnuts (Arnesby) Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age not falling within any other category - Code OP. Date of last inspection Brief description of the care home Chestnut Park Care Home provides residential care for up to 15 older people in an adapted property in its own grounds. The home is in Mapperley Park, which is approximately a mile from the centre of Nottingham with its range of shops, places of worship and leisure and recreational facilities. Parking is available on the premises and there is good access to local transport on Mansfield Road. 0 Over 65 15 Care Homes for Older People Page 4 of 34 Brief description of the care home The communal areas consist of a large lounge and a dining room. The bedrooms are on the ground and first floors and there is a vertical lift which gives access to other floors for people who have mobility difficulties. The home has front and rear gardens which can be accessed by ramps. The current fee levels at the home range from £336 to £400 per week. The fees do not include charges for hairdressing, private dental treatment, private optician fees, transport for activities and chiropody. The service user guide and the statement of purpose are on display in the reception area of the home and these are given to all prospective residents. A copy of the latest report was not displayed. This is available for people to read at the home if they ask at the office. Care Homes for Older People Page 5 of 34 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and acting managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the owner when we asked for it, all areas were completed, although the evidence they provided could have been more in depth and from more varied sources. We used this document to help plan our visit and to decide what areas Care Homes for Older People Page 6 of 34 to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out surveys to people living at the home, but only received one back which had been completed with the help of a relative. The form was positive about the care and the accommodation, but said that people have to wait too long for staff assistance. Our main method of inspection is called case tracking which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the people who live at the service at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff and three people who live at the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: When a review of a care plan or risk assessment indicates there have been changes, Care Homes for Older People Page 8 of 34 the care plan must be updated to reflect the current needs of the person and ensure that the staff meet these effectively. Care plans should have a more rational format so that all of the key information about each need is kept together for staff to read, digest and understand. Health care plans and risk assessments must clearly highlight the condition, the key symptoms and the actions staff need to take to meet peoples needs to maximise their health and wellbeing Regular weekly audits must be carried out to check physical quantities of medication against the running balances recorded. To make sure people receive their medication as their Doctor prescribed. People must not be woken up if this is not their wish to accommodate the needs of staff. People who live at the service must be given choices in terms of their lifestyle and these must be respected unless there are valid, recorded reasons to do otherwise. Decisions about resuscitation must be made by the person concerned where they have been assessed as having capacity. Where the assessment shows this is not the case, the Resuscitation Council Guidelines must be followed. To ensure people have the right to life saving treatment where this is their wish. Find alternative ways of advising people who live at the service of their right to formally complain and how to do this to ensure their concerns are heard and responded to. Appropriate locks must be fitted to bedroom and bathroom doors to allow people privacy and maintain their dignity whilst offering staff access in an emergency. Review the deployment of staff to make sure that people receive help promptly and when they need it. The areas for development highlighted in this report must be addressed to ensure the service is well managed and operates in the best interests of the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs fully assessed so they can be assured that these will be met at the service. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that regular reviews of peoples needs are held. We looked at the file of the person who was most recently admitted to the service to check that their needs fall within the category of registration and can be met at the service. We found that the persons needs had been fully assessed by their social worker before the person was admitted to the service. The persons needs fall within the category of registration and can therefore be met at the service. We spoke with the person who told us they could not remember being admitted to the service, though they thought this had been in an emergency. The persons family were Care Homes for Older People Page 11 of 34 Evidence: instrumental in choosing the service. The person said, I didnt think it was a good idea at the time, I wanted to be independent, but my family gave me a guarantee that I can go home if I dont like it. I have no complaints about the home really, but it is not like being in your own home. I have agreed to stay here now. Staff we spoke with told us the acting manager assesses people before they come and live in the home to check their needs can be met properly. She always goes out to assess new people and will give us verbal information about peoples needs. We are also encouraged to read the paperwork as the Single Needs Assessment Profile (SNAP) doesnt always give you the right information. Intermediate care is not provided at the service and this standard does not apply. Care Homes for Older People Page 12 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their personal care needs assessed and met in a way which protects their personal dignity but staff do not have the information and knowledge they require on peoples healthcare needs to enable these to be met effectively. