Care Home: Collingwood Court Nursing Home

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What the care home does well People that choose to live at this home enjoy being there and have confidence in the staff team. Care is delivered in accordance with individuals` wishes, it is flexible and consistent. The home benefits from the presence of a staff team that are trained and competent for the role. Staff engaged are vetted throughly, those employed display the right qualities and attributes which residents appreciate. Residents find staff to be kind and dedicated to the job, comments received include these remarks " We are well cared for, nurses and carers have a lovely approach", "staff are friendly and sincere, always willing to help me with whatever I need", " my carer starts off my day with a friendly face". The home has effective quality assurance systems in place that involve people that use the service. The organisation gives attention to addressing any shortfalls that are identifed in the rigorous monitoring process. Maintenance issues are managed well with attention given to promoting the health, safety and welfare of residents and staff. The physical and psychological care needs of residents are promoted by staff, staff are vigilant when monitoring residents needs. They respond appropriately to any concerns that arise by making referrals to relevant external professionals. What has improved since the last inspection? Medication procedures are safe and protect resident. We make some further recommendations in this area. Management changes have resulted in improved staff morale among the staff team. More investment has taken place in training and developing the staff team. Residents are now issued with contracts with the organisation. The internal premises has benefited from the refurbishment programme, however this is not fully completed and further work is planned for Rose unit. What the care home could do better: Although the service has made improvements in a number of areas there is potential to develop the service further and make it an excellent service. There were few shortfalls, on one unit staff spoken to were unaware of all the dietary needs of one resident. Staff must make sure that they are fully aware of any special therapeutic food that is required by a resident, and serve the appropriate food if a resident has any swallowing difficulty. The home makes limited provision for social activities, the activities programme is very general and is not meeting the needs of all residents. Consideration must be given to responding to individual`s needs and interests, particular consideration to be given to people with physical disabilities and cognitive impairments. Key inspection report Care homes for older people Name: Address: Collingwood Court Nursing Home Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR     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: Mary Magee     Date: 2 9 0 9 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 35 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 35 Information about the care home Name of care home: Address: Collingwood Court Nursing Home Collingwood Court Rear Of 1-95 Nelson`s Row Clapham London SW4 7JR 02076271400 02077201998 mauchazp@bupa.com www.bupacarehomes.co.uk BUPA Care Homes (ANS) Ltd care home 80 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 80 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE (maximum number of places: 52 Mental Disorder, excluding learning disability or dementia - Code MD (maximum number of places: 52) Old Age, not falling within any other category - Code OP (maximum number of places: 28) Date of last inspection Brief description of the care home Collingwood Court is a purpose built nursing home owned and managed by BUPA . The home provides nursing care for up to 80 people. It is set in its own grounds on a quiet street. The home has three separate units., two of which are on the ground floor. The Care Homes for Older People Page 4 of 35 1 9 1 1 2 0 0 8 52 52 0 Over 65 0 0 28 Brief description of the care home third unit is located on the first floor. Two of the units Rose and Hazel provide nursing care for people with mental health problems. The third unit Diana on the ground floor is for frail older people and people with a physical disability who require nursing care. Each unit has a lounge and dining room. The main kitchen and laundry facilities are located in the basement. A passenger lift is provided for access to the first floor and the basement, it is accessible to those in wheelchairs. Fees range from£650 to £750 per week. Care Homes for Older People Page 5 of 35 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: We undertook this unannounced key inspection over two days. Three inspectors were involved, including the pharmacy inspector. Prior to the inspection we received a completed AQAA, (annual quality assurance self assessment). We received completed surveys and comment cards from residents, relatives , health and social professionals, and staff members. We met with all residents present over the two days, and spoke to thirty of them individually. During the inspection we held discussions with the manager, deputy manager and twelve members of staff. We examined a selection of personnel records relating to residents, and staff, we also checked maintenance records. We toured the home, and viewed all communal areas, the kitchen and laundry and the majority of bedrooms. All the information we gained as used as evidence in this inspection report to inform judgements. Care Homes for Older People Page 6 of 35 We are grateful for the cooperation of residents and staff who were helpful in facilitating the inspection. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 35 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 35 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 35 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. The service is careful to avoid inappropriate placements. No new person is admitted to the home without having their needs fully assesed first, and assured that these needs will be met at the home. The home employs a staff team that have the skills and competencies to deliver the services offered. Evidence: We viewed the pre admission assessments completed for three new residents. Senior nursing staff complete pre admission assessments. The home demonstrates improvements in this area. Staff make sure that the home is suitable for people that move there to live. We found from speaking to the manager and deputy that during the pre admission assessment they consider all the factors. They also consider if they have the necessary specialist skills required to meet the assessed needs of people referred. The assessments we found to be comprehensive and give full details of all the support Care Homes for Older People Page 11 of 35 Evidence: and care required by the individual moving into the home. We found that the home is meeting the needs of current residents. The outcome for residents is good, we gathered this information from records of reviews, response from the residents and relatives. The home we found continues to drive improvement, and employs suitably skilled and competent staff members that care and support the residents of the home. Care and support is delivered accordingly and in response to assessed need. We found that appropriate arrangements are made in advance to have all the necessary equipment in place prior to the admissions. We found that the equipment supplied for new admissions includes pressure relieving equipment and profiling beds. People that moved to the home in recent months reported their experiences. Many felt that more effort should be made to ease the transition for new residents. The manager told of the arrangements now, people are allocated a dedicated staff member assigned to supporting new residents and to assist with settling in process. We recommend that consideration is given to making the admission process as smooth as possible. We found that contracts were supplied to new residents recently admitted, copies of these were viewed. In a bedroom occupied by a new resident we found that service guide records relating to the previous occupant were still present even though the new resident occupied the room for over three weeks. We also heard from a residents relative of a similar experience. Bedrooms should be suitably prepared for all new residents prior to admission, emphasis should be placed on the preparation, information relating to and belonging to previous occupants should be removed before new admissions are made. Care Homes for Older People Page 12 of 35 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. At Collingwood Court staff makes sure that individualised written care plans are developed for people that live there. The care arrangements for residents are good, people have all aspects of safety considered and receive the care and support they require in a dignified and respectful manner. Appropriate interventions take place as necessary, with issues of concern recognised and responded to, and prompt referrals made to health professionals. Medication procedures are good, residents receive their prescribed medication on time. Evidence: The assessment tool is known as Quest , a document in which a range of personal information and detail is recorded . This is ued to record as much information as possible, such as sleep patterns, what care and support is needed, from this the home develops and record appropriate care plans. We examined the written care plans available for each of the nine residents selected. We found that the care plans reflect the care and support required by the people they were developed for. Risk assessments viewed demonstrated that staff recognise and identify risks associated Care Homes for Older People Page 13 of 35 Evidence: with providing care and support, guidelines are place to respond to the risks. There were risk assessments around the use of bed rails and these were discussed and signed by relatives. Guidelines incorporate recommendations and advice supplied by external professionals such as mental health team. We found that care plans and risk assessments are kept under review, monthly reviews are completed for residents or more frequently if changes arise. There were copies of end of life instructions that had been signed by relatives in residents care plans. Staff on duty were observed in practice, we found that people were treated respectfully. Staff are instructed during their induction programme (personal best programme)on how to treat people with privacy and respect. The attitude and approach of staff is good; we found staff morale is good. Care is delivered by a friendly staff team. this was consistent with reports from residents spoken to and from residents surveys received. Residents and relatives spoken to find that staff approach has improved. We spoke to staff over both days. Staff told us of the routines of the home. A high number of staff have developed a good knowledge of residents, having worked at the home for some time. They are competent at recognising small but significant changes to individuals needs and seek intervention by referral to mental health professionals before a crisis occur. We found that care files are well organised and contain copies of individual need and risk assessments, also held are details of the required care and support. At hand overs, that is change