Care Home: Colbury House Nursing & Residential Home

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What the care home does well The home manager or senior trained staff undertake a comprehensive pre admission assessment on all potential service users, this ensures their needs can be met. The home provides a range of activities that are organised by the person employed as the activities organiser that meets a variety of recreational needs. The home employs appropriate numbers of nursing and ancillary staff. The home has a good recruitment process to ensure service users are protected. What has improved since the last inspection? The previous inspection report made nine requirements. An improvement plan was requested by CSCI which was received and detailed how the provider/manager planned to comply with the requirements. Action has been taken for the requirements from the previous report to be complied with. The care plans are recorded electronically and also there are now paper copies in individual files for care staff to use as working documents. These are reviewed monthly and evaluated when any changes take place. The call bell system has now a facility to record the time the call bell was activated and the time the bell was responded to by deactivating it. These records are audited by the manager and unacceptable response times are addressed with staff. Call bell pendants have been purchased for those service users who have difficulty in activating the call bell alarm. The management of the medication system and storage of medications has improved. A new controlled drug cupboard has been purchased and fitted appropriately. A new drugs fridge has been installed with records of temperatures maintained daily. The medication administration records are now documented appropriately and audits are undertaken every week to ensure they have been fully recorded. If MAR sheets for prescribed drugs have to be hand written, two staff sign to agree the drug, dose and frequency of administration. Improvements to the environment have been made. New side tables have been purchased for the lounge areas and the large dining room has been redecorated and new flooring and furniture installed. New electric beds and pressure relieving mattresses have also been purchased. The laundry has been redecorated and new flooring and hand washing facilities installed. The garage roof tiles have been made safe and the surrounding area of the garage hasbeen cordoned off to prevent service users wandering near the area. The manager has reviewed the homes safeguarding policy and procedures to ensure it reflects the Hampshire safeguarding adults procedures. The home has a registered manager/provider who has appointed a new manager and who is imminently applying to CSCI for registration as the manager. The home has also appointed the senior clinician as the deputy manager, giving the home a more robust management structure. What the care home could do better: Risk assessments must be undertaken by appropriate professionals of those people using tilt back chairs that restrict their freedom to ensure the equipment is being used appropriately and for the benefit of the service user`s safety. If food and fluid charts are monitoring a service user`s fluid and food intake over a 24 hour period they must be completed fully to ensure accurate information is gathered for the assessment process. Wound care must be documented on a care plan to identify wound type, prescribed treatment and evaluation of the healing process and must not be put just in daily notes. The manager should have a training plan for the coming year to ensure that all staff undertake appropriate training. The manager should ensure that the service users are aware of the complaints policy and know who they can go to if they wish to complain. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Colbury House Nursing & Residential Home Hill Street Totton Southampton Hampshire SO40 2RX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Colbury House Nursing & Residential Home Hill Street Totton Southampton Hampshire SO40 2RX 02380869876 02380867119 margaret@colbury.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Jeffrey Collins,Mrs Margaret Josephine Collins Name of registered manager (if applicable) Mrs Margaret Collins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 51. 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) Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Colbury House Nursing and Residential Home is situated on the outskirts of Totton, in a quiet lane, surrounded by pleasant countryside and close to the New Forest. There are close links to the M27 motorway and the nearby amenities of Totton and Southampton. Care Homes for Older People Page 4 of 36 care home 51 Over 65 0 51 0 51 0 51 Brief description of the care home The home provides accommodation for up to fifty-one people over the age of sixtyfive. Up to seventeen of these places are available for people with dementia and thirtynine for people with a physical disability. Up to six places can be used for people with a physical disability aged between fifty and sixty five years of age. Accommodation is arranged on two levels accessible via a passenger lift. The home has a pleasant lounge with views over the homes gardens, a lounge/dining room with views of the courtyard garden and main garden and there is a separate dining room. The home has an annex, the coach house, providing single bedrooms. Residents that live in the Coach House can use the lounge and dining area in the main building if they wish to although the coach house has its own lounge/dining room. The home is owned by Mr and Mrs Collins. Mrs Collins is currently the registered manager for the home. Fees at the home range from £341.23 per week for persons needing personal care and up to £1.000 per week for those needing nursing care. Fees are dependant on assessed level of need. