Care Home: Claremont

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What the care home does well People benefit from having all their care and support needs assessed when they are considering moving in. People have the opportunity to see the accommodation before they move in. People have their preferred routines for receiving personal care set out in their care plan. People have good support from the local healthcare professionals. One of the GPs visits the home once a week, although people can see their own GP when they want to. Risk management assessments are in place for nutrition, moving and handling, going out alone, and risk of pressure sores. People are promptly referred to the relevant healthcare professional if concerns are noted. Systems are in place to make sure that people have their medicines when they need them. Some people make use of the local facilities and are encouraged to retain their independence by continuing to go out on their own. People benefit from having a full time activities organiser who makes sure there are lots of things that people like to do. People are offered a range of things that they like to eat. The menus are changed when people suggest different things to the chef. People`s concerns and complaints are taken seriously and fully investigated. People are told about what the home is doing to make things right. Members of staff are confident in recognising and referring any allegations or observations of abuse to the local safeguarding procedure. If people want to keep small amounts of money in the home`s safe, they regularly see the records of all transactions and balances. People are encouraged to personalise their bedrooms to reflect their personality. People benefit from a warm, comfortable and clean environment that is well maintained. Mrs McCulloch looks at different ways to improve the building for people. The staffing levels mean that people have staff available at the times they need them. A robust recruitment process means that people are protected from anyone who is unsuitable to work with people who may be vulnerable. Members of staff benefit from having a full time training manager who is qualified to teach and has a background in working in care. There is a programme of relevant training which is regularly updated. Members of staff receive regular supervision. All but the two new members of staff have at least NVQ Level 2 in care. Members of staff respect people`s privacy and dignity. Staff make sure they knock on bedroom doors before being invited in. People have built good relationships with members of staff. Mrs McCulloch has over thirty years working at the home in different roles, twenty seven of those in a management capacity. She has NVQ Level 4 in care and NVQ Level in management. She keeps herself up to date with current good practice with regular training. Mrs McCulloch is supported by a deputy manager who has NVQ Level 4 and the Registered Managers Award. The home is run in people`s best interests. What has improved since the last inspection? If for any reason people cannot sign their care plan, their representative now signs on their behalf, to ensure their views are reflected in the plan. Hoists and wheelchairs are now stored in a designated room. Individual room risk assessments now include the risks posed by access to hot water. What the care home could do better: Individual room risk assessments must identify what the risks are and how they are to be reduced or eliminated. Other risk assessments must also show what the identified risks are and give guidance to members of staff on what they must do when using any equipment or carrying out tasks. The home should consider consulting the Tissue Viability Specialist Nurse to see if there is a better tool to use which identifies the common indicators of people`s risk of developing pressure sores before any red marks appear. The district nurse should be involved in any decision making about the use of bed rails. This is so that the proper support and equipment is used when people are at risk of falling out of bed. Immediate care charts for what people are eating and drinking should be totalled so that their intake can be properly monitored. Guidance on what should be achieved each day should be included with the chart to aid monitoring. Directions should also be included in charts for recording when people who spend time in bed are turned to relieve pressure. The home must make sure that any free standing radiators comply with the requirements of the Fire and Rescue Authority. So that people are not at risk of scalding themselves or tripping over the appliance or leads. Key inspection report Care homes for older people Name: Address: Claremont Linleys, Gastard Road Corsham Wiltshire SN13 9PD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Walker     Date: 0 8 0 4 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: Claremont Linleys, Gastard Road Corsham Wiltshire SN13 9PD 01249713084 01249701381 claremonthome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warrington Homes Limited Name of registered manager (if applicable) Mrs Mandy McCulloch Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Claremont is run by the charity, The Warrington Homes Limited. The Registered Manager is Mrs Mandy McCulloch. The home has been in existence since 1946 and occupies a large site on the main road between Corsham and Melksham. The original building has been extended and modified over the years. Many of the rooms look out onto the homes grounds and open fields beyond. The accommodation is on the ground and first floors. A passenger lift