Care Home: Claydon House

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What the care home does well The service provides personal care to older people and older people with mental health illness relating to old age. The home is divided into a general care unit and three dementia care units. The home intends to commence providing nursing care in part of the general unit in the future. Positive comments received about the home, both from surveys and from talking with residents included `Claydon House provides excellent food, care, and enjoyable activities`. `All the staff are very kind`. " I always receive the support I need and we have good activities. The meals are nice and the home is always fresh and clean. The home supports people who require care for dementia or dementia related illnesses. This care was being given in a patient and kind manner with staff respecting the dignity of the residents. There was a cheerful atmosphere in the dementia care units with residents being involved in some activities and conversation with the staff. In the general unit residents appeared comfortable and well cared for and were able to choose how and where they wished to spend the day in the several communal areas available to the residents. Residents right to choice is fully recognised in the home, with staff enabling residents to stay in bed until whatever time they wished and to spend the day doing the activities provided or sitting quietly either in their rooms or in communal areas. Both the standard of care planning and medication administration were good and ensured that residents holistic care needs were being met. Residents were enthusiastic about the catering and were particularly impressed that the catering staff spent time talking to them and seeing them each day and knew their likes and dislikes. The chef also visited residents to get their comments about the meals served that day. Very good practice was seen in the dementia care units whereby staff take a trolley around the residents with the selection of the food available at that meal to enable residents to make their choice at the time of the meal. This aids independence and enables residents who may have memory loss, to make an informed choice. The amount and delivery of training offered to staff is excellent. Staff are enabled to follow up what they have learnt in the training room by e- training, with time being allocated for staff to do this. The company has its own trainers who visit the homes and the home has a moving and handling trainer so that this can be delivered immediately new staff are employed. The home has a full time activities person and a variety of activities take place, some outings by company minibus are also offered although residents said that more of these with a greater variety of venues would be appreciated. What has improved since the last inspection? Up until recently the home has had periods of low staffing levels and concerns have been raised about this and a substantial amount of agency staff have been used. The home has recently successfully recruited a number of staff who are at present undergoing induction and health and safety training. This will be of benefit to the residents in the home. The home has a new extension which is used for dementia care and parts of the original home have been redecorated and refurbished which will improve the home for the residents. What the care home could do better: The brochure produced for the home does not accurately reflect what is happening currently in the home and therefore is misleading. The company must ensure that both this and the Statement of Purpose are contemporaneous. A requirement has been made around this. Not all resident, specifically those funded by local authorities have received statement of terms and Conditions. The regulations state that all residents should receive this document and a requirement has been made. Requirements have not been made around other issues found in the home as the manager and the area manager gave assurances that these will be addressed. They will be checked at the next inspection. Staffing has been an issue at the home, both the recruitment of permanent staff and ensuring that sufficient staff are on duty, particularly in the dementia units and at night. The area manager and manager gave assurances that staffing will be reviewed regularly. A member of staff commenced employment prior to two references being received and the manager gave assurances that this would not reoccur. There were some additional risk assessments required and a maintenance issue needing attention, subsequent to the inspection the commission was informed that these had been addressed. Key inspection report Care homes for older people Name: Address: Claydon House 8 Wallands Crescent Lewes East Sussex BN7 2QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 0 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Claydon House 8 Wallands Crescent Lewes East Sussex BN7 2QT 01273474844 01273486175 Claydon@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Claydon House Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 49. The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Claydon House is registered to provide personal care and assistance for up to 32 Older People and has been owned by Caring Homes Ltd since March 2000. The building consists of a detached Victorian house and has been extended to provide accommodation over four floors. It is situated in a quiet private drive on the outskirts of Lewes. . There is limited parking space outside the home but unrestricted parking in Care Homes for Older People Page 4 of 31 Over 65 0 49 49 0 Brief description of the care home surrounding roads. Wallands Park is within five minutes walking distance. Accommodation is comprised of mainly single