Care Home: Colne House Care Home

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What the care home does well Visitors are always made welcome. Relatives felt that staff communicated with them well and kept them up to date with any issues concerning their relative. People living at the home have regular opportunities to express their views on the service. Communal accommodation is spacious providing different areas to meet different needs. This was a friendly home. Staff were observed to provide care for residents in a dignified way. We saw residents being offered choice at lunchtime. What has improved since the last inspection? Since the previous inspection visit there has been progress made with the provision of activity and stimulation for people living at Colne House. People were encouraged to participate in a range of activities to engage them. The manager has consulted with the fire service since the previous inspection visit, actions have been taken to meet the previous inspection recommendation of good practice to revisit the fire risk assessment to ensure it complies with the most recent legislation for fire safety in residential care premises. The manager has revisited the service`s infection control policy to ensure it is in line with the Department of Health guidelines (DOH), Essential Steps. Records showed us that the previous inspection recommendation that staff working in the home should be provided with adult safeguarding training to ensure people using the service are protected from abuse has now been met. Work has begun to improve the environment for the people living at the home. A rolling programme of refurbishment has been developed. What the care home could do better: The initial assessment of needs undertaken prior to people moving into the home needs to be more detailed to provide an accurate picture of individuals` personal care and support needs, their strengths, independence levels and how their current skills can be maintained. This is so people can be confident that their individual and diverse needs can be met and that a detailed and informative care plan can be developed to provide staff with personalised instruction to be able to support people to lead a fulfilling life and promote their sense of self worth. The home is registered to provide care for people who have dementia. Many of the care staff team had not received training in this area. This means that they may not have the skills to understand and meet peoples` needs in a consistent way that is in line with current ideas about best practice. Some areas of the home were poorly maintained and this detracted from the overall environment. This specifically related to communal bathrooms and toilets. The programme of refurbishment needs to be progressed in a timely manner to benefit the people living at Colne House. Key inspection report Care homes for older people Name: Address: Colne House Care Home Station Road Earls Colne Colchester Essex CO6 2LT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 34 Information about the care home Name of care home: Address: Colne House Care Home Station Road Earls Colne Colchester Essex CO6 2LT 01787222227 01787224749 colnehouse@kingsleyhealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Althea Healthcare Properties Name of registered manager (if applicable) Mr Viktor Zak Type of registration: Number of places registered: care home 38 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 38 The registered person may provide the following categories of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP dementia - Code DE Date of last inspection 2 7 1 1 2 0 0 8 38 38 0 Over 65 0 0 38 Care Homes for Older People Page 4 of 34 Brief description of the care home Colne House is owned and operated by Althea Healthcare Properties Ltd, who are part of Kingsley Healthcare. The home is a Grade 2 listed building set in spacious grounds. The main house provides accommodation to thirty three people. Communal rooms in the main house consist of three lounges, a conservatory and a dining room. These are well furnished with domestic style furniture, carpets and curtains. From the dining room double doors lead into large conservatory, which has good views over the gardens and pond. There is an additional annex separate to the main house providing accommodation to a further five people. The annex has its own communal areas and kitchen facilities. Colne House is close to the village of Earls Colne, which has a range of shops, a library, post office, doctors surgery, public houses and churches. Fees for care and accommodation range from £447.76 to £1314.04 per week dependent on the level of need and support. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced keysite visit. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of eight hours. A tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. Prior to the site visit the manager had completed and sent us their Annual Quality Assurance Assessment (AQAA). This provided detail of how the service feels they are meeting peoples needs and how they can evidence this. Care Homes for Older People Page 6 of 34 The views expressed by visitors to the home during the site visit have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The initial assessment of needs undertaken prior to people moving into the home needs to be more detailed to provide an accurate picture of individuals personal care and support needs, their strengths, independence levels and how their current skills can be maintained. This is so people can be confident that their individual and diverse needs can be met and that a detailed and informative care plan can be developed to provide staff with personalised instruction to be able to support people to lead a fulfilling life and promote their sense of self worth. The home is registered to provide care for people who have dementia. Many of the care staff team had not received training in this area. This means that they may not have the skills to understand and meet peoples needs in a consistent way that is in Care Homes for Older People Page 8 of 34 line with current ideas about best practice. Some areas of the home were poorly maintained and this detracted from the overall environment. This specifically related to communal bathrooms and toilets. The programme of refurbishment needs to be progressed in a timely manner to benefit the people living at Colne House. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive an assessment of their needs to help them decide if Colne House is the right home for them, however this may not always contain enough detail to ensure their needs are met according to their individual wishes and preferences. Evidence: The previous inspection of this service resulted in a recommendation for the Statement of Purpose to be updated to reflect the current management details. We looked at a copy of the current Statement of Purpose and Service User Guide, these documents were up to date however the complaints procedure included within them needs to inform people that they are able to contact the Local Authority if they have any concerns, and include the relevant contact details. The Statement of Purpose informed people considering using the service that all staff have been trained to meet the needs of people living with dementia. According to evidence available at this visit this information did not provide people with an accurate Care Homes for Older People Page 11 of 34 Evidence: picture of the skills and experience of the staff team. The statement of purpose tells people they have a six week trial period built into their contract so they have time to decide if Colne House is the right place for them. The manager told us that when an enquiry regarding a placement at the home was received he obtained basic information in the first instance. The family were then invited to have a look around the home and given a Service User Guide, Statement Of Purpose, a copy of the complaints policy and procedure and a copy of the homes brochure. He then advises peoples that the prospective resident should visit the home in person if possible. The manager told us he always visits the prospective resident in person, either in their own home or in hospital. We saw evidence to confirm that the manager obtained supplementary information from outside agencies such as social workers and Community Psychiatric Nurses before confirming that he felt that the home could meet peoples needs. We looked at the pre admission assessment for one person. There was clear evidence of the managers visit to the person with a very brief outline of their care and support needs. This assessment did not include any individual choices and preferences, purely a basic outline. For example needs prompting with personal care but no detail as to how the person needed or wished their care to be delivered and no detail of the support needed to meet the persons needs. Peoples initial experiences when they move into a care home are pivotal to how quickly they settle in. Personal needs, choices and preferences about all areas of their lives need to be provided for the staff to make sure that peoples experience is as seamless as possible. The assessment did not include any information about the persons strengths, levels of independence or skills. This means that staff would not have the information neccesary to promote the persons independence to enhance their quality of life. We saw contracts in place both for people funded by local authority and funded privately. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the basic care and support they need however, the lack of detailed care planning means the individual needs of people living with dementia may not be met. Evidence: The manager had a care planning system in place, three care plans were reviewed at this visit. Where possible, residents had signed their care plans to say that they agreed with the content. One care plan we looked at stated the person needs prompt and help to do personal care however there was no detail in the care plan to say what help was needed and how it should be delivered. The care plan instructed staff to assist the person with their meals however there was no information available to show how this support should be delivered to maintain the persons independence to the full. The monthly review stated the care plan was to be followed but there was no specific instruction in the care plan for the staff to follow. The manager told us that the staff team knew what was needed to maintain peoples personal care and how to assist people to eat but the care plans did not include specific instruction to ensure people consistently Care Homes for Older People Page 13 of 34 Evidence: received their support according to their own individual preferences and needs. Tracking through from documented activities of daily living, through the care plans to the daily notes it was not possible to discover what personal support had been provided. We saw a daily sheet, for each resident, for staff to complete daily by a tick to indicate they had delivered personal care including areas such as Bath/shower/hairwash/teeth etc. This provided the manager with a monitoring tool to confirm that personal care had been provided for all residents. We saw evidence in the care plans to show that regular reviews took place to ensure that the care regime continued to meet peoples changing needs. We noted that this took place on one day per month for all residents. The manager had written to peoples families inviting them to participate in care plan reviews. The care plans we looked at covered areas of daily life such as personal hygiene, eating and drinking, rising and retiring to bed, communication, medication, skin care, mobility and weight monitoring, There were records to show where health professionals had been involved with peoples care such as GP, District Nurses, Opticians, Dentist and Chiropodists. Whilst people received a good standard of basic care, the care of people living with dementia is a specialist area. There were no care plans in place to support peoples individual strengths or to maintain their levels of independence and their skills. Care plans did not demonstrate an appreciation of the understanding of people living with dementia therefore we cannot confirm their needs in this area were being met. We saw various assessment tools to assist staff in maintaining peoples health and well being. These included a Waterlow assessment for skin care, a falls risk assessment for mobility, a nutritional assessment to ensure people were maintaining a healthy diet and maintaining their body weights and a moving and handling assessment where people needed assistance to mobilise. We saw that areas of risk to individuals was identified and planned for, such as for constipation, trips, falls, dietary neglect, alcohol abuse and aggressive outbursts towards others. We saw that control measures had been identified to reduce the level of risk to people, these were subject to monthly reviews in line with the care plans. We saw there had been body maps completed to indicate any injuries sustained through accidents or incidents such as falls. The homes annual quality assurance report indicated that 33 of respondents felt the Care Homes for Older People Page 14 of 34 Evidence: care they received always matched what was written in the care plan, 67 of people said it usually matched what is written in the care plan. Professionals responded: Care plans could be further developed, however they have improved dramatically since I first came. The manager told us that a key working system was in the development stage at the home. Currently each resident had a designated person to organise their supply of toiletries and