is available. There are 38 single rooms, of which 16 have en-suite facilities. The communal rooms include a large lounge, a conservatory and a dining room. There are two bathrooms on the ground floor and two on the first floor. Respite care (temporary) stays can be arranged, subject to the availability of a vacant Care Homes for Older People Page 4 of 34 0 Over 65 38 Brief description of the care home room. For the majority of people who live in the home, Claremont is their permanent home for as long as this remains appropriate to their needs and wishes. Claremont is not registered to provide nursing care and district nurses attend to peoples nursing needs. People receive care and support from a permanent staff team. A keyworker system is in operation. There is a statement of purpose which provides detailed information about the service. The fees range between 2478.65 pounds and 2978.10 pounds each calendar month. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 8th April 2010 between 9:10am and 5:30pm. Mrs Mandy McCulloch, registered manager, was present during the inspection. We looked at care plans, risk assessments, daily reports, staff recruitment and training records, medicines and menus. We made a tour of the building. We spoke with four people who use the service and four members of staff. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, members of staff, relatives and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. Care Homes for Older People Page 6 of 34 The last Key inspection was on 5th and 11th June 2007. The Judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 7 of 34 What the care home does well: People benefit from having all their care and support needs assessed when they are considering moving in. People have the opportunity to see the accommodation before they move in. People have their preferred routines for receiving personal care set out in their care plan. People have good support from the local healthcare professionals. One of the GPs visits the home once a week, although people can see their own GP when they want to. Risk management assessments are in place for nutrition, moving and handling, going out alone, and risk of pressure sores. People are promptly referred to the relevant healthcare professional if concerns are noted. Systems are in place to make sure that people have their medicines when they need them. Some people make use of the local facilities and are encouraged to retain their independence by continuing to go out on their own. People benefit from having a full time activities organiser who makes sure there are lots of things that people like to do. People are offered a range of things that they like to eat. The menus are changed when people suggest different things to the chef. Peoples concerns and complaints are taken seriously and fully investigated. People are told about what the home is doing to make things right. Members of staff are confident in recognising and referring any allegations or observations of abuse to the local safeguarding procedure. If people want to keep small amounts of money in the homes safe, they regularly see the records of all transactions and balances. People are encouraged to personalise their bedrooms to reflect their personality. People benefit from a warm, comfortable and clean environment that is well maintained. Mrs McCulloch looks at different ways to improve the building for people. The staffing levels mean that people have staff available at the times they need them. A robust recruitment process means that people are protected from anyone who is unsuitable to work with people who may be vulnerable. Members of staff benefit from having a full time training manager who is qualified to teach and has a background in working in care. There is a programme of relevant training which is regularly updated. Members of staff receive regular supervision. All but the two new members of staff have at least NVQ Level 2 in care. Members of staff respect peoples privacy and dignity. Staff make sure they knock on bedroom doors before being invited in. People have built good relationships with members of staff. Mrs McCulloch has over thirty years working at the home in different roles, twenty seven of those in a management capacity. She has NVQ Level 4 in care and NVQ Level Care Homes for Older People Page 8 of 34 5 in management. She keeps herself up to date with current good practice with regular training. Mrs McCulloch is supported by a deputy manager who has NVQ Level 4 and the Registered Managers Award. The home is run in peoples best interests. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 benefit from the homes detailed assessment process. This means that people know when the home can meet their care and support needs. Evidence: One person told us that their daughter had visited a number of care homes on their behalf before they visited this one themselves. They told us they had looked at the bedroom to see if would be suitable. Either Mrs McCulloch or the care manager carried out the pre-admission assessments. In the AQAA she told us that if a local authority funds someones placement, she will always obtain a copy of the care management assessment and care plan. The homes assessment included speaking to the persons GP and any other healthcare professional involved in their care. Mrs McCulloch showed us the statement of purpose which was given to people who Care Homes for Older People Page 11 of 34 Evidence: are considering moving in. Other local information about the home and local facilities were included in the pack. In the AQAA Mrs McCulloch told us that people who use the respite service were asked to put any comments in a survey form about their admission. This information was included in the annual quality audit. 