rooms, with a shaft lift accessing all floors. There are two lounges and dining rooms and a conservatory, which allows easy access to a sheltered garden. The newly built extension consists of dementia care units over three floors,accessible by shaft lift. Each unit has its own dining and lounge area. All of the rooms in these units have ensuite facilities . An eight bedded nursing unit has been put in place but is not currently being used for providing nursing care. The commission was informed that the current fees as on the9th November 2009 range between £550 and £800 per week, extra services such as hairdressing and chiropody are charged separately and information on these are available from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 9th November 2009 from 10:00 to 19:00. it was facilitated by the acting manager and the acting area manager. The home is currently undergoing a changeover of management and there is no registered manager in the home. The acting manager will be referred to as the manager throughout this report. The inspection involved eight of the residents, three visitors and ten members of staff who gave their views on the services offered by the home and their experience of either living or working in the home. The Annual Quality Assurance Assessment (AQAA) was sent to us by the service. The AQAA is a self assessment required by regulation, that focuses on how well outcomes are being attained for people using the service. It also gave us some numerical Care Homes for Older People Page 6 of 31 information about the service. Prior to the inspection the Care Quality Commission sent fifteen surveys to residents and their representatives, ten to staff and three to health and social care professionals. Of these fourteen were received back from residents or their representatives, five from staff and none from health and social care professionals. The methodology used to inform the judgements made in this report included visiting all parts of the home including residents private accommodation, examination of documents necessary for the care of the residents and smooth running of the home, conversations with residents, staff and visitors to the home and discussion with management which included the company staff trainer. Documents examined included residents care plans and medication charts, personnel files, the staff training matrix,catering records and health and safety records. Thanks are extended to residents, visitors, staff and management for their courtesy, help and hospitality during the day. The last key inspection took place on the 16th November 2007 and the last Annual Service Review was undertaken on the 3rd November 2008. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Up until recently the home has had periods of low staffing levels and concerns have been raised about this and a substantial amount of agency staff have been used. The home has recently successfully recruited a number of staff who are at present Care Homes for Older People Page 8 of 31 undergoing induction and health and safety training. This will be of benefit to the residents in the home. The home has a new extension which is used for dementia care and parts of the original home have been redecorated and refurbished which will improve the home for the residents. 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 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current information available to residents is not wholly accurate relating to the services currently offered by the home. This can be confusing for prospective residents and their representatives. The home does not ensure that all residents receive a copy of the Service User Guide or the homes Terms and Conditions of Residence, which may result in residents and their relatives being concerned about any restrictions, rules or fees relating to the service Failure to assess prospective residents could put residents at risk of the home being unable to meet their needs, and written confirmation that the home can do this will allay any concerns the prospective resident may have. Evidence: Prospective residents receive information about the home from brochure, Statement of Purpose, Service User Guide and the person who undertakes the preadmission assessment. The brochure currently produced by the parent company and used by the Care Homes for Older People Page 11 of 31 Evidence: home states that the home provides registered nurses twenty four hours a day and provides professional nursing and health care. This is also referred to in the Statement of Purpose and Service User Guide. Although the home is registered to provide nursing care, following publication of the brochure, the parent company made the decision not to implement this at the current time and therefore does not provide either nursing care or registered nurse cover. The CQC is aware that one person has been mislead by this brochure. Information for prospective residents must be contemporaneous and accurately reflect services offered by the home. A survey received showed that one person had not received sufficient information about the home prior to moving into the home. Three residents spoken with had no knowledge of the Service User Guide and this was not present in the rooms visited. Prospective residents or their representatives can visit the home prior to making a decision over whether they wish to live there. Three care plans were examined to ensure that prospective residents are being fully assessed prior to admission. There was evidence both from a care plan and from a member of staff that a recently admitted resident was not assessed prior to admission and therefore no information available for the staff. The two other assessments examined were comprehensive and robust. The manager gave assurances that all prospective