of morning and evening shift staff provide details of each resident and the state of health and well being. A report is also made. We found that the home has a robust assessment tool to capture all the necessary information to provide accurate and ongoing care. Consideration is given to developing plans of care that are reflective if individual needs and preferences. Risks are identified, and plans are in place to manage these. We saw examples of how staff manage situations such falls from a bed at night, two residents have special mattresses placed on the floor as cot sides were not considered appropriate. Care arrangements are good. Residents from all three units told us of their experiences, they said staff are kind, they are gentle and understanding and know what each individual prefers, I look forward to seeing my carers each day as they know what help I need, they always make sure I am well cared for. Residents feel confident that the home provides all the care that is needed, they said the managers are around to check we are wll looked after, they often can be found on units overseeing the care of residents. The records examined for all nine residents contained evidence of the care delivered, daily records are made of all the care given. We found that staff at this home are good at monitoring how individuals are progressing, also how they respond to prescribed treatment. The psychological states of residents are closely monitored, Care Homes for Older People Page 14 of 35 Evidence: mental health professionals are consulted about any concerns. Residents feel confident in the staff team, and particularly feel reassured by the skills of staff. We found that staff recognise changes to individuals well being, and respond promptly by seeking the views of relevant health professionals. We found records of occasions when residents were observed to be unwell and of the referrals made to the GP, and also to hospital consultants. We were told of the good communication that exists. Relatives find that staff keep them informed too of changes that arise. Daily records are maintained up to date and demonstrate a clear picture of the care support given to individuals. None of the residents have pressure sores. Those at risk of developing them are identified, risk assessments are then completed with action plans agreed and put in in place. Appropriate pressure relieving equipment such as special mattresses are supplied where necessary. Profiling beds are supplied to residents that require them. Records were examined of the wound care given to people with ulcerated conditions, there was also included with care plans recommendations made by the tissue viability nurse. According to records seen, dressings and care are given in accordance with recommendations made, photographs also confirm the response and the progress. One of the residents we consulted has a fluid chart maintained, this is considered necessary as part of the care planning arrangements and the information collected contributes to the monitoring of the residents health. Residents are supported to consult with the GP who visits the home twice a week, also he responds to emergency calls. Individuals receive support and assistance with personal care, regular bathing and showering takes place according to preferences. Attention is given to manicures and foot care. We viewed records of podiatry and chiropody visits. Arrangements were taking place during day two of our inspection visit for the domiciliary dentist to attend to residents. In the past there were issues raised by persons unfamiliar with home about the unkempt appearance of some residents on Hazel/ Rose Units. Visitors have on occasions have commented negatively on the appearances of some residents, and concluded that individuals are not cared for appropriately. We explored this, and we found that both Hazel and Rose units have residents with mental health issues, often many have lead unstable lives, and a life of alcohol abuse, self neglect, many are quite challenging. We observed on both visits that staff at the home are working hard to promote self worth among individuals, they respect individuals rights and endeavor to promote and encourage good personal hygiene with individuals. We noticed that some residents were unshaven and their nails needed attention. But we also noticed that at times when staff tried to assist the residents with this area of their care the response from some of the residents often is to refuse assistance with shaving, hair grooming and nail care. However we found that staff continue to make every effort to promote good personal hygiene. Care Homes for Older People Page 15 of 35 Evidence: We inspected medication records and storage on all three units. On all 3 units, all medicines were available, all residents were receiving their medicines on time and as prescribed, controlled drugs stocks and records were accurate and storage facilities were good. Medicines are regularly reviewed by the GP who visits the home at least twice weekly. Records of medicines received, given and destroyed are generally good. There are photographs of all residents, and allergy information to ensure their safety. There are information leaflets available for all medicines so that staff are aware of what each medicine is for and potential side effects. Staff have also had medication refresher training. Regular medication audits are being carried out at the home which have been effective at picking up and addressing issues. One resident is being supported to store and take his own medicines, there is a risk assessment in place to ensure he can do this safely. On 2 units, there were no issues with recording, and medication is being managed well. There were minor issues on one unit which haven not placed any residents at risk but which should be addressed. Recommendations are made on the following. 