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 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 very good standard of care and support in meeting their health and personal care needs. However this is not always evidenced by the records. People have good access to healthcare professionals. Safe systems are in place for managing peoples medicines. Evidence: Each person had a plan of care. There was a long term care plan which was more person centred and a separate care plan for more specific interventions. We saw that on occasion there was information in the daily report which had not been put in the care plan. We thought that the pre-printed format did not always allow space for person centred recording of detail, as many of the entries were ticks or yes or no responses. The long term care plans at the front of the files gave a better picture of how people wanted their care and support to be provided. Action had been taken to address the good practice recommendation we made that when a person is not able to sign their care plan, a relative or representative should sign on their behalf so that their views are reflected in the care plan. In the AQAA Mrs Care Homes for Older People Page 13 of 34 Evidence: McCulloch told us all clients have a section in their files which relates to both the Mental Capacity Act and the Deprivation of Liberty Safeguards. Moving and handling assessments were in place. People were regularly weighed. Any significant weight loss was referred to the persons GP. In the AQAA Mrs McCulloch told us clients who develop bed sores are referred to the district nurse who then implements a plan of action and orders any equipment. Clearly this was too late as the damage had already occurred. We said that the home should aim to prevent pressure sores. The pre-printed format for assessing peoples risk of developing pressure damage did not contain a section to record whether there was any history of pressure sores. The form gave a number outcome for the level of risk, but did not give any guidance about which outcome number should prompt a referral to the district nurse. We said that as members of staff had received recent training from the Tissue Viability Specialist Nurse, they may have a suitable format to meet the needs of non-nursing members of staff carrying out the initial indicator assessments. Mrs McCulloch told us that the district nursing service provided profiling beds and pressure reducing mattresses when needed. One person told us that they had not been able to get out of bed that morning because they had rails on their bed. Their bed had been fitted with bed rails and bumpers. We looked at the persons care plan. There was no risk assessment with regard to the rails. Members of staff showed us the record of discussion with the persons family for the use of the bed rails, in the persons daily notes. There was no record of the district nurse being involved in the discussion. By the end of the inspection, a senior member of staff had consulted with the district nurse who agreed to assess whether bed rails were the appropriate solution to safeguard the person from falling out of bed. One person who used oxygen in their bedroom had a detailed risk assessment in their care plan. There was also information from the oxygen supplier on how to use the equipment. The persons bedroom had a notice identifying that oxygen was being used and that no one should use a naked flame in the area. Some people were being cared for in bed. In the AQAA Mrs McCulloch told us that all care staff had trained in end of life care with some staff attending course at a local hospital. Mrs McCulloch told us that people could be supported with end of life care if the district nurses were able to provide any nursing care. We looked at the immediate care charts in peoples bedrooms. These recorded when Care Homes for Older People Page 14 of 34 Evidence: the person was turned and given food and drink. We saw that not all the interventions were being recorded. We visited one person at 12.15 but the last entry on their chart was for 08.00am which stated that they had taken half a cup of tea and that they had been placed on their back. They were lying on their left side. We had noted that members of staff had been providing care and drinks to the person during the morning but clearly had not been filling out the details on the form in the bedroom. The form had been regularly filled out two hourly before 08.00am but not signed. The persons long term care plan referred to the person as being more active. The persons daily report stated two hourly turns. Urine output good and fluids pushed. It was recorded that the person had a small blister detected on front of left upper foot. We said that body maps could be used to record any marks or wounds. These maps should record the size, colour and skin condition. We said that all the drinking vessels should be measured so that monitoring was more accurate. We said that the amount of fluid to be achieved each day should be recorded with the charts. The charts had not been totalled each day to monitor whether the desired amounts had been achieved to reduce the risk of people becoming dehydrated. We looked at one persons care plan. There was clear guidance about when the person should be supported to move their position in bed. We said that this information should be included on the turn chart for better monitoring. We saw that the persons daily record