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that people who live at the service are now involved in planning their care, she also told us that all care plans have been redeveloped and made more person centred. We looked at the care plans for three case tracked people to check that these contain the necessary guidance and help staff to understand most of the needs of people living at the service. We found the care plans contain more information than previously, and we found some very detailed and person centred information in some plans about peoples daily routines and life experiences. We could not find evidence of service user signatures to say they agree to plans and have been consulted about care, but the level of detail contained within the daily Care Homes for Older People Page 13 of 34 Evidence: routine and life experiences documents gives clear evidence to show that plans have been discussed with them. We found evidence that care plans are being reviewed every month, but the updates to the care plans are recorded in reviews and the plans have not been changed to update the guidance to staff. For example one person told us they can dress themselves now, having previously needed help from staff to do this task. The Care plan still states the person needs assistance to get dressed. The people we spoke with told us, I have not seen my care plan but they have talked to me about what I like and my past. Another person told us, Im comfortable with the care and the staff are very kind. When you are old you get frightened. Its nice to be somewhere where you are looked after. The staff we spoke with told us, I feel our care plans are better, I like our care plans, I find the daily routine sheet the most helpful, I like the information we get in those a lot. Another said, I look at the care plans when I have a quiet moment or when something is wrong with a resident. I find the risk assessments and their personal histories most useful in telling me about the person. The owner told us in her Annual Quality Assurance Assessment (AQAA) that weekly health checks are carried out on all of the people living at the service, including blood pressure, weight and skin tone. Monthly urine tests are done to check for infections. The AQAA states there is a good rapport between Doctors and the service and other health professionals also visit including the District Nurse, Physiotherapist, Dietician, Occupational Therapists and advocates as requested. People who live at the service told us, I was a bit rough, health wise and I lost weight, they were giving me vitamin drinks but I dont have those now. They weigh you regular here. We looked at the health care plans for the people we case tracked. We found people have various health care needs to do with continence, Diabetes, falls, weight loss, pressure area care, and other rare and very specific illnesses. We saw evidence that people are being referred for assessment and treatment appropriately and the staff at the service are being supported by external health care professionals such as District Nurses, Dieticians, the Falls Prevention Team, Continence Specialists, Physiotherapists and specialist Consultants. However,we found that although the service have obtained key information about specific needs (for example from the Hospital. the Diabetes Nurse, or the falls prevention team) the information has not been added in to a plan of care and risk Care Homes for Older People Page 14 of 34 Evidence: assessment, the information is also not kept near to the relevant care plan meaning staff can be unaware of this key information. For example, one of the people we spoke with told us, I have Diabetes, I use tablets to control it and I dont have any sugar in my diet. The District Nurse comes every week to check my blood sugars. When we spoke with a member of staff they could not tell us what kind of Diabetes the person has or how it is controlled, I dont know about (the persons) medical condition other than Diabetes, Im not sure how it is controlled. I dont really know much about Diabetes.The other staff member we spoke with knew the person has tablets to control Diabetes, and when we asked, she knew the signs of hypoglycemia as a family member also has this condition, but the information was not readily available in a plan of care or risk assessment to inform all staff effectively. We looked at the storage of medication to make sure it is safe, secure and that all medicines are stored as directed on their labels. We found the storage of medication to be appropriate in all cases. We looked at the arrangements for storing and recording Controlled Drugs and found these to be safe and appropriate. We checked the records and found these tally with the Controlled Drugs held at the service. We looked at the records of receipt and returns and found these to be well maintained. The service