1,The medication fridge has been out of range for most days in the month, reading a minimum of C instead of between 2 to C. Some medicines stored in this fridge such as insulin must not be frozen, so this should be checked. 2, One resident has been refusing medicines on a regular basis, and needs a care plan for non-compliance to show what action the home has taken to ensure the residents health needs are met. 3, For residents prescribed PREN medication for agitation the prescriber should indicate the maximum number of doses which can be given in 24 hours. and the time interval between doses. The home works with the palliative care team on promoting good care for people that are approaching the end of their lives. For one of the residents with a terminal illness that moved to the home recently the home has devised an end of life care plan. The resident has found staff to demonstrate a professional and emphatic approach. The staff team continues to improve the quality of life experienced by residents. Improvements are particularly observed for people that are terminally ills. It benefits from working with the expertise from external professionals. The home demonstrates the benefits from commencing the Gold Standards Framework. . Care Homes for Older People Page 16 of 35 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. Friends and family are welcome at the home. Relatives find that the communication is generally good, they are kept informed of events. Residents benefit from receiving a balanced diet, meals are served in pleasant surroundings with a number of pleasant staff present to support people discreetly. Staff need to be arare of the guidelines around residents with chewing and swallowing problems. Evidence: Visitors are welcomed at the home and can visit freely during the day. We met ten visitors over the two days visits. We attended the relatives meeting that was held on day two. The manager is proposing to establish a relatives and friends committee to enhance the lives of people at the home. For all persons moving to the home staff complete a social care needs assessment, this is referred to as map of life and is individualised. It gives a good picture of the previous lifestyle experienced by the individual, and records social cultural and leisure Care Homes for Older People Page 17 of 35 Evidence: pursuits and interests. We looked at how the social care needs for residents on all three units are provided for. A planner for the week was displayed of all the options available. We found that should be further developed as it is not currently appropriate for the needs and number of residents. Of the events at the home that are consistent we found that each month birthday celebrations take place. There also additional shows and occasional trips out to events but these are less frequent. recently due to the lack of activity coordinators. Aromatherapy is also provided as an extra benefit for residents. The overall programme of activities at the home is based on individuals social care needs. We found during our visits that some residents were engaged in various activities throughout the home. Of the nine residents we selected for case tracking there were records of the residents choices and wishes. For example for two residents we found that following consultation with the resident it was recorded, He likes to be on his own. Two of the residents we spoke to said, they liked to spend time in their own rooms listening to televisions and radios. Another disabled resident who communicates well verbally with people, is unable to use his arms. He finds the quality of life experienced is enhanced by aids provided. He is seen by the occupational therapist and uses the specialist equipment supplied. With this special equipment he can switch on his television or uses the call bell to request assistance from staff with toileting. He does not favour communal activities but enjoys the one to one support given by staff. Another resident that is receiving palliative care told us of how much he is enjoying his visits to the local Clapham area, I enjoy it and staff encourage me to pursue my visits locally. Another residents daughter spoke to us of her fathers contentment with the home. He feels secure at Collingwood Court, and trusts staff, they are welcoming and encourage me to become involved in his care. Visitors are welcomed at the home and can visit freely during the day. We met ten visitors over the two days visits. One visitor comes to the home every week to visit her friend, she has no other visitors and values her friends visits. We attended the relatives meeting that was held on day two. The manager is proposing to establish a relatives and friends committee to enhance the lives of people at the home. Staff were involved on Hazel Unit encouraging and engaging those that enjoy singing, and used a karaoke machine for this. We observed that others in the lounge although not directly involved in the singing enjoyed the footage seen on the big screen and enjoyed reading the words. Another resident on Hazel Unit helped prepare the dining tables for lunch. The capacity for social activity and stimulation varies greatly at the home, for example Care Homes for Older People Page 18 of 35 Evidence: those on Rose and Hazel unit may need more structure as part of their programme. We viewed the additional one to one times commissioned by the placement authorities and allocated to a number of residents. We were told of the absence of activity coordinators which has affected the volume of activities available. People on Diana are more physically