showed that they were eating well. Food supplements were prescribed for those people who had been assessed as being at risk of poor nutrition. There was good information in the persons care plan about how personal care should be provided, including mouth care. One of the local GPs visited the home one day a week. People had a choice of two surgeries. One person told us that the GP would come at other times when needed. In the AQAA Mrs McCulloch told us with the clients agreement families are informed of any change or outcome of medication after the doctors visit. The same was true if anyone experienced a fall or other injury. Mrs McCulloch told us that the local dentist came to the home to provide treatment. Mrs McCulloch reported very good support from the visiting district nurses. We spoke with one of the district nurses. They described the home as wonderful, second to none, they always put the patients first. Theres never any smell. They discuss any issues with me. One person, who told us they were living with diabetes, said they monitored their own blood glucose levels. They told us they were aware of what they could eat to stay healthy. Another person showed us the bandage on their leg and told us the district Care Homes for Older People Page 15 of 34 Evidence: nurse regularly changed the dressing. One person told us that the members of staff held their medicines and that they were always given at the right time. The NHS pharmacist had recently inspected the arrangements for medicines. People could administer their own medicines following a risk assessment. The home used a monitored dosage system put up by the supplying pharmacist. Only members of staff who have been assessed as competent administered medicines. They received regular in house training. Members of staff had also attended a local college for an accredited training programme for the safe handling of medicines. The home had a homely remedies policy. Any remedies would be checked with the persons GP to see if they were able to take it with their prescribed medicines. The medicine administration records, including those for controlled medicines were being properly filled out. Those medicines to be taken only when required were not always recorded in peoples care plans. We said that the care plans should state what symptoms trigger an administration. The medicine administration record recorded that medicine administered via an adhesive patch was being given on particular days but only recorded left or right. We said that the care plan should be more detailed and body maps may make identification of the sites more explicit. Following the inspection we sent the home information about the new legislation for storing controlled medication. There were body maps to show the right place to apply topical creams. Everyone we visited had their call alarms and a drink within easy reach. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People decide how they spend their day. People benefit from having things to do that they enjoy. People consult with the chef about what they like to eat. People are offered a healthy diet. Evidence: People chose where they spend their day. Visitors were encouraged and offered refreshments. In the AQAA Mrs McCulloch told us that clients choose who they wish to see and who they dont. In survey forms in answer to the question about what the home did well, three people said everything. People were given a monthly newsletter in large print. This gave information about events, visiting services such as the hairdresser, activities and religious services. There was also a board displaying each of the sessions for that week and another board showing the daily events. In the AQAA Mrs McCulloch told us that in the quality audit questionnaires, some people had said that there were not enough activities. As a result of this the activities organiser visited everyone to see what they wanted to do. There were plans to increase the one to one trips out for people and provide more Care Homes for Older People Page 17 of 34 Evidence: activity equipment. A full time activities organiser was employed to provide a programme of events each weekday morning and afternoon from 9:00am until 4:00pm. At the weekends, care members of staff provided an activity programme. The activities organiser had an NVQ in providing activities and had attended training in providing activities specifically for people who live with dementia. In the AQAA Mrs McCulloch told us that as a result of listening to people, a darts game had been purchased. Some people asked to do painting, so canvasses, easels and paints had been purchased. She told us we held discussion afternoons mainly based on the days newspapers. Those not wishing to join in are visited in their rooms on a one to one basis; a chat or social session. Mrs McCulloch planned to purchase a computer for people to use. One person we spoke with told us they liked to join in with the singing. Another person told us they liked the quizzes. A third person told us they continued to pursue their interests and clubs in the nearby town. Mrs McCulloch told us that members of staff regularly took people out in wheelchairs to the nearby town or the countryside. The home also had its own accessible transport. An accessible coach was hired for some of the outings; people had access to an adapted taxi for smaller outings. Some people had recently made banners at a local arts centre to decorate the town during a recent festival. Mrs McCulloch told us she was arranging a debating group following suggestions from the resident meeting. She went on to say that she