residents are now receiving a full assessment. Not all residents have received a copy of the homes Terms and Conditions of Residence, two surveys received from residents stated they had not received a copy of this and the administrator confirmed that this is not given to all residents. All residents, irrespective of their funding arrangements, should receive a copy of this document either prior to, or on admission, to the home. The home has only recently commenced providing prospective residents with written confirmation that the home can meet their needs. This is required by regulation. Assurances were given that this would continue to be done, therefore a requirement has not been made. The home currently admits residents for personal care on either a respite or permanent basis but does not admit people for transitional or intermediate care. Care Homes for Older People Page 12 of 31 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. Care plans showed that staff understood the importance of individualised care planning in holistic care, and the role that this played in ensuring the residents needs are met. Staff are proactive in accessing health care professionals or accompanying residents to health care appointments. Policies and procedures and robust staff practices in administration of medication ensure that residents are not put at risk Evidence: Five care plans belonging to residents across both the general unit and the EMI units of the home were examined. These showed that staff were aware of the need to care plan for personal, physical and mental health and social needs and to individualise each plan of care. There was evidence of regular review and where possible, evidence that the resident had been consulted about the care they were to receive. Care plans showed that staff recognise the need for nutritional assessment of the individual and ensured this was kept under review. Care Homes for Older People Page 13 of 31 Evidence: Risk assessments relating to the risks affecting each resident were in place. Discussions were held with the manager regarding the few additions and improvements required to ensure that records were robust. Care plans are audited on a regular basis. Health care professionals such as general practitioners, physiotherapists and community psychiatric nurses visit the home as required and district nurses attend to any nursing needs that may occur. Records of visits made were available and care plans showed that instructions by health care professionals were carried out by the staff. Residents said that the home was proactive in contacting health care professionals and would also arrange for residents to be accompanied to appointments. Comments made by residents at the home showed that generally they were happy with the care received. They give us good care and the staff are very nice. Our own staff know what we like and they give us good care, but they used a lot of agency staff which didnt know our care and our tablets were often late. Management gave assurances that this issue is being resolved. Whilst surveys showed that generally people were pleased with the care currently given at the home, a survey received said Staff always listen and act on what I say, but not always intelligently or with good will. However there have been changes in the staffing and recruitment over the past month, with some core staff remaining, and observations of staff working with residents showed that residents were being treated with courtesy and respect and there was a very good and friendly interaction between staff and residents. This interaction was particularly evident in the EMI unit where staff were seen engaging very well with the residents and promoting independence and dignity. Concerns were raised about an incident which took place since the last inspection which had compromised the dignity, privacy and rights of two individuals. Current management gave assurances that future staff and management training on the Mental Capacity Act would identify the rights of the individual in this type of situation and prevent reoccurrence. Staff who administer medication are trained to do so. Medication rounds observed Care Homes for Older People Page 14 of 31 Evidence: safeguarded the residents. Records of medication administered, medication storage and recording of controlled drugs, and medication policies and procedures, were robust and met both the pharmaceutical and CQC guidelines. Specific care plans are in place for those medicines required to be given on an as required basis and risk assessments for people who wish to maintain their own medication are in the medication charts. Management are reminded that staff must review these regularly. Medications and records relating to them are audited on a regular basis. End of Life care planning has not been fully completed and the management were aware that current good practice guidelines require these to be in place with all relevant information. The manager is currently accessing courses for staff regarding end of life care. Care Homes for Older People Page 15 of 31 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. The quality of life and range of leisure activities provided meet the expectations of the majority of the residents. Staff were proactive in providing stimulation and activities to people in the specialist units in the absence of the activities coordinator. They showed understanding of both the residents needs and abilities, and the majority of the residents were seen to be enjoying the afternoon. The home provides a menu which is nutritious and varied and allows residents choices at each meal. The catering staff take the time to be with residents, to discuss the meals with them and to find out how they enjoyed the meals. Evidence: Leisure activities for residents are