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report details the evaluation of the quality of the service provided at Colbury House and takes into account the accumulated evidence of the activity at the home since the last inspection, which took place in February 2008. The visit to Colbury House on the 25th February 2009, formed part of the process of the inspection of the service to assess the service against the core minimum standards. The Annual Quality Assurance Assessment (AQAA) was returned by the manager but did not give good quality information about how the home evaluates the outcomes for the people who use the service. The registered manager Mrs. M Collins and the deputy manager assisted with the Care Homes for Older People Page 6 of 36 inspection process. Surveys were sent to service users, staff, visiting professionals and GPs. We gathered information from sixteen surveys returned to CSCI from people living in the home. We also spoke to a number of service users, two visitors and staff at the time of this visit. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that residents were happy living in the home and with the services the home provides. Evidence for this report was obtained from reading and inspecting records, touring the site and from observing care practises and the interaction between staff and service users. At the time of this visit there were forty one people in residents. None of the service users were from an ethnic minority What the care home does well: What has improved since the last inspection? The previous inspection report made nine requirements. An improvement plan was requested by CSCI which was received and detailed how the provider/manager planned to comply with the requirements. Action has been taken for the requirements from the previous report to be complied with. The care plans are recorded electronically and also there are now paper copies in individual files for care staff to use as working documents. These are reviewed monthly and evaluated when any changes take place. The call bell system has now a facility to record the time the call bell was activated and the time the bell was responded to by deactivating it. These records are audited by the manager and unacceptable response times are addressed with staff. Call bell pendants have been purchased for those service users who have difficulty in activating the call bell alarm. The management of the medication system and storage of medications has improved. A new controlled drug cupboard has been purchased and fitted appropriately. A new drugs fridge has been installed with records of temperatures maintained daily. The medication administration records are now documented appropriately and audits are undertaken every week to ensure they have been fully recorded. If MAR sheets for prescribed drugs have to be hand written, two staff sign to agree the drug, dose and frequency of administration. Improvements to the environment have been made. New side tables have been purchased for the lounge areas and the large dining room has been redecorated and new flooring and furniture installed. New electric beds and pressure relieving mattresses have also been purchased. The laundry has been redecorated and new flooring and hand washing facilities installed. The garage roof tiles have been made safe and the surrounding area of the garage has Care Homes for Older People Page 8 of 36 been cordoned off to prevent service users wandering near the area. The manager has reviewed the homes safeguarding policy and procedures to ensure it reflects the Hampshire safeguarding adults procedures. The home has a registered manager/provider who has appointed a new manager and who is imminently applying to CSCI for registration as the manager. The home has also appointed the senior clinician as the deputy manager, giving the home a more robust management structure. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All service users are assessed prior to moving into the home to determine that their needs can be fully met by the home and receive information about the service to inform their decision about moving into the home. Evidence: The AQAA states that the home has a comprehensive pre admission assessment and prospective clients are offered to visit the home before they make a decision about living in the home. A sample of three pre admission assessments were viewed by us. The manager stated that before anyone is admitted to the home a pre admission assessment is completed by herself or a senior member of nursing staff, in clinical areas or the persons current residence. Care Homes for Older People Page 11 of 36 Evidence: The pre admission assessments seen contained thorough details of past medical history and described health care needs and dependency levels. The detailed assessments covered aspects of the persons physical, social and emotional needs. Also available in the assessment were discharge and transfer notes from the hospital. The assessments are supported by information gained from relatives if they are involved with the assessment process. A relative spoken to at the time of this visit via she had been involved with her mothers admission to the home and said the manager had come to their home to undertake the assessment. The manager told us that care needs assessments are received from care managers if they are involved with the placement or if the person is coming from out of the county. The Statement of Purpose and Service User Guide has been reviewed and updated and the AQAA says that the home will improve the format and layout of the service user guide in the coming year. Surveys returned from sixteen service users indicated that generally they did receive information about the home with comments that say: I received just simple information. I do not feel I received enough information about the home but I am happier than I thought I was going to be. My social worker organized everything for me. I was happy with the information I received, My family found the home for me and I am happy. I do not feel I had enough time from meeting someone from the home to moving in. The home does not provide intermediate care. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users health, personal and social care needs are set out in plans of care and ensures service users health care needs are met. Service users right to privacy is respected. Evidence: The AQAA states that the home maintains comprehensive care plans for service users which are regularly updated. The sample of three care plans was viewed, one being the most recently admitted service user at that time. The care plans included risk assessments and records relating to accidents, visits from medical staff and daily records. These are all held on a computer system and were viewed with the manager and were found to cover all aspects of health, personal and social care needs. For the purpose of care and record keeping, the home has been divided geographically into five areas for which each area has a team of nurses and carers. Paper copies of all care plans are kept in service users individual files that are stored in these specific areas of the home giving staff access to all the information about the service users and Care Homes for Older People Page 13 of 36 Evidence: how service users wish to be cared for. The same sample of hard copy care plans were examined as that on the computer and were found to b exact copies of the electronic records. Care plans demonstrated various assessments including falls, moving and handling, nutrition continence, mobility. It was observed for those service users using special chairs with tilt back or restraining facilities that there was no information available as to how the decision had been reached for the use of these chairs for these people. The manager must not be using such chairs until such times that an assessment has been done by an appropriate health professional. This was discussed with the manager, who said she would ensure that the service users were assessed by a professional for the suitability of using these chairs. Risk assessments were in place for the use of bed rails with signed agreement from the service user or their next of kin for their use. The home has purchased a set of sit on scales and records of monthly weights were seen in care plans with action taken when weight variation was identified. The home was seen to have consulted with the dietitian and speech and language therapist with regards to the assessment and management of a service user who is fed via a tube, to ensure their nutrition status is not compromised. There was evidence in some service users files that fluid and food monitoring charts had been maintained and audited by the manager to ensure staff were completing them appropriately. On visiting a service user in her room it was observed that a fluid and food monitoring chart had not being fully completed for the previous day. This was discussed with the senior nurse who reported that she usually ensures the charts are completed daily if the care plan indicates it necessary to monitor service users input and that she would speak to the staff concerned and ensure that records are maintained appropriately in the future. Daily records within care plans were comprehensive and detailed the care that had been provided to people daily. It was noted that in the daily notes for one service user, wound care was being recorded as being administered.There was no care plan to describe the wound and what dressing was being used for this wound or the progress of its healing. This was investigated by the manager who told us that she had discussed this with the nurse concerned who reported she had omitted to write a care plan but would do so immediately. There are separate care plans to guide night care. The care plans evidenced that they are reviewed monthly or whenever the service users condition or needs change. A service user and relatives spoken with confirmed Care Homes for Older People Page 14 of 36 Evidence: to us that they are invited to be involved with the reviews of the care plan, one visitor saying that the home invited her to have a discussion about her mothers planned care. There was evidence in some care plan files that forms had been signed by service users or their relatives to say they had been involved with the care planning and reviewing process. Care plans contained a medical history of the service users and detailed records of consultation and visits to the home by GPs, dentist, optician, dental care, dietitian and other health professionals. The home is currently involved with the local PCT in undertaking a pilot scheme to ascertain the outcome and value of providing care homes access to a multidisciplinary team for consultation and advice.The home would contact the team if a service users condition changes, or they become unwell and may necessitate an assessment or guidance on treatment. The assessment can be undertaken within the home where a decision can be made about treatment, which, with the support from the team, the home can manage and in turn this may prevent the service user being admitted to hospital.The manager told us that one of the benefits of having access to this team is that the home have built up good relationships with the team and are able to ask advice on various aspects of the management of care. Each care plan evidenced risk assessments undertaken by the psychogeriatrician with regards to service users mental health status and these are maintained in the paper files for each service user. The home is visited by the community psychiatric nurse who, the manager said, is available to contact should the home need advice or review of a service user. The previous report identified areas in the management of medication not being up to the expected standard. These have now been addressed by the manager. The AQAA reports that the home has changed their medication suppliers to