frail and may need greater assistance to assist them engage. We found that unless additional hours are commissioned then numbers of staff on duty is not making provision for care staff to become fully involved. We were not confident that this is fully acknowledged throughout the home. Our observations were that residents on Diana Unit were less involved in participating in activities. Staff were busy undertaking other caring duties. We noted that in Diana Unit a number of residents were grouped around the television. On both days of our visits groups of residents were seated by televisions. However we observed staff engagement during meals and refreshment times. We were informed of the very low number of people with dementia, but for those on Hazel and Rose units the primary need is mental health. Staff were observed chatting to and engaging with residents for short periods. Staff discreetly assisted people that needed support at mealtimes. We were told of the absence of activity coordinators which has affected the volume of activities available. We met with the part time activities coordinator on the Hazel and Rose unit. We recognise that activity coordinators were absent for a period, and that one part time activity coordinator is leading on the programme. The lack of activity coordinators has directly impacted on the service, the home is offering less opportunities for residents to become involved in leisure and recreational pursuits. The manager reported that she has recruited an additional activity coordinator. We recommend that further attention is given to developing more structured activity programmes that respond to the social care needs of the residents. We observed meals served for breakfast and lunch. We viewed the menus devised with residents by the chef. Menus are changed every week, also seasonal menus are prepared. Residents are generally pleased with the meals supplied. For mealtimes dining tables were prepared in advance with tablecloths, condiments and drinks. The meals served on both days were attractively presented, looked wholesome. The majority said they enjoyed the meals served. We observed that some choose to change from the original selection and were offered an alternative. Residents are encouraged to remain independent eating for as long as possible. Assistance is provided discreetly at mealtimes for those requiring support. We received three comments about the lack of variety of meals that meet cultural needs. It is recommended that more consideration is given to the cultural needs of residents when planning meals at the home. Care Homes for Older People Page 19 of 35 Evidence: Following admission new residents are seen by the chef. He discuses their personal meal preferences with them and with staff to find out about any additional dietary needs. Their conditions monitored closely. The nutritional needs of residents are regularly monitored from time of admission. Those residents at risk due to poor nutrition are identified and appropriate action is taken as required if there is any weight loss, the home uses the nutritional tool for this. Two of the residents we case tracked had been referred to the speech and language therapist because they were having chewing and swallowing problems. The guidance details that all food served must be pureed. We found although there were clear guidelines from the speech and language therapist in the residents notes these were not being followed up by care staff or recorded in the daily notes or when the care plan was reviewed. When we spoke to staff about this we found they were unaware of the quidelines. This record was not recorded on the kitchen records for the chef to follow. Staff need to be aware of the importance of residents who have swallowing and chewing problems are given the correct consistency of food and that professional guide lines are followed at all times when they are eating. We found that frail residents with concerns about nutritional intake are provided with additional supplements. We found that for some of the residents the information recorded was well detailed, others have less information. We were told by staff that this was due to the lack of capacity by some residents. Staff should endeavour to gain further information by speaking to relatives and any friends who come in to visit them. We looked at how the social care needs for residents on all three units are provided for. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the home are safeguarded from abuse or neglect by robust procedures in which staff receive ongoing training. People that use the service find that the home has an accessible complaints procedure and that issues raised are responded to promptly. Evidence: We examined the complaints procedure. Records of complaints show that these have reduced. A low number of complaints were received at the home, records seen show that thjese were responded to within timescales. We have not received any complaints about the home at the Commission. It was reported by staff that the manager observes care practices and is present on the units every day, and responds promptly to any areas of practice that are unsatisfactory. The new manager residents find has a more visible to the residents and their families. People spoken to both residents and visitors feel that there are improvements in how service operates the complaints system. People feel their views are listened to, a number of compliments were also received at the home complimenting staff on the service. The managerment welcome suggestions and comments and and use these as an opportunity to improve the service. All staff receiive safeguarding training in the induction period. We found that during interviews with eight