provided by an activities coordinator who is employed for 32 hours per week, these hours can include some time at the weekend. The activities programme which is displayed in the lounges shows that activities available include crafts, exercise, quizzes, cookery sessions and some outings. The home currently shares a company minibus with sister homes in the area which is available to take a few residents out at a time, residents are also accompanied out for walks and shopping trips by care staff or the activities coordinator. Whilst all residents were pleased with the type of activities available saying: We have good activities Care Homes for Older People Page 16 of 31 Evidence: provided.; Interesting things to do, and I love the quizzes, comments from surveys showed that there is a need for increasing the amount of outings available: Our excellent activities could be better if the minibus could take us out as they used to and maybe have first aid training for someone who accompanies us. Good activities but we could do with more outings and walks, I would like to go out walking more. we need more outings especially to the sea and the downs. A breath of sea air would be good. Due to the activities coordinator not being in the home on this day, the majority of the residents in the general residential unit were sitting and talking amongst themselves or watching television in their rooms. By contrast the EMI units were lively, with residents being engaged in board games, knitting, conversations with staff and other residents, or singing along to the music the care staff had put on as background. Staff were very proactive in ensuring everyone was occupied if they wished to be and there was plenty of friendly interaction and laughter between staff and residents. Staff were showing a very good understanding of both residents capabilities and needs. All residents have a social care plan in their care plans and whilst these generally showed the residents interests, little had been written about their previous lives or current interests. No records were in place showing residents participation in the activities provided although the manager said she is aware of this and is in the process of ensuring that these are done. Routines in the home are sufficiently flexible to enable residents to make choices about activities of daily living and these choices are respected by the staff. Residents can have visitors at any time and visitors spoken with said that they were made welcome, staff communicated well with them about their resident and that they could have a meal with the residents if they wished. The home maintains links with ministers of various faiths although currently the residents in the home are predominantly of the Christian Faith, both C/E and RC services are held monthly. The home provides a varied and nutritious menu which offers a choice of menu at each meal, the chef is aware of the likes and dislikes of individual residents, any special diets and whether meals require fortifying. Care Homes for Older People Page 17 of 31 Evidence: Residents in the EMI units choose their food when it is prepared, a selection of different meals available for the meal are wheeled around on the trolley to each room and residents make their selection whilst it is visible, some residents were seen having three different meals on either the same plates or different plates dependant on their choice. Both the chef and kitchen assistant were seen visiting all of the units and talking to residents about the meals and their preferences and there was good interaction. All residents were very positive about the chef and the way he interacts and Bothers to get to know us.He is happy to do us other meals if we dont like that particular meal and always asks us if we enjoyed the food. Residents said the standard of meals provided had improved significantly since this chef had been employed: 100 improvement I would say, Gosh what difference its made to my day. Residents said that fresh fruit was provided at meal times, with some saying that they wished the home would provide some fruit in the communal areas, particularly for people that do not have visitors to bring it in. All meals, including pureed meals, were attractively presented with both tables and trays being attractively set out. residents are encouraged to take meals together to make it a social occasion although can have meals in their rooms if they prefer to do so. Residents in the specialist units are facilitated in their choice of meals by staff taking a selection of the meals available around on a trolley at mealtime to each resident. Residents choose the meal (and in some cases more than one) that they prefer. The home is commended for this good practice which ensures that people who are not so cognitively able are able to make an informed choice of meals which are served whilst the person is still aware of what they have chosen. All of these residents said that they enjoyed the meals. Care Homes for Older People Page 18 of 31 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. Residents are aware that they can make any complaints or concerns they may have known to the manager or senior staff. They were confident that these would be dealt with in an open and transparent manner. Staff receive training in how to ensure that those in their care are fully safeguarded. Evidence: Whilst the home has a complaints policy which is available in the Service User Guide, discussions with some residents and three surveys received showed that residents either were unaware of the complaints policy, or unsure of how to make a formal complaint should the situation warrant this. Most residents said that they would speak to the manager who would resolve the complaint. The home has received 6 complaints in the past twelve months, all