offer clients a better service. The AQAA states that the medication policies and procedures have been reviewed in the past year, the manager told us that these are currently being reviewed again. The home has a monitored dosage system (MDS) in place that is supplied to the home monthly by the local pharmacist.The medication cupboards and trolleys were viewed and were organised and clean. There was no evidence of the home over stocking on medications that are not needed frequently and only on an as needed (PRN) basis. The medication administration sheets (MAR) were viewed and found to be documented appropriately and no gaps in signatures identified.If a medication had not been given there was evidence of a code to indicate why this had not been administered and Care Homes for Older People Page 15 of 36 Evidence: reasons why is had not be taken. The home has introduced a administration of medication self auditing system by way of a book which is signed by the nurse at each drug round as evidence that they have checked the MAR sheets and document if there are any omissions of signatures. This book is audited by the manager weekly and the person responsible for any omissions is seen by the manager.The MAR sheets are printed by the supplying pharmacist with instructions of frequency of administration. If it were necessary to hand write on the MAR sheet, there was evidence that two people had signed to agree the medication, frequency and date it commenced had been documented correctly. The home has had a controlled drug cupboard fitted in the medication cupboard that is kept locked at all times. The cupboard complies with the expected standards as stated in the Misuse of Drugs (Safe Custody) Regulations 1973. The contents of the cupboard was checked by us and found to be stored correctly. A sample of the medication checked against the balance recorded in the controlled drugs register and were current. The home has at least two registered nurses on duty during the day, each of whom take responsibility for different areas of the home to administer medication. It was observed that the home has one medication trolley on the first floor and one on the ground floor. We observed the registered nurse distributing medication and this was observed to being undertaken in a safe and timely manner and as procedures stated. There were no service users choosing to self medicate at the time of this visit. Service users spoken with and surveys returned from service users say in general that they receive the care and support they need and that staff act and listen to what they say. Comments saying It is a very good home. I only have to ask for helped somebody is there. However, it was identified in the previous report that the call bells were not within reach of some service users and were not being answered within a reasonable timescale for peoples needs to be met. The manager has addressed this by installing a monitoring system that prints out the time the call was first alerted and the time of response when the alarm is switched off. She is auditing this regularly and discussing with the staff any unacceptable time lapses in response times. On this visit to the home the call bells were constantly in use during the morning period. The system is of the type that it only identifies one room number at a time and has to be turned off at the point of call so that if any other service user is using the alarm it will not be identified until the first call has been responded to. This then gives the impression that the call bell system is continually in use and not being responded to. Care Homes for Older People Page 16 of 36 Evidence: A small number of comments about this was made on the service users surveys returned to CSCI: Not always quick to answer the buzzers. I know the staff are busy but feel they could respond quicker at times. Sometimes they are too busy to be available immediately. Service users spoken to did not identify this as a problem. However, in the records of the residents meetings it is an issue that is highlighted frequently. This was discussed with the manager who told us that she audits the records for response times and she has purchased some neck pendants for those service users who are unable to access their call bell easily. The manager said she will continue to monitor this issue. Staff were observed to be interacting well with service users and respecting their wishes.Service users told us that staff are very kind and I am looked after like a queen. It was observed in the care records that one service user will only have a female staff to give her care and this is respected. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users experience a life style living in the home that in general, matches their expectations and meets their cultural and recreational needs. Service users are able to maintain contact with family, friends and the local community and are encouraged to make decisions within their daily lives. Service users are offered a nutritious diet that takes into account preferences and dietary needs. Evidence: The home has a good activities programme that is arranged by the activities co ordinator who works for 30 hours a week. She distributes the programmes weekly and these give information of what activities are taking place and where they will be held. The activities are usually held in the lounge area of the new wing. Activities records demonstrate that there is a good variety of activities to suit most people such as quizzes, bingo, floor games, arts and crafts, flower arranging, reminiscence therapy, outings to the theatre or for rides into the surrounding countryside. If there is a person who chooses to stay in their room, the coordinator will visit them and talk or undertake some activity of their choice. This was confirmed by a service user spoken to who told us that she does not like to go to the lounge and prefers to stay in her room and the co ordinator will come to her