was hoping that the local Womens Institute would provide speakers on different subjects. Some of the other activities included: manicures, foot spas, bingo, card games, flower arranging, cream teas, cocktail parties, reminiscence, and someone came regularly to play the piano. A local potter provided a class and took the items people made away to be fired. The chef provided regular cooking sessions for people. Leaders of different faiths regularly provided services and one church invited people to visit them for tea parties. There was a large table in the sitting room where people could exclusively do jigsaws and not have to put them away before they had finished. There was a selection of large print books. The local library visited each month. Members of staff supported those people with choosing books if they could not access the library van. The care plans had a form where a letter code was recorded when people joined an Care Homes for Older People Page 18 of 34 Evidence: activity. We thought that this method of recording did not allow for evidencing the quality of the activities or the purpose and outcome for people. It was clear from talking with people that there was a positive outcome from the range of activities on offer. There was a large flat screen television in the sitting room with equipment to watch videos and DVDs. Mrs McCulloch showed us a collection of photographs and information about the usage of the building and the area from the twentieth century. One person told us theres always something going on. I like the quizzes. Its up to you what you do. Another person told us I dont need entertainment. I regularly go out with friends and I like to sit here and look at the view over the fields. There is a van that they take us out in. A further person told us they have singers and we dance about. The lunch and supper menus for the day were displayed on notice boards. There was also a folder in the entrance hall with the weeks menus displayed. Mrs McCulloch told us that the dining room had been reorganised with new smaller tables. She went on to say that she wanted to provide people with a dining experience like that in a hotel or restaurant. The chef showed us the list of what people had chosen the previous day. Everyone we spoke with knew what the choices were for the lunch menu. There was a choice of soup or juice as a starter. There was leek and potato soup, chicken kiev or liver and bacon casserole with carrots, cauliflower and dauphinoise potatoes. The pudding was apple crumble and custard. Vegetable tureens were put on each of the tables for people to help themselves. The meals were served according to peoples individual appetites and looked well presented and tasty. Seven people had their lunch taken to them in their bedrooms. Some people had special crockery so they could eat their meal more easily. This crockery looked the same as other peoples so they were not made to feel different. Some of the people we spoke with told us they had enjoyed their meal. One person told us that the chef produced interesting vegetarian meals and supported them to follow a diet suitable for diabetes. The chef told us that people following dairy-free and celiac diets could be catered for. The chef told us that they had tried using full fat milk to increase the calorific value of drinks and puddings, but people said they preferred semi-skimmed. People could have milky drinks mid morning, mid-afternoon and at Care Homes for Older People Page 19 of 34 Evidence: supper time. The chef told us that people could have drinks and snacks any time of day or night. The evening meal was chicken soup, fish fingers or sandwiches, with ice cream and sauce to follow. The chef consulted with people at the residents meetings about the menus, which were compiled for a six week period. In the AQAA Mrs McCulloch told us that as a result of listening to people the following changes had been made: vegetables were cooked so they retained more bite, meals were served more promptly and each person had been asked what they would like to be included on the menus. Seasonal availability was taken into account when compiling the menus. The chef told us that new dishes were regularly introduced as peoples tastes changed and new people moved in. They told us that different calendar events were celebrated with the menus changed accordingly. We asked the chef whether there were any restriction on the ingredients ordered. They told us people could have whatever they wanted. They told us people had wine and sherry if they wanted. All of the puddings and cakes accompanying morning and afternoon drinks were home made. The majority of the soups were home made too. The chef had a diploma in professional cookery. Care Homes for Older People Page 20 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. People are confident in letting management know when things go wrong. Peoples complaints are taken seriously and fully investigated. Staff are confident in recognising and reporting abuse. Evidence: We asked those people we spoke with about making complaints about the service. One person told us that they had been given information about making complaints in an information pack when they moved in; I expect my daughters got it. Another person told us I immediately go to Mandy [the manager] and she puts it right. In the AQAA Mrs McCulloch told us the complaints procedure is displayed in the front hallway and gives clear guidance on how to invoke the procedure and the lines and order of contact. Clients, relatives, friends and staff are most welcome to discuss any problems. All staff are issued