of which were substantiated. One complaint was received by the Care Quality Commission and passed to the provider to address.The commission is currently communicating with the provider with regard to them revisiting their response to this complaint. The home showed that generally it has responded to complaints well and has kept full records of both their investigations and responses. Care Homes for Older People Page 19 of 31 Evidence: Residents are able to take part in the civic process if they wish, either by postal voting or by being enabled to access the polling station. There have been no adult safeguarding issues in the home since the last inspection, although there was one issue which would have benefited from being taken to adult safeguarding for guidance. All staff receive adult safeguarding training both on induction and through more detailed study. Care Homes for Older People Page 20 of 31 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 home has been extended and refurbished and provides a pleasant, clean and comfortable home for residents. There were some areas around the original building needing attention may detract from residents comfort and hindering provision of the services that they expect. Evidence: The home has been extended over the past twelve months to provide a unit which may be used for nursing care and an EMI unit which has been built over three floors. This is served by a shaft lift. The original part of the home, now used for general residential has been redecorated in most areas. Communal space consists of lounges and dining rooms in each of the new units and two dining rooms, lounge and conservatory in the original home. Well maintained and attractive garden areas are accessible to residents. Whilst all of the new rooms have ensuite facilities and assisted showers are provided, there are no assisted baths in the new part of the home, resulting in residents having to come over to the original building if they wish for a bath. Records were seen of the hot water temperatures to resident outlet and these were within recommended parameters. However some of the radiators in residents rooms in the original building were not efficient and some draughts were coming through Care Homes for Older People Page 21 of 31 Evidence: windows. The manager gave assurances that this would be attended to . The underfloor heating in part of the conservatory was not working and the home was awaiting a contractors visit to address this. All parts of the home were clean and the majority of the home free from odours, however one of the lounges in the new building was malodorous and this was discussed with the manager. Equipment relevant to the needs of the residents has been purchased for the new units, including variable height electric beds. However some of the divan beds in the original home do not have impermeable bases and this could impact on the spread of infection. Assurances were given that this would be addressed. All staff have received infection control training. Whilst there were disposable towels and soap dispensers in all bathrooms, no alcohol hand gel was visible. This was discussed with the manager. The laundry area and equipment provided is insufficient for the amount of residents in the home with staff saying that Laundry takes a long time to get through because we only have one machine, ironing has to be done in the hairdressing room due to lack of space in the laundry area. Care Homes for Older People Page 22 of 31 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. Current recruitment success may ensure that residents continue to be cared for by the homes own staff and that all units in the home have sufficient staff to ensure the well being and safety of the residents. The standard and content of training given to staff is excellent, with staff being given the opportunity to ensure that they have the knowledge to give a good standard of care to the residents. Whilst recruitment systems were generally good, a shortfall did occur which could have put residents at risk. Evidence: There has been difficulty in recruiting staff over the past year which has resulted in agency staff being used to a significant extent, this has now been reduced due to a number of suitable staff having been recruited recently. The manager said that any agency staff currently in use are staff that have been to the home frequently and know the residents. A number of new staff were attending in house training and also more staff that had recently joined the company were working on the units. Residents spoke of their dissatisfaction with the number of agency staff that had been used: Most unsatisfactory, not what one would expect from this home. You just dont know where you are with them, they dont know what we want but they do their best. Over the past twelve months two concerns have been received by the commission Care Homes for Older People Page 23 of 31 Evidence: regarding the number of staff on duty at night, and more recently in the dementia care units over the twenty four hours. Whilst the number of staff on duty at the day of inspection was sufficient for the wellbeing of the residents currently in the home, the manager should ensure that the dementia care units are not left without a member of staff in the units even for short periods. The manager gave assurances that staffing levels will be reviewed on a regular basis. There is a robust training programme and the company employs its own trainer for homes in the South East and other regions. Training was being delivered to new and existing staff on this day and staff spoken with said that the standard was good. Training available includes face to face training, e-learning and distance learning with staff also receiving training from outside agencies if applicable. Staff are