keep their wardrobes tidy. The manager reported the plan is for the key workers to be directly involved with residents care planning and reviews. The Service User Guide tells people that a key working system is already operating. The managers AQAA stated: key-workers should be more involved in care planning. The managers AQAA stated: Plans for improvement over next 12 months included: to encourage residents and relatives to participate in care planning. We spoke with health professionals subsequent to this inspection site visit. They told us Health provision a bit hit and miss depending on what carers are on duty, reasonable standard of care in the main house, No particular improvement in the past year, lots of staff changes which doesnt help to promote continuity especially when you are looking after dementia patients and Not as pro-active in making referrals as they used to be. In the activity lounge we saw a number of records including accident and incident reports relating to individual residents. Whilst it is acknowledged that these records need to be accessible for staff the practice of keeping them in a communal area does not promote the dignity of the people living at the home. The manager told us that appropriate storage was being sourced for these records. The homes annual quality assurance report indicated that 60 of the respondents said they were always treated with dignity by the staff and 40 said this was usually the case. 70 of respondents said they were always treated with respect and 30 said usually. Some peoples bedroom doors had numbers to identify them, some had numbers and names, some had photos, some had memory boxes. We saw some with the persons names written directly onto the door with permanent marker pen. The manager agreed that the writing on the bedroom doors was inappropriate and did not respect peoples dignity. He told us residents had been asked if they wished to have a memory box positioned outside their rooms to help them orientate themselves. If they chose to Care Homes for Older People Page 15 of 34 Evidence: have one they were supported to select personal items to go in it. During the course of this inspection we observed kind, polite and respectful interaction between staff and residents. The manager undertook monthly audits of the medications used in the home. The organisations Medical Director visited the home unannounced and undertook full medication audits. The most recent visit was 2 months prior to this inspection. A Pharmacist audit took place 1 month prior to this visit. We noted that the managers medication audits were effective, in June there had been a number of shortfalls identified but over the recent months these had diminished with no identified issues at the most recent audit. The manager told us this was a credit to his staff team. An external pharmacy provided medication training for the staff team. Senior carers only were responsible for the medication administration. The manager and senior carer undertook competency assessments to confirm the staff were sufficiently skilled in the safe administration of medication. They had both received training to do this. We saw a homely remedies policy was in place, this had been validated by a GP from the local surgery. We saw records of all medications returned to the pharmacy. These were signed and dated to indicate when they had been returned and who had received them. Medication was stored in locked trolleys in both the main house and the annexe and were secured to a wall when not in use. The trolleys were clean, tidy and well organised. Most medications were supplied in blister packs to aid with safe administration. All bottles and packets of medication were dated to indicate when they had been opened. This assisted in providing a clear audit trail of all the medications in the home. Stocks of controlled medications were checked and agreed with the register. We looked at the Medication Administration Records (MARs)in both units, there was a list of staff signatures and a photo of each resident. The records were fully completed with no gaps in recording. We saw that where prescribed instructions had been amended since the medications had been delivered by the pharmacy this was done clearly and signed and dated by the nurse practitioner. Care Homes for Older People Page 16 of 34 Evidence: Both units had a medication fridge, there were records to confirm that the temperatures of the fridges were routinely monitored. The manager told us that medication reviews were undertaken by the GP on request. It was positive to note that people were on minimal medication. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people experienced good outcomes with regard to activities, however people were not always satisfied with the food provision. Evidence: The previous inspection of this service had identified that more could be done to improve the daily life of the people using the service, by incorporating information in their life histories and previous social interests to ensure they are engaged in meaningful activities of their choice. The manager reported that life story booklets had been sent to all families for completion. to date there had been a 50 return rate. Some residents with no family input had completed these with assistance from the activity co-ordinator. The managers AQAA told us of many things the home had done over the past year to improve the experience of people living at Colne House. These included extending the variety of activities offered to people, arranging outings and get-togethers for people some involving families and friends and gaining a better understanding of individuals daily life and social needs. Residents meetings had been introduced, staff now spent more 1-1 time with residents and new activity equipment had been purchased. Care Homes for Older People Page 18 of 34 Evidence: We saw an activity diary on the notice board in the communal hallway. this showed us that people were offered the opportunity of doing puzzles, listening to talking newspapers, playing games including dominoes, hairdressing, bingo, music, films and 1:1 time with activity staff. A further diary page included residents birthdays for the month, an Alzheimers society outing and church services etc. We saw activities going on during the morning of this visit. People were seated around the table in the activities lounge, there was happy banter going on whilst they listened to music and stuck pictures on cards etc. We noted pleasant interaction with residents as they talked about pets they used to have and the sadness of losing pets. There were very clear activity records maintained with one page for each person with a description of what activity/stimulation they had enjoyed. Relatives we spoke with confirmed they were welcomed at the home whenever they visited, we observed staff interacting with visitors in a