members of staff that they demonstrated a good knowledge on Care Homes for Older People Page 21 of 35 Evidence: protecting vulnerable adults, and are fully aware of reporting procedures. Reporting procedures continue to improve, we receive notifications promptly of all notifiable incidents. The home accepts placeemnts from a variety of local authorities. It has copies of local authorities safeguarding procedures. Staff receive extensive training on all issues pertaining to abuse or harm. There is ongoing training for staff on protecting vulnerable people. We viewed the training plans for the next six month period. On two of the units residents accomodated have mental health related issues, episodes of challenging behaviour are experienced frequently. To equip staff with correct skills they also receive training on the management and prevention of violence, safeguarding people from financial and material abuse. The home has policies and procedures in place to support residents manage their finances safely. We examined the support and assistance given to two residents with personal allowances. We found that the administration department has clear audit trails that are audited on a regular basis. The home operates a safe system in auditing and monitoring this. Care Homes for Older People Page 22 of 35 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. Residents benefit from living in a home that is safe and wel maintained. An ongoing refurbishment programme makes sure that the home is well presented and kept in good state of repair. Attention to hygiene and cleanliness is good. Evidence: We toured all the communal areas, the kitchen and the majority of bedrooms were seen. The home we found to be clean and odour free. Hygiene procedures were observed to be good, the kitchen we found to be well organised. Food is prepared in a kitchen that has robust food and hygiene procedures. It was awared five stars in the last environmental health inspection. Both Diana and Hazel units are pleasant and inviting following a refurbishment programme. This is not yet completed on Rose unit, it is scheduled to have new floor coverings in October 2009. The previous requirement made in the last key inspection remains with the timescale extended. We met both maintenance persons. They keep the premises in a good state of repair. New wood look floor coverings have replaced carpets, residents and staff feel these are more practical. We viewed a number of residents bedrooms in home. We found the majority were homely and had personal touches, having brought in their own furniture, pictures and photos. There were other residents bedrooms who may not have family or friends. These were sparsely Care Homes for Older People Page 23 of 35 Evidence: furnished that we felt could be encouraged and supported to add a personal touch to their bedrooms to make them warm and friendly. Many have not experienced living in their own homes and the importance of a homely touch. We recommend that staff support residents with personalising bedrooms so that they develop a sense of belonging. Keypads are used for safety on Hazel and Rose Units. We were informed by the manager of an instance of absconsion on Diana Unit despite the monitoring arrangements in place. We recommend that security arrangements are reviewed for Diana Unit. We observed that in one bedroom on Diana unit damage was found from the movement of the profiling bed against the wall. Staff should be made aware of the need to place the bed away from the wall when raising and lowering it. Residents are supplied with all the necessary equipment and adaptions. We observed call bells close to hand for thos ethat are frail and remain in their bedrooms. There are sufficient numbers of bathrooms and showers available for residents use. All bedrooms are en suited. Profiling beds are supplied for residents that need them. We found that some of the beds supplied are very low and pose difficulties for staff when personal care is given to a person in bed. A recommendation is made. The garden we found is easily accessed for people with mobility issues. However it appears poorly maintained, there is no longer a person employed for this role. We saw the new furniture supplied. The garden was not in use on either of the days we visited. Residents told us that they are not using the garden to its full potential, this was also confirmed by staff too. It is recommended that the garden is well maintained, and that residents are enabled to enjoy the outdoor space available. The home meets the requirements of the Disability Discrimination Act and the layout and design of the home is suitable to meet the specific needs of the people who live there Care Homes for Older People Page 24 of 35 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. Residents enjoy having a staff team that are dedicated and caring, a strong sense of professionalism is promoted. Recruitment procedures are robust, staff are vetted thoroughly before appointment. Staff development is focused on, the staff team are provided with a great range of training that equips them with the skills and competencies for their role. Evidence: We met twelve members of staff and spoke to them individually over the two days. The home has retained a number of experienced nursing and care staff. ten staff surveys were received. During discussions staff on Hazel and Rose units demonstrated a good understanding of residents needs, we also observed appropriate responses to residents that were challenging. Staff on Diana had a professional approach and undertook their duties in a calm and competent manner, approach was good with residents feeling encouraged, and responding positively to the kindness and compassions shown. It was