with the whistle blowing and safeguarding adults and the prevention of abuse policy alongside the code of conduct, dealing with violence and aggressions, management of clients money, valuable and financial affairs and sexuality and relationships. These policies are regularly updated. Members of staff had undertaken training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Mrs McCulloch gave us an example where a best interest decision had been made with an Independent Mental capacity Advocate with one person who no longer lived at the home. Care Homes for Older People Page 21 of 34 Evidence: We asked members of staff about what they would do if they witnessed or were told about abuse of people who use the service. They were quick to tell us that they would report any incidents to management. However they were not always certain of the local safeguarding process and the point at which the police and the safeguarding team should be alerted. One member of staff showed us the No Secrets booklet in the staff room. We saw that abuse training was on the training matrix. We said that although it was not members of staffs direct responsibility to make an alert, they should be more familiar with the process. One member of staff told us that they had been involved in making an alert in the past. Care Homes for Older People Page 22 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. People benefit from a warm, comfortable, clean and well maintained environment. Evidence: All the bedrooms were single accommodation and the majority had ensuite facilities. People had furnished their bedrooms to reflect their personality. Members of staff respected peoples private space; always knocking on doors and waiting to be invited in. People had a choice of blankets or duvets for their beds. The bed linen and towels were of good quality and regularly renewed. People could have a choice of bath or shower. Mrs McCulloch had plans to refurbish another bathroom upstairs into a wet room. Action had been taken to address the good practice recommendation we made that there should alternative and appropriate storage of hoists and wheelchairs. A designated room had been provided. The wheelchairs were clean and had the footplates in place. Mrs McCulloch told us that she plans to have paving laid to the gravelled area outside near the conservatory. There were also plans to install a stair lift and a larger passenger lift. Mrs McCulloch showed us where frequent use of wheelchairs around a tight corner had resulted in damage to the walls. The maintenance person was Care Homes for Older People Page 23 of 34 Evidence: keeping the area repainted. Mrs McCulloch was considering fitting guards to avoid damage to the walls. There were plans to replace all the old windows and doors. The call alarm system would also be replaced. The sitting room had been re-decorated and a new carpet fitted. New pictures had been hung in the corridors. All the older style toilets had been replaced and all the bathrooms re-decorated. The staff room had been redecorated with new carpet fitted and new chairs. The home employed a contractor to carry out the homes fire risk assessment. Another contractor regularly tested the homes water supply for llegionella. In the AQAA Mrs McCulloch told us the garden is flat and has paths running around the edge to allow clients to enjoy the garden. We are also in the process of upgrading our sensory garden...there are plenty of areas for clients to sit and chat with families...in the summer house or gazebo. Mrs McCulloch told us the home had a no lifting policy. The training manager was the homes trained trainer in moving and handling. A set of new hoist slings had been purchased. We said that it was best practice for people to have their own nominated slings, due to size, weight and to reduce any risk of cross infection. Mrs McCulloch told us that this was easy to arrange as only a few people needed a hoist for moving and the new hoist slings would be allocated. The home was cleaned to a high standard, including those areas not always visible. We did not notice any unpleasant odours at any time during the inspection. People we spoke with told us they were very satisfied with the cleaning service. We saw housekeepers ask people if they could clean their bedrooms and ensuite facilities. Members of staff had access to protective clothing and disposable gloves. There were bottles of disinfectant gel at different points around the home. There was a team of six housekeepers with a head housekeeper. All the housekeepers were trained in infection control. They also had NVQ Level 2 in cleaning and support services, or were working on the qualification. All of the radiators of the central heating system were guarded to reduce the risk of scalding if anyone fell against them. All the radiators had been fitted with new thermostats so people could regulate the heat in their bedrooms. We saw some free standing radiators that were available to people if they felt cold. There was no risk assessment for these heaters. Since the inspection we have sent Care Homes for Older People Page 24 of 34 Evidence: the home information from Wiltshire Fire and Rescue service about the safe use of free standing radiators in care homes. All of the windows to the first floor had their openings restricted to reduce the risk of people falling out. People were still able to open these windows and benefit from fresh air. One person we met with had a kettle for them to make hot drinks in their bedroom. We looked at the risk management documentation in their care plan. The kettle was recorded in a list of risks