courteous, respectful and friendly manner. We saw people having their breakfast in the dining room when we arrived at the home. There were 7 tables accommodating up to 4 people at each. The staff dished up breakfast for residents, they were heard to offer choices however people were not encouraged or supported to put their own conserves on their toast, pour their own tea or help themselves to cereals/porridge. It was all done for them without any support to maximise their independence. We took lunch with the residents in their dining room. The tables were nicely laid with linen cloths, serviettes and condiments. It was positive to note that people were offered a choice at the table and their food was dished up for them individually from a hot trolley. Some people appeared to be off their food which was obviously a concern for staff who demonstrated gentle encouragement. The home had experienced an outbreak of sickness in the preceding few days and staff were very aware of who needed encouragement to eat. We saw some people being supported to eat their meals in the lounge area. This was undertaken in a quiet calm and unhurried manner. The carer sat on a stool beside people chatting gently whilst supporting them to eat their meal. Residents told us: Its quite nice and Food is average. One person, who was not enjoying their meal told us: For the first time I looked at my plate and though oh not again, there is little variation in the menu. Care Homes for Older People Page 19 of 34 Evidence: We were provided with copies of the menu as part of this inspection. These showed us there was a 3 week revolving menu offering 2 choices of main meal every day. Afternoon tea provided a choice of a warm option such as soup, sausage rolls or beans on toast and sandwiches, fruit salad and cakes. The manager told us he was planning to develop a daily menu to be available on the tables to assist people in making their choices, he was waiting to get photographs of every meal available on the menu so this can be done. The homes quality assurance report indicated that 20 of respondents said the quantity, quality and choice of meals always met their needs, 60 said this was usually the case but 20 said this was rarely so. Residents meeting minutes of October 2009 showed us that the recommendation resulting from the previous inspection of this service, that mealtimes could be split into two sittings, had been discussed and vetoed by the majority of residents. Comments that residents made made at this meeting about the food provision included: Portions not always enough, didnt think the quality of meat was good enough, (Persons name) was happy with the meals, (Persons name) said they liked the food and (Persons name) enjoyed the food. We saw a person seated in the communal hallway enjoying a mug of tea. The mug had a large chip on the lip of it. This constituted an infection control hazard and a danger that the person could cut their lip. Despite this being pointed out to manager during the morning we noted that the person continued to use this mug later in the day. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that any concerns they have would be listened to and dealt with properly and that, as far as possible, they would be protected in the home. Evidence: We saw a copy of the complaints procedure, this needs to be updated to inform people they can take any complaints to the Local Authority and to contain the contact details for them to do so. We looked at records of complaints received by the home since the last inspection. There was information to show what investigations had taken place and we saw copies of the letters sent to people to acknowledge receipt of the complaint. These records detailed the outcome of the investigations undertaken. We saw records of compliments made to the home from relatives and health and social care professionals praising the manager and staff for the care, support and kindness afforded to the people living at Colne House. A relative told us: If I make a complaint it is responded to. The managers quality assurance report indicated that 30 of the respondents felt they could always speak to staff about anything or their concerns and 70 said they could usually do this. Care Homes for Older People Page 21 of 34 Evidence: The managers AQAA told us that two adult safeguarding referrals had been made since the previous inspection. We had monitored the progress of these referrals as they had been made and are confident that the manager took appropriate actions in line with adult safeguarding procedures and the homes policies and procedures for safeguarding vulnerable adults. We noted that the policies and procedures relating to safeguarding vulnerable adults were available in the activity lounge for staff to access at will. There was also contact information for the Local Authority safeguarding team. The previous inspection of this service had resulted in a recommendation for staff safeguarding training to be updated. Training records showed us that this training had taken place. Discussion with staff members showed that they had a clear understanding about what constituted abuse and what they should do to report any suspicion of abuse. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Colne House provides a homely environment however, people living there will benefit from the planned refurbishment of the home. Evidence: People living at Colne House benefit from access to ample communal facilities, in the main house there are three large lounge areas, a dining room and a spacious communal hallway. The managers AQAA stated: we have a variety of rooms as we care for different personalities - quiet room, TV room, music room, conservatory, activity room. The previous inspection of this service resulted in a requirement for the manger to consult with an Occupational Therapist to ensure people were assessed for the correct slings in relation to their weight, height and size. The manager told us he had made many attempts to secure this support for the home to no avail. Care plans had since been updated to indicate what slings were required for each individual needing to be supported to move by hoist and the hoist supplier had been contacted for up to date information. The previous report included a requirement for the manager to obtain red bags to be used with soiled laundry, this has been done. Care Homes for Older People Page 23 of 34 Evidence: There had been a recent outbreak of sickness at the home, we saw the infection control policy and procedure were available in the activity lounge for staff to access at will, hand sanitisers were positioned throughout the building and liquid soap and paper towels available for staff to maintain their hand hygiene. The previous report included a requirement for a risk assessment to be in place for the glass partition on the top floor of the home. This risk assessment