good to see the committment and loyalty of staff members who demonstrate that they enjoy the job they do. We found that there is much progress experienced by individual staff members, a number of carers have worked at the home for some years and have completed NVQ levels 3 & 4. A high volume of care staff have acquired NVQ qualifications. Staff spoken to, three nurses and nine carers are enthustiastic in their roles. They were busy and made every effort not to rush individual residents. Residents told us of the qualities of individual staff members, Care Homes for Older People Page 25 of 35 Evidence: they are so kind and gentle, I look forward to her cheerful ways every monrning were some of the many complimentary remarks we received. A visitor present told us of the practices she observes, she said I see tenderness and care shown to residents here when I visit A small number of residents have additional hours of one to one agreed with placement authorities. The staffing rotas demonstrate this clearly and confirm that these additional hours are delivered. We observed staffing levels on both days and compared staffing rotas. Two Units were short of staff according to the rota, one staff member absent, but there were also less residents to be cared for due to hospital admissions. Morning and afternoon rotas show less staff are needed and thus available for afternoons. This is due to the fact that more staff are required for morning duties. We heard from a number of staff, they feel staffing levels could be increased as they experience frequent absences that are not filled. They say they have less time to spend with residents, and that as a result they fear that the quality of care may be compromised. We observed that staff were very busy over both days of our visits. We recommend that a review of the needs of residents is completed, and that staffing levels are allocated to reflect these needs. We found another member of staff that started as carer some years ago. She has completed training and qualified as a nurse. Staff members are pleased that she has returned to nurse the residents at the home where she began her caring role. There is a significant improvement in staff morale in the past nine months, and this is tangible in the service. Staff find that the new management team are open and transparent in approach. They feel confident in the management and are at ease raising issues or concerns. Recruitment procedures were examined. We checked the personnel files for five new staff members. All the required information was present. for each new staff member. We observed that on occasions references were not accompanied by comapny letterheads or stamped to demonstrate authenticity. We recommend that the service only accepts professional references for new staff recruits when it is accompanied by supporting documentation. Staff receive full induction following appointment. New staff complete probationary periods. Should a staff member be found to be unsatisfactory in the probationary peiod then this time is extended to address any shortfalls. The service provides staff with a full and varied training programme. We were supplied with records of all the training given and planned for the staff team. We found that the plan contains subjects that relate to the needs and conditions of the Care Homes for Older People Page 26 of 35 Evidence: current residents. Staff are kept updated on changes in legislation, staff training on the Deprivation of Liberty Assesment is planned for the the future. Care Homes for Older People Page 27 of 35 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. Residents benefit from living in a home that is well run and where the managemnt is open and transparent. Staff practice and training needs are supported and addressed through regular supervision that is cascaded through the staff team. The health, safety and welfare of residents and staff are promoted and protected with safe health and safety practices. Evidence: The home has experienced a complete change in the management team. A new manager is in post since January 2009. She is a qualified nurse with a variety of experience and skills. She demonstrates good leadership skills. She is supported by an experienced nurse that is also a deputy manager. The open transparent approach of management team has contributed to raised staff morale. Staff feel supported and motivated, they receive regular one to one supervsion. Records of these seen showed these to be consistent and regular. Care Homes for Older People Page 28 of 35 Evidence: Staff tell us that they have regular team meetings at the home. The manager should make sure that she submits an application to register with CQC as the manager for the home. The home has a system to monitor and evaluate the service delivered, this is effective and involves surveying the people using services. Collingwood Court is supported by a national team of Quality and compliance officers whose role is auditing and supporting quality issues within the home. The home receives a visit every month from a representative of the organisation, we viewed copies of these Regulation 26 visit reports. Monthly audits take place of all areas of evaluations, this also includes environmental and health and safety procedures. Any shortfalls are identified and addressed. We were informed that policies and procedures are reviewed internally by the organisation. The information we received in the AQAA recorded that these policies and procedures were not datedto show a recent review took place. We are conscious of changes to legislation since the period when the time of the last review. We recommend that policies and procedures at the home are reviewed and udated. The home has two