in their bedroom and identified as low. None of the risk associated with the use of the kettle, which was on the floor, were identified. We said that risk assessments must identify what the actual risks are and how they are to be minimised or eliminated. The laundry was in a separate building in the grounds. The room was well organised and clean. We saw that care was taken in laundering delicate and woollen items. There were special arrangements for laundering soiled or contaminated items. People we spoke with told us they were very satisfied with the laundry system and that clothing was returned quickly. The home employed a laundry person between 9.00am and 3.00pm each week day. We saw that their shifts were covered if they were on leave so that care staff were not taken away from caring for people. Mrs McCulloch told us that she had advertised for a weekend laundry person. One person told us wonderful cleaning, wonderful laundry. Wiltshire Councils Environmental Health Department had recently awarded the home 5 stars for their kitchen. In the AQAA Mrs McCulloch told us we employ a full time maintenance man who has a rolling programme of repairs and maintains the building both inside and out. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels mean that people have support when they need it. Staff are experienced and qualified. No one starts work until checks are made on their suitability to work with people who may be vulnerable. People have built up good relationships with members of staff. Evidence: There was a minimum of 6 care staff working during the mornings, with 4 care staff working until 5:30pm and five care staff working in the evenings. At night there were three waking night staff. There was a chef, kitchen assistant, housekeepers, an activities organiser and a maintenance person. We looked at staff recruitment files. All the documents and information required by regulation were on file. No one started work until the home had obtained confirmation from the Independent Safeguarding Authority that they were suitable to work with people who may be vulnerable. Mrs McCulloch told us that all members of staff were required to have a new Criminal Records Bureau certificate every three years. The training manager and the manager both inducted new members of staff into their role. During that time they receive training in fire safety, moving and handling, equality and diversity and safeguarding people who may be vulnerable. Care Homes for Older People Page 26 of 34 Evidence: One of the newest members of staff told us they had had a three week period of induction. They told us they had not started working alone until their Criminal Records Bureau certificate was received. They told us they had trained in first aid, health and safety, fire safety, moving and handling and dementia. They told us they regularly attended staff meetings. They said I love my job; I feel Im doing a job thats worth doing. All of the care staff, except two new employees had NVQ Level 2. The new members of staff had registered to start the training. Support staff were also expected to undertake NVQs in their different subjects. Six members of staff had NVQ Level 3. The care manager had the registered managers award and NVQ Level 4. The home employed a full time training manager. They showed us the training matrix which identified the required training for each staff members role and when updates were needed. This included health and safety, food hygiene, infection control, moving and handling, diabetes, mental health, coping with aggressions, dementia, safeguarding and the Mental Capacity Act 2005. In the AQAA Mrs McCulloch told us we have purchased a new training manual which covers equality, diversity and equal opportunities and we are raising awareness within the home. There were individual staff training files with personal training plans. Some training takes place in house using workbooks, DVDs and face to face instruction or discussion. Members of staff had recently undertaken training with a local college on team leading, health and nutrition, dementia and handling medication. Other external training included continence, sensory loss and nutritional assessment. The training manager was qualified to teach further education to adult and was the homes moving and handling trainer. They had NVQ Levels 2 and 3 in care and was an NVQ assessor. In the AQAA Mrs McCulloch told us The chef is qualified in The Principles of Diet and Nutrition, HACCP [Hazard Analysis Critical Control Points], City and Guilds and has recently obtained NVQ2 in Catering. We saw members of staff had time to chat with people who use the service. Members of staff knocked on peoples bedroom doors before waiting to be invited in. One person told us the staff are excellent, friendly and relaxed. They do whatever I ask them. I just ring the bell and they come. Another person told us they go the extra mile. They are interested in me as a person. A further person described Care Homes for Older People Page 27 of 34 Evidence: members of staff as just like daughters. There were no male care staff. Mrs McCulloch told us that she intended to recruit a male care staff member. One person told us the staff are very nice, young and old. Two girls help me in the morning to get dressed. They help me to go to the dining room. In a survey form one person told us The carers are first class and always do their best to help. Another person told us see that youre comfortable and help with everyday needs. A third person told us Over all they do everything I need. A fourth person said The home provides a comfortable