room for a chat or do some activity with Care Homes for Older People Page 18 of 36 Evidence: her. The homes main lounge has two televisions sets, one at each end, neither were switched on at the time of this visit, but identified in the previous report, could cause some conflict if both are on at the same time with different programmes. The care plans document personal history profiles that record social history, hobbies, likes and dislikes, if the home have been able to capture the information on admission or subsequently. The activities co ordinator, who has received training from Age Concern and is very motivated in her role, spoke to us about her role and how she arranges the programme. She maintains records of all the activities that take place and who attends and the persons level of participation. Some service users spoken to said they enjoyed the activities. One resident was colouring pictures and told us that he preferred to do that on his own and not attend the group activities. Another person was looking forward to the afternoons activities which was to be a group quiz. The co ordinator usually chairs the residents meetings and she showed us the records of the minutes which demonstrated that various issues are discussed at these meetings such as activities, food and the call bell system. Service users surveys returned to CSCI mostly indicated that activities are always or usually arranged. Comments say, I find the activities brilliant.I enjoy the activities but do not want to always join in. Visitors are made welcome and the visitors book is recorded that the home has visitors most days.Two visitors were in the home during this visit. One spoken to said she was very pleased with the care and service her mother was receiving since her admission recently. She said she visits every week and is made welcome and is involved with her mothers plan of care. The routines for daily living and activities made available are flexible. Service users spoken with and relatives confirmed that they are able to choose where in the home they spend their day, many were seen to spend time in the homes lounge with others remaining in their bedrooms. Personal choices and how the service users like things done,and what clothes they like to wear, are well documented in the social care plans. One service user chooses to have only female carers, which staff are aware of but this could not be found documented in the care plan at the time of this visit. The manager told us that she would ensure it was recorded on her care plans and that she is certain this lady only ever has female carers, as she would loudly protest if otherwise. Care Homes for Older People Page 19 of 36 Evidence: The kitchen was visited and the chef spoken with. The kitchen was well organised and tidy. The AQAA told us and the chef confirmed that the home is in the process of changing menus with suggestions from the service users. People confirmed to the inspector that they are given choice over their meals with options being chosen on a daily basis. The home has recently employed a qualified chef, the second cook having been at the home for some time. There is also a kitchen assistant on duty all day. The menus seen demonstrated a wholesome diet with choices each day. The chef told us that he sees all residents in the mornings to ask them what their preferences for meals are for that day. The day of the visit there was a choice of roast dinner or vegetable curry, which was to accommodate the resident who is vegetarian. The service users have a choice of where they eat their meals. The home has a large main dining room where most service users have their meals., others were choosing to have their lunch in their rooms. There is also a lounge dining room in the new extension, which did not appear to be used very much on the day of this visit. Most service users have breakfast in their own rooms but choose to have lunch in the one of the two dining rooms. The lunch time meal was observed being served in the main dining room. The routine for the home is that those needing to be assisted with eating their food are served their lunch first. We observed the carers sitting down next to the service users interacting with them on a one to one basis whilst assisting them in a courteous manner. The lunch time meal was observed to be well presented and the service users appeared to be enjoying their food with little wastage The gentleman who was vegetarian was having to wait for his curry and this caused him to be quite agitated as he thought the chef has forgotten his meal. He was being reassured by the carers in the dining room but resented the wait for his food. Service users and a relative spoken with were complimentary about the food. Surveys returned to CSCI by service users indicated that they always or usually like the meals. Comments on surveys said. Lovely meals.Being a vegetarian I am given choice but it is very limited. Would like more variety of fresh vegetables. Very good food. I do not like some of the food but I am given choice. The chef has the intermediate certificate for Food Handling and Hygiene and is about to undertake training for diabetic diets and will access training for other diets as and when they are needed. Nutritional assessments are undertaken and care plans are written to manage any risks identified. Service users are weighed monthly and graphs record weight variations. Care Homes for Older People Page 20 of 36 Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place however not all service users are aware of how to complain. The home has a policy and procedure in place for the protection of vulnerable adults and staff are aware of the procedures. Evidence: The AQAA states that the home has a very comprehensive complaint recording system which is available on the computer system. There is no detail of the policy and procedure for the protection of vulnerable adults (safeguarding) and how the home deals with these and