maintenance persons employed that take responsibility for keeping the premises in a good state of repair. They also complete regular health and safety checks of the environment. One area that should be address we identified. We found that oxygen cylinders supplied for two residents, one needs to be made more secure and fixed to the wall. We recommend that oxygen cylinder are made secure. The maintenance persons also take responsibility for the duties of fire drills and the arrangement of the maintenance of essential fire fighting equipment. We found that the home has fire fightng equipment that is kept in good working order, weekly testing of fire alarms takes place. A full fire drill was not completed for a long period of 2009,then two fire drills were completed in short succession recently. We recommend that more consistency is introduced in the frequency of fire drills. The home has robust systems to support individuals manage their money safely. Personal allowances where residents are unable to manage themselves are held centrally in a bank account, individual statements are supplied for each resident that has an account. We examine records and receipts for two residents of management of their personal allowance, we found that the rigorous sytems in place ensure that this is managed appropriately. Safe working practices are in place, manual handling training for staff is kept up to date. Staff demonstrte this in practice. Food hygiene practices are good with food stored and and prepared in a hygienic environment. All accidents and incidents are recorded and promptly reported. Care Homes for Older People Page 29 of 35 Evidence: Staff receive health and safety training as part of the induction programme. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person must 31/12/2009 ensure that the programme of maintenance and renewal for the fabric and decoration of the building includes the refurbishment of bathrooms and bedrooms. Redecoration of damaged/ peeling paintwork in some en-suite bathrooms. (Programme is still underway for Diana unit, so extension to timescale of 31/03/09 given)) Phase one of refurbishment done, on 28/09/09 both Diana and Hazel complete, Rose wing is having new flooring, starting 8th October 09. Care Homes for Older People Page 31 of 35 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 1 12 16 Attention must be given to 27/11/2009 developing more appropriate structured activity programmes that responds to the social care needs of the residents in the home. To make sure that residents are provided with facilities for recreation, fitness and relaxation. 2 15 15 The home must ensure staff 11/11/2009 have training and are aware of the importance of residents who have swallowing and chewing problems, are being given the correct consistency of food and that professional guide lines are followed at all times when they are eating. Staff need to make themselves familiar with residents guidelines aound eating and swallowing. 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 Care Homes for Older People Page 32 of 35 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 2 Bedrooms should be suitably prepared for all new residents prior to admission, information relating to and belonging to previous occupants should be removed before new admissions are made. We recommend that consideration is given to making the admission process as smooth as possible for all new people moving to the home. For residents prescribed PRN medication for agitation the prescriber should indicate the maximum number of doses which can be given in 24 hours. and the time interval between doses. One resident has been refusing medicines on a regular basis, and needs a care plan for non-compliance to show what action the home has taken to ensure the residents health needs are met. The medication fridge has been out of range for most days in the month, reading a minimum of 1C instead of between 2 to 8C. Some medicines stored in this fridge such as insulin most not be frozen, so this should be checked. It is recommended that more consideration is given to the cultural needs of residents when planning meals at the home. The home should ensure that the garden is well maintained, and that residents are enabled to use and enjoy this additional shared space. We recommend that consideration is given to staff health and safety, the design and height of the beds should reviewed for those receiving any form of personal care while in bed. We recommend that security arrangements are reviewed for Diana Unit. Residents should be encouraged and supported to add a personal touch to their bedrooms, promote a sense of belonging and to make them warm and homely. Staffing levels should be reviewed, the number of skilled staff on duty should always reflect the needs and number of residents. The manager should make sure that she completes and 2 5 3 10 4 10 5 10 6 15 7 20 8 22 9 10 22 24 11 27 12 31 Care Homes for Older People Page 33 of 35 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 submits an application to register with CQC as the manager for the home. 13 14 33 38 We recommend that the manager reviews and updates the policies and procedures at the home. We recommend that more consistency is introduced in the frequency of fire drills. Fire drills should be carried out at regular intervals. Oxygen cylinders have been prescribed as back up for two residents on oxygen concentrators, one needs to be secured to the wall as storing this loose can pose a safety hazard if it topples over. 15 38 Care Homes for Older People Page 34 of 35 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. 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. 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