relaxed atmosphere and inspires confidence. In a survey form a member of staff told us Training is always given and updated as required and again I feel I can discuss any matter with the training officer. Support help and praise is always given and team work works well within the home. Another member of staff told us I have always felt well supported and encouraged to develop and learn new skills. Care Homes for Older People Page 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs McCulloch is experienced and qualified to run the home. The home is run in peoples best interests. The senior team work well together and support the manager with delegated tasks and responsibilities. Members of staff are well supervised. Everyones health and safety is promoted, although this is not always evident in the records. Evidence: Mrs McCulloch had over twenty seven years experience in managing the home and has worked at the home for thirty one years in different roles. She has NVQ Level 4 in care and NVQ Level 5 in management. Mrs McCulloch had recently trained in dementia, deprivation of liberty Safeguards and the Mental Capacity Act 2005. In a survey form a member of staff told us I have worked for Claremont for x years and have always felt able to discuss any matter I may have with ease with the homes manager and care manager. Care Homes for Older People Page 29 of 34 Evidence: A suggestion box had been put in the sitting room with pen and paper nearby. One person told us that the governors of Warrington Homes Limited regularly visited them to ask them different questions about the service. Residents meetings were held every three months. Those people who do not attend for any reason put their comments to the activities organiser, with feedback to the manager. In the AQAA Mrs McCulloch told us we conduct an annual quality assurance survey, we then analyse and publish the results... review any comments both positive and negative. Comments are passed on to the appropriate departments and then discussed with me [as to] how we can improve each section of service. Some action had been taken to address the good practice recommendation we made that the individual room risk assessments should include the risks posed by access to hot water and control measures to reduce these risks. People can keep small amounts of cash in the homes safe. The administrator showed us the arrangements for recording transactions. Records and receipts were kept with copies sent each month, either to the person who uses the service or their representative. Only the manager and the administrator had access to the accounts. There was a regular two weekly audit of the arrangements by either the administrator, the manager or the care manager. Members of care staff received supervision six times a year from the training manager. Other members of staff received supervision four times a year. Records were kept of each session. Mrs McCulloch told us that any issues from staff supervision would be discussed with her. The individual room risk assessments contained a list of the items together with a statement of whether the risk were low, medium or high. There was no detail about how these levels had been arrived at. We said that there should be a record of what constituted a risk and how they were to be reduced or eliminated. Mrs McCulloch told us that the Environmental Health Officer from Wiltshire Council was due to visit. We said that advice on risk assessment and management should be discussed with the Officer. Mrs McCulloch told us she was going to consider how to improve the recording format that was being used so that documentation could be more person centred. The homes insurance document was up to date and displayed in the entrance hall. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 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 13 Individual room risk 31/05/2010 assessments must identify what the risks are and how they are to be reduced or eliminated. Other risk assessments must also show what the identified risks are and give guidance to members of staff on what they must do when using any equipment or carrying out tasks. So that people are protected from unnecessary risk. 2 19 23 The home must make sure 31/05/2010 that any free standing radiators comply with the requirements of the Fire and Rescue Authority. So that people are not at risk of scalding themselves or tripping over the appliance or leads. Care Homes for Older People Page 32 of 34 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 The district nurse should be involved in any decision making about the use of bed rails. This is so that the proper support and equipment is used when people are at risk of falling out of bed. Immediate care charts for what people are eating and drinking should be totalled so that their intake can be properly monitored. Guidance on what should be achieved each day should be included with the chart to aid monitoring. The same directions should be included in charts for recording when people who spend time in bed are turned to relieve pressure. The home should consider consulting the Tissue Viability Specialist Nurse to see if there is a better tool to use which identifies the common indicators of peoples risk of developing pressure sores before any red marks appear. Risk assessments should identify what the risks are and how decisions have been made about the level of risk. There should also be guidance on how to use each piece of equipment or carry out a task. 2 8 3 8 4 37 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. 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