how staff are trained in these issues. There is limited information on the AQAA. It records the home has received one complaint since the last inspection and this has been resolved. Records of this were seen on the computer. The CSCI has received one written complaint in the past year and this was resolved with the support of the social worker. The surveys returned from service users indicate that five of the sixteen returned did not know how to make a complaint, one saying that the procedure had been explained to them when completing the survey. The other twelve indicated they knew how to make a complaint with one person saying they would take any complaint to the residents meeting. The relatives spoken with said she would know how to complain Care Homes for Older People Page 22 of 36 Evidence: and that they had received a complaints procedure with the service user guide. A copy of the home complaints policy and procedure is provided to all staff at induction. The staff told us they would refer any complaints to the manager or deputy manager. The home now has a copy of the Hampshire adult protection policy and procedures and the home follow these procedures when reporting any safeguarding issues. The home had recently referred a safeguarding issue to social services, which is currently being investigated, but the home had delayed in informing the CSCI via a Regulation 37 notice of this occurrence. This was discussed with the manager who said she would return the notification immediately. This has subsequently been received by CSCI. It was reiterated that the CSCI should be informed via a regulation 37 without delay of any incidences in the home that adversely affects the well being of the service user. The staff training on the abuse policy is initially given at the time of induction. Staff spoken to were aware of what constitutes abuse and how to report this to the manager or senior person on duty. Staff who have undertaken the NVQ training will also have received further training in the protection of vulnerable adults (POVA). Training files evidence that most staff have undertaken the training or are in the process of doing so. The matron who is the newly manager, is in the process of introducing a more structure training programme for mandatory training of which POVA will be one of them. The training is delivered via DVD together with a questionnaire to test the knowledge gained, and further information is given to the staff for guidance. This will be updated yearly. The home undertakes full Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks before any person can commence employment. The home does not manage any of the service users money and locked facilities are provided in every room for service users to keep any personal items secure. The home does discourage service users from keeping money and valuables in their rooms and this is a choice made by them. However, there has recently been a report of a service users money going missing and the home has reported this to the appropriate authorities. During the walk round the home it was observed that two service users were sitting in special chairs with tilt back or restraining facilities with no information available as to how the decision had been reached to use these chairs. This was discussed with the manager and is discussed in the Health and Personal Care section of this report. Care Homes for Older People Page 23 of 36 Care Homes for Older People Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, mainly safe home that meets their individual and collective needs. Evidence: The AQAA states that the home provides a range of accommodation to suit different needs. The new extension has a large lounge dinner which was not being used at the time of this visit but is generally used in the afternoons for the activities. The AQAA told us that the provider has purchased side tables for the lounge areas and she has purchased new electric operated beds and replaced all the pressure relieving mattresses. The home comprises of a large older building with a new extension and a separate smaller building, known as the coach house. The home can accommodate up to fifty one people, the majority in single bedrooms with seven twin rooms. All bedrooms have washbasins and all those in the new extension have en-suite facilities. The home has a large lounge, separate dining room and a lounge dining room in the new extension. Care Homes for Older People Page 25 of 36 Evidence: There was evidence that the provider has invested over the past year in new beds, small side tables for the lounge and has refurbished the dinning room with redecoration, new flooring and purchased new furniture. The provider showed us the improvement plans for the coming year and this is to include demolishing the garage, whose roof was deemed unsafe in the previous report, and build a link connection to the main house from the coach house across the courtyard. This will not increase the numbers of bedrooms but will upgrade the coach house, which is looking very tired and in need of refurbishment, to provide better facilities for the service users living there and will provide office accommodation for staff. The house is surrounded by extensive grounds and countryside that provides lovely views from most of the windows. There is a courtyard area and paved patio area outside the house which the service users use for sitting out in the better weather. On looking around the home it was observed that the accommodation was generally clean with no offensive odours detected. The furniture was of an acceptable standard. The laundry room was visited and contained appropriate washing and drying machines. The laundry has been redecorated with new flooring and now has hand washing facilities installed. The laundry person was in attendance in the laundry and when asked was aware of how to deal with fouled laundry and the principles of infection control. Carers were observed to be wearing appropriate protective clothing and are provided with gloves. The AQAA does not document how many staff have undertaken infection control training. Staff training records evidenced that some staff have received infection control training and those spoken to understand the principles of how to prevent cross infection. The matron/manager told us that infection control training is being organised by her as part of the training plan. Service users surveys returned to CSCI told us that they consider the home is kept clean and fresh. Comments on the survey say The home is spotlessly clean all of the time. Better now we have another cleaner. The Environmental Health Officer had visited the home in January and is to return to the home imminently to ensure the recommendations made by them have been complied with, one being the cleanliness of the kitchen area. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of nursing, care and ancillary staff that ensure that peoples needs are generally met. Staff receive an induction training and other training appertaining to the service users. Robust recruitment procedures are in place. Evidence: We viewed staff rotas, recruitment records, spoke with people who live in the home and staff. Surveys were returned by sixteen service users. Training records and recruitment records were viewed with the administrator. The AQAA did not provide detailed information and stated the home employs a mixed range of staff with special skills. The home was accommodating forty one service users at the time of this visit. The home accommodates people with both residential, low care needs and nursing, high care needs. There were 8 carers and 2 registered nurses on duty and the registered manager and newly appointed matron/manager were in the home to assist with the inspection process. The afternoon shift identified 2 trained nurses and 6 carers being on duty and 2 trained and 3 carers at night. The home is divided into areas and there is a team of carers allocated to that area each day which is headed by a senior carer. Care Homes for Older People Page 27 of 36 Evidence: Ancillary staff of a chef, kitchen assistant, maintenance man, laundry person, domestic staff and administrator are also on duty each day. The provider/manager told us that she is currently recruiting more registered nurses to support the existing trained nurse team. The surveys returned and service users spoken to indicated that people consider there needs are met by sufficient numbers of staff each day who know what they are doing and said staff are very good. Comments on the surveys were mainly positive and said that service users felt they were given time and were listened to. Other comments said Usually staff are available but some staff listen some staff do not. Sometimes they are too busy to be available immediately.I only have to ask for help and somebody is there. I am very pleased and receive the care and support I need. I feel I need more help from staff to help me walk. I feel that staff do not always listen and act on what I say but I feel there has been a great improvement from before. Yes staff are always available when you need them. At the time of this visit although call bells were in use most of the morning, and the home was busy, the staff were observed to be giving the service users time and interacting with them in an unhurried way. Staff spoken with said they felt they had enough time to meet the service users needs and they fully understood their roles within the team. The AQAA records that the home employs a mix of part time and full time care staff which comprises of 15 registered nurses and 23 care staff. The staff are of mixed gender and from a mixed cultural background. The administrator told us that 10 care staff have achieved the NVQ level 2 and a further 12 are currently undertaking NVQ levels 2, 3, & 4. This currently represents approximately 50 of the care staff qualified to NVQ level 2. The AQAA did not give detailed information about staff training and what has been undertaken in the past year or what the future training plans are for the coming year. The training records seen did evidence that some staff have undertaken mandatory training appertaining to health and safety but also identified that some staff had not undertaken all training. Staff spoken to said they had undertaken various training and that they have opportunities to do training and felt they had the necessary skills to care the for service users. The home has employed a new matron/manager who is taking responsibility for all Care Homes for Older People Page 28 of 36 Evidence: staff training. Her role was discussed and she is currently planning the coming years training programme in the form of a matrix and will ensure that all staff have undertaken the appropriate mandatory training and other training appertaining to the client group that they care for in the home. A training package has been purchased and she will ensure that staff are trained appropriately. The senior trained nurse/deputy manager, spoken with, told us that she has undertaken various training sessions in relation to her development as a trained nurse and to meet the training requirements a detailed by the Nurses and Midwifery Council (NMC). Appraisal and supervision is taking place and a sample of records were viewed. A sample of five recruitment files were viewed. All appropriate documentation, CRB, POVA checks and two references was in place. Interview notes were also evidenced in the more recently recruited peoples file. Induction booklets for the new recruits were in place, one not having been completed to date, were also in the personnel files. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a registered manager in post who is fit to be in charge. The home has a quality assurance system in place. The service users financial interests are safeguarded. The health and safety of service users and staff are protected. Evidence: The report of February 2008 stated that the home had been without a registered manager for some time. Mrs. Collins the provider subsequently registered CSCI as the manager. She is a qualified nurse and is involved in the home on a day-to-day basis. Mrs. Collins has now employed a matron/manager, who commenced her duties in February. She is a registered nurse and has experience in working with the client group and managing a care home. Mrs Collins informed us at this visit that it is anticipated that the matron will be applying imminently to the CSCI to be registered as manager. We discussed Mrs. Collins role in the home as the registered provider and the future management structure. She said that once the new manager is registered Care Homes for Older People Page 30 of 36 Evidence: she will not be so involved with the home on a daily basis. The home also has a senior registered nurse who has been at the home for a year and is now the deputy matron/manager. She is undertaking her NVQ level 4. The AQAA returned to CSCI gave limited information about the quality assurance system used in the home. It said that the home monitors service users feedback three times a year. Service user benefit from a family run home environment. The AQAAs says the home liaises with outside organisations to offer more diversity. As with other sections the homes AQAA in relation to the management and administration outcome group lacked insight and contained very little information about the outcomes for the service users in relation to the management of the home. Overall the AQAA did not provide the information required and this was discussed with the provider and the newly appointed matron/manager during the inspection visit. The section in the AQAA relating to the views of people and to equality and diversity were incomplete. The homes AQAA did not give a reliable picture of the service. Some sections did not respond to the areas of practise to which they referred. The homes AQAA did not state when equipment had been serviced. Therefore we checked a sample of servicing certificates for systems and equipment and these were in order and evidenced that equipment had been serviced and maintained appropriately. The quality assurance system was viewed. This is based on the Nursing Home Association format for quality monitoring. Questionnaires are distributed three monthly and any issues identified on the returns are addressed, one of the issues being the menus and this is being addressed by the creation of a new menu. Generally the responses were positive. The manager undertakes an audit of the medication, care plans, accident recording and complaints. A sample of two accident records were tracked and these were completed appropriately and had been recorded in the service users daily records. A file was shown to us which held feedback letters and cards from service users families, and significant others, to compliment the home on the care of their relative. The home does not become involved in peoples money. All additional costs incurred are invoiced directly to the representative responsible for the persons money. Locked facilities were observed to be available in peoples bedrooms. The administrator does handle one service users monies, which is supervised by Social Care Homes for Older People Page 31 of 36 Evidence: Services. The records of all transactions and the account were viewed and records were in order. No other monies are kept in the home. Whilst touring the building it was observed that the cleaning chemicals were in a trolley that was being supervised by the housekeeper who told us that as soon as the cleaning is completed the chemicals used that are hazardous to health are stored in a secure cupboard. The home has a programme of mandatory training to include infection control, manual handling, safeguarding adults, fire and health and safety. The training matrix identified that there are some staff who have not attended all the mandatory training. The new matron/manager told us that she is addressing this immediately and that the new training package the home has purchased will enable more staff to undertake some of the training at appropriate times. The home has a fire risk assessment which is updated yearly. The fire log was examined and evidenced that the fire alarm system and equipment is tested at appropriate intervals. The fire training person attends the home twice a year to give fire training and practise fire drills. Records showed that staff have undertaken this training. The home has an environmental risk assessment recorded. Care Homes for Older People Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 12 The registered person must 30/04/2009 ensure that care plans are documented to guide practice for the treatment of wounds. Care plans must be documented to describe the type of wound, treatment and progress of healing to ensure the treatment prescribed is effective. 2 18 13 The registered manager must ensure that any form of equipement used that restricts freedom of movement of the service user must be risk assessed by a professional and document the rationale for its use A risk assessment must be undertaken by a health professional to ensure that the use of equipment that uses any form of restraint is used for the welfare and in 30/04/2009 Care Homes for Older People Page 34 of 36 the best interests of the service users 3 18 37 The registered manager 30/03/2009 must ensure that the CSCI are informed via Reg 37 notification of any incidences that adversely affect the service users. This must be done to ensure that all incidences that adversely affect service users is recorded and monitored. 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 16 The registered manager should ensure that all service users are aware of how to make a complaint. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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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