given time during their shifts to complete training or e-learning, with staffing levels adjusted accordingly. The home also has its own moving and handling trainer. Subjects covered include basic care, mandatory health and safety training and more latterly, Dementia Care and Mental Capacity Act training. New staff commence the Skills for Care recognised induction course for care staff. Over 75 have attained their National Vocational Qualifications at either level 2 or 3 in care, with one member of staff in the process of studying for this qualification at level 4. The home is increasingly finding that staff applying for posts have the National Vocational Qualification at level 2 or 3. Three personnel files were examined belonging to both current and existing staff. Whilst two of these contained all documentation required by regulation to ensure that residents are not put at risk, one personnel file showed that the member of staff had been employed prior to references being received. The manager gave assurances that this would not reoccur. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in place support the safety and well being of residents and staff and ensure that staff have the training to ensure residents safety. Evidence: There have been some management changes during the past year, both at local and higher level, with the home currently being managed by an acting manager, who is a qualified manager from one of the other homes in the group. The company are engaged in recruiting a new manager. Senior staff, including management, have received the required training in Deprivation of Liberty safeguarding and the Mental Capacity Act and this is being cascaded to other staff. There has been some unrest in the home in the past twelve months, much of the disquiet was due to the refurbishment of the home and the extension being built which resulted in some residents having to temporarily move rooms. This appears to have Care Homes for Older People Page 25 of 31 Evidence: abated and residents spoken with were pleased with the improvements to the building but still voicing concerns at the numbers of agency staff still being used, although this is now reducing considerably. Staff surveys, which were received two or three months ago, showed that generally staff did not feel supported and also said that there were often insufficient staff. Staff spoken with are now saying that this has improved; We have more staff on duty, sufficient to do the job well, and we are getting plenty of management support. Things have improved 100 and the current manager is very supportive. The Annual Quality Assurance Assessment (AQAA) ( an assessment completed by the home manager or provider,required by regulation, which gives us details of what has happened in the home in the past twelve months and plans for the next twelve months) was received when we asked for it, and gave sufficient information about the current status of the home. A current certificate of registration was displayed in the home. The AQAA told us that policies and procedures are being reviewed on a regular basis. Only medicine policies were examined at this time and these showed evidence of review. The company runs its own quality monitoring system, with questionnaires being sent out to residents and their representatives. Results of these and areas for improvement are made available to the home. The home does not act as appointee for any resident although holds some money for resident spending. Records of this were seen and have been regularly audited and were accurate. The majority of the staff have received formal supervision recently and this is continuing at regular intervals. Regulation 26 visits (visits and reports by the provider on a monthly basis required by regulation) have been undertaken and reports from these were in the home. One of the residents room doors has a significant gap between the floor and the door and it was requested that the manager take advice from a fire safety officer regarding this. She gave assurances that this would take place. Servicing and checks of utilities and equipment have taken place at the required intervals and records of these were seen, and Staff have received mandatory health and safety training including fire safety. Care Homes for Older People Page 26 of 31 Evidence: Risk assessments were in place for all areas and equipment in the building. It was noted that one window restrictor was not patent although records showed it had been checked. This was addressed the same day. Risk assessments had been omitted for kitchenettes on the units, subsequent to the inspection the manager informed the commission that these were in place. One resident had a high temperature portable oil filled radiator in their room, although this had been risk assessed, it could pose a significant risk should this resident become unwell, this was replaced by a cool touch portable radiator. Risk assessments have been put in place for the portable fan also in the room. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 4 That information given to prospective service users is contemporaneous and accurately reflects the current services being offered by the home. To ensure that prospective and existing service users are fully aware of the services that the home is able to offer and that the home can meet their needs. 10/12/2009 2 2 5 That all prospective and 10/12/2009 existing service users receive a copy of the homes Terms and conditions of Residence either prior to or after admission to the home. To ensure that service users are aware of any rulings or restrictions applicable to their stay in the home and are aware, as far as can be ascertained, of the amount of fees payable Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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