have recently been visited by a Pharmacist from the Primary Care Trust who recommended the manager do weekly audits to check physical quantities of medication against the running balances recorded. When we checked the medication we found this is still an issue which needs to be addressed. The owner took immediate action to remedy the two administrative errors so we did not issue an immediate requirement but this must be addressed. People who live at the service told us, the staff look after my tablets. I am happy with this. They give me my tablets with food and a drink, they dont leave them with me to take later though. Staff we spoke with told us, the medication has definitely improved. The staff give out medication carefully and stay with the person to make sure they take it. Another person who gives out medication told us, I had medication training from Boots last yea rand I have also done further, more in depth training at Stevenson College. The staff would never share peoples medication with other residents, medication is given outs safely and (the owner) does audits. The people we spoke with who live at the service told us, the girls are mainly very nice, you get the odd one who wants to tell you they are the boss, but they are good at making you feel comfortable when they help you with personal care. Care Homes for Older People Page 15 of 34 Evidence: Staff we spoke with told us, in terms of personal care, we always lock the door, if they are using the toilet I always make sure people are covered up and give lots of reassurance. Care Homes for Older People Page 16 of 34 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. People have a flexible and varied lifestyle, the social and recreational activities provided meet their needs and expectations but they are not always consulted about key decisions in their lives in line with Legal requirements. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that all of the staff encourage people to undertake their interests and hobbies where possible. They say they have improved by organising day trips and have been out on a canal boat trip and to Holme Pierrepont. Their plans for improvement include there being a vehicle to use when going on community activities and they have employed a specialist day care coordinator to deliver a training session on activities which the current staff team are trying to develop with the service group. People who live at the service told us, Its alright, its not perfect, but you get these little things. When I first came here they said I could watch TV in the lounge but I like football and the others dont. I have now got my own TV in my room. We do exercises here. I personally dont go out, I couldnt alone. Another person said, I spend all day in the lounge with my four friends, we do a quiz, exercises, we sometimes go out to the pub. I feel there is enough to do. Others told us, My son comes over and takes Care Homes for Older People Page 17 of 34 Evidence: me out to garden centres so I can look around. He is always made welcome. Staff we spoke with told us, We are going out on a lot of outings at the moment, even if it is just to the local pub. its nice for the staff and the residents as we all eat together. A member of staff does group exercise every day with the residents. The owner told us in her Annual Quality Assurance Assessment (AQAA) that they encourage people to have a varied lifestyle, with a choice of meals, daycare, occupation. The owner also said that people have the opportunity to attend service user meetings to express their wishes and concerns. People who live at the service gave us mixed views about the flexibility of their lifestyle, the staff wake me early, I dont know why, its how they go on. I get myself ready. I like to go to bed late though, about midnight. Sometimes i go early and watch the football. Others told us, staff come in at about 06.00 and I wake up, I dont want a lie in, once Im awake thats it. Ive always been an early riser but I like to go to bed early. I can more or less do what I want to but they dont like me in bed too early. Staff we spoke with told us, the night staff get a couple of residents up so its easier for the morning staff. We looked at the service user meeting minutes, these are held regularly and meetings are held without staff present. Staff told us the owner feeds back any issues to them directly.We looked at care planning to see if the Mental Capacity Act and Deprivation of Liberty Safeguards are being considered and planned for. We found that this is an area which still needs significant improvement, especially in the areas of resuscitation wishes, self medication, people deciding what time to rise and retire (see above) and issues around consent to accept risks. We found a care plan indicating a person is not to be resuscitated, but this has not been discussed with the person concerned, and there is no evidence of a capacity assessment nor of the consultation and agreement of the Doctor. The owner has removed this care plan. We spoke with the staff who told us about the people they believe have capacity to make decisions, but there was no record of these assessments having been made in care plans and when we asked staff they told us, Im not sure if I have had Mental Capacity Act training. We spoke with the owner about this, and she showed us the training matrix indicating staff have had this training, but they have clearly not fully understood it, or are not implementing it. Whilst we were at the home, the owner booked some further training on the Mental Capacity Act and the Deprivation of Liberty Safeguards. Care Homes for Older People Page 18 of 34 Evidence: We observed lunch and found this to be a relaxed meal. There were two choices and both were available as well as another alternative. People we spoke with told us they had enjoyed their lunch. A relative commented to us in a survey that the meals could have more variety and be less stodgy.People who live at the service told us, the food is not bad, its varied and we get plenty. We also get plenty to drink and you can buy other bits and pieces to have in your room. Another person told us, I think we get too much to eat. I would like to see tripe and onions on the menu more often. Staff we spoke with told us, we have special crockery and cutlery for people and we will liquidise food if necessary, some people also have build up drinks. Care Homes for Older People Page 19 of 34 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. Peoples complaints are responded to and investigated, though not all of the people who live at the service know how to do this formally. People are safeguarded by staff who have been trained and who are committed to their protection. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that they have received 3 complaints within the last year, 2 are resolved with 1 outstanding. We have also received an anonymous complaint about the conduct of the manager. We referred this matter to the provider who refuted all claims. The owner tells us that the complaints board is situated in the reception area and is also available in a large print format. We looked at the record of complaints and found that these are being properly recorded with a full record of investigation and actions taken. One person who completed a survey told us they do not know how to make a complaint. However the people we spoke with told us, I have complained about my television, but this is resolved now. Another person told us, I have never had to complain. but if I was worried about anything I would speak to (a named member of staff). I think they would deal with any complaint. Staff we spoke with told us,I have never dealt with a complaint but I would pass any Care Homes for Older People Page 20 of 34 Evidence: comments on to the manager or to the senior. The owner told us in her Annual Quality Assurance Assessment (AQAA) that staff have been on safeguarding training, we confirmed this by looking at the training matrix and at the certificates in staff files. There has been a safeguarding referral since our last visit about a named member of staff reporting to work in an inappropriate state. The member of staff was suspended from duty whilst the Local Authority investigated the matter. The allegations were not found to be substantiated. People who live at the service told us, I think some staff can be a bit rough with me and I have to tell them to be careful with my leg when getting me into the bath. The person was not specific about who did this and said it only happens sometimes so we passed these comments on to the owner for further action. Others told us, I have never seen staff behave in an unpleasant way towards the residents, and, I feel safe and well looked after. I quite like it in here. Staff we spoke with told us, I think the staff are very good with the people living here, I have never seen anyone behave inappropriately and if I did I would report it to the manager. I feel confident she would deal with it. We have had safeguarding training and I know what to do. I feel any of the current staff would blow the whistle on poor practice. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is comfortable and provides a pleasant place for people to live but the lack of working locks on doors compromises the privacy and dignity of people who live at the service. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that the home is furnished and decorated to a very high standard with all areas well maintained. She told us that some bedrooms have high/low beds, en suite facilities and all have nurse call alarms. She said that all visitors comment how nice the home is and they have said that they can see continued improvements being made to the home environment. The new nurse call, wireless system has improved the response to need. They say they have improved by replacing dining table and chairs and by redocorating two more bedrooms. (See a fuller list of improvements in the What has improved since the last inspection summary. We did a partial tour of the accommodation, including all communal areas and a sample of bedrooms to make sure the home is safe, comfortable and well maintained. We found the home to be clean, comfortable and homely throughout. However, people who live at the service told us that they cannot lock their doors and at night there is a person who disturbs them and enters their room. When we looked at the records of incidents we found evidence that this does happen. We found several doors, including Care Homes for Older People Page 22 of 34 Evidence: bathroom doors do not lock and this clearly profoundly affects peoples privacy and dignity. Staff we spoke with told us, repairs are variable, if the lift breaks down it is fixed straight away and any essential moving and handling equipment as well but bathrooms still do not have lockable doors and we have a resident who wanders around a lot. The home is kept very clean though. Care Homes for Older People Page 23 of 34 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. People are supported by trained staff who have been safely recruited, but there are not enough staff available at key times to meet the needs of people promptly. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that staffing levels have improved. They state they have employed a further 2 staff to increase the current workforce to 17 staff. These are part time positions and offer the service the ability to provide more staff support at key times. We looked at the staff rota and found that on paper there seem to be enough staff to meet the needs of the people living at the service. However, a person commented to us in a survey, sometimes (staff could) attend a little quicker to requests. Staff dont always come when requested.People we spoke with told us, staff sometimes come quickly and others we have to wait a long time. Others told us, there are not enough staff on in a morning, I sometimes have to wait for 10 or 15 minutes after I have buzzed. We spoke with staff who work at the service about this and they commented, there are not always enough staff on in an afternoon as we also have to cook the tea, and if one person is doing medication and another is cooking it only leaves one person to Care Homes for Older People Page 24 of 34 Evidence: look after the residents. We need three on for the full shift, we always do have three on but only between 5 and 10. Sometimes people do have to wait as we only use one bathroom downstairs for people in wheelchairs. There is an outstanding requirement about staffing levels, which the service have tried to address by increasing staff numbers, it may be that the deployment of staff needs to be considered to ensure good outcomes for people living at the service. The owner told us in her Annual Quality Assurance Assessment (AQAA) that 11 staff have achieved their National Vocational Qualification Level 2. This means the service has already exceeded the National Minimum Standard in this area. The owner told us in her Annual Quality Assurance Assessment (AQAA) that all staff files have been checked and they are maintained to a high standard. We looked at four staff files to check that these contain the information and documents required by Law to ensure people are safe to work with vulnerable people. We found that people generally have the documents they need, although we could not find any evidence that one persons previous caution had been discussed and risk assessed, nor could we find any written verification for the reasons one person left employment with vulnerable adults. The staff concerned verified that these conversations had taken place with them and were previously recorded, but these could not be found. Both of these issues were corrected before we left the building. Staff we spoke with confirmed they completed applications, supplied referees and had Criminal Records Bureau checks before starting work at the service. The owner told us in her Annual Quality Assurance Assessment (AQAA) that all new staff have induction training and that they have supported staff with further training opportunities in key areas. When we looked at staff files we saw certificates showing staff have undertaken training on the Mental Capacity Act and the Deprivation of Liberty Safeguards, Moving and Handling, Health and Safety and Food Safety. Staff we spoke with told us, I have done lots of training; Nutrition, First Aid, Fire Safety, Safeguarding, Moving and Handling, Health and Safety. People who live at the service commented to us, the staff are friendly and caring, the staff are kind at giving me care, all of the staff are good, they are patient. The staff seem to know what they are doing and they know how to help me. Care Homes for Older People Page 25 of 34 Evidence: Care Homes for Older People Page 26 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are improvements in the service, but also areas of weakness which means we cannot ensure that the service always runs in the best interests of people who live there. Evidence: The owner told us in her Annual Quality Assurance Assessment (AQAA) that they are in the process of recruiting a new manager, who has since been appointed and we have been told by the owner is applying to become registered. As can be seen from this report, there remain a number of issues which need to be effectively managed in order to secure the necessary improvements to outcomes for people (See OP7, OP8, OP9, OP14, OP18, OP19, OP27.) People who live at the service gave us mixed views on the management of the home, one told us, they dont give you a lot of information here. However another told us, (the manager) is good, the home seems to run well. I feel able to say what I want Care Homes for Older People Page 27 of 34 Evidence: about the service in the residents meetings. Staff told us, (the manager) is brilliant, if you have a problem you can talk to her. She will pull people up when needed, I feel staff respect her. The owners have taken the decision not to retain peoples money on the premises. If people want anything, the service pays for it and then bills the person or their relative. The only exception to this is a person who has the Local Authority acting as their receiver. We looked at the records of transactions and cross checked these with receipts and balances and found these tally. Only the owner and the acting manager ever have access to this money. This was confirmed when we spoke with the staff. The owner told us in her Annual Quality Assurance Assessment (AQAA) that they are aiming to improve our homes operational procedures. We looked at the most recent Quality Assurance Questionnaires and found these to be mainly positive. Comments included, (the home is) friendly clean and cheerful now changes have been made. Another person commented, the care offered is excellent, staff treat (my relative) with great patience. Others agreed, (the home is) clean and friendly, staff caring and helpful. good, caring comfortable. However, some raised issues of concern, we feel more staff during the day would be of benefit to the home, as would more mental stimulation/activities. Another commented on the fact that there is no visitor room, and said they are not always offered refreshments. They ranked privacy as fair as they have to use bedroom for private conversations and they commented that the acting manager is rarely on duty. These responses have been collated and the owners have developed an action plan to address the areas of concern, which covers all of the issues raised. This shows they are trying to be responsive to comments on the service. People who live at the service and the staff all commented that questionnaires are done and people have the chance to express their views. The owner told us in her Annual Quality Assurance Assessment (AQAA) that all staff have received regular support sessions from the home owner. We looked at the staff files and found evidence that there has been an improvement in that there are records in every file of formal supervision. However, three staff out of the four had no evidence of supervision taking place in the last seven or eight months. This is an outstanding requirement and must be addressed to avoid further action, especially in light of some of the evidence from this inspection indicating staff do not always respond as the service would expect. (See OP10, OP14, OP18, OP27.) Care Homes for Older People Page 28 of 34 Evidence: Staff we spoke with confirmed that they do have supervision, but this is not every 6 weeks as recommended, one told us, I have supervision, I had one last year and one 2 or 3 weeks ago. Another told us supervision is held, every three months. The owner told us in her Annual Quality Assurance Assessment that all Health and Safety testing has now been undertaken to make sure people are safe and protected. We found accidents are being properly recorded and from the records it appears that staff are taking appropriate action in relation to accidents. We also found the staff have been doing a number of course to ensure their health and safety and that of the people living at the service. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 14 18(1)(c)(i) Staff must understand when and how they must assess and record decisions about capacity. 30/07/2009 to ensure people living at the service have the right to make their own decision if they have capacity. 2 36 18(2) There must be evidence that 30/07/2009 staff are closely supervised and monitored and that any issues raised about their performance are recorded to ensure that people living at the service are supported by a caring and effective staff team. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 When a review of a care plan or risk assessment indicates there have been changes, the care plan must be updated to reflect the current needs of the person and ensure that the staff meet these effectively. 07/07/2010 2 8 12 Health care plans and risk assessments must clearly highlight the condition, the key symptoms and the actions staff need to take to meet peoples needs to maximise their health and wellbeing 07/07/2010 3 9 12 Regular weekly audits must be carried out to check physical quantities of medication against the running balances recorded. 30/06/2010 Care Homes for Older People Page 31 of 34 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 to make sure people receive their medication as their Doctor prescribed 4 14 13 Decisions about 30/06/2010 resuscitation must be made by the person concerned where they have been assessed as having capacity. Where the assessment shows this is not the case, the Resuscitation Council Guidelines must be followed. to ensure people have the right to life saving treatment where this is their wish. 5 14 12 People must not be woken up if this is not their wish to accommodate the needs of staff. People who live at the service must be given choices in terms of their lifestyle and these must be respected unless there are valid, recorded reasons to do otherwise. 6 18 13 Investigate the comments made about staff during this inspection to ensure that people are being helped in a caring and sensitive manner. 30/06/2010 30/06/2010 Care Homes for Older People Page 32 of 34 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 7 19 23 Appropriate locks must be fitted to bedroom and bathroom doors to allow people privacy and maintain their dignity whilst offering staff access in an emergency. 07/07/2010 8 27 18 Review the deployment of staff to make sure that people receive help promptly and when they need it. 07/07/2010 9 31 9 The areas for development highlighted in this report must be addressed to ensure the service is well managed and operates in the best interests of the people living there. 07/09/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Care plans should have a more rational format so that all of the key information pertaining to each need is kept together for staff to read, digest and understand. Find alternative ways of advising people who live at the service of their right to formally complain and how to do this to ensure their concerns are heard and responded to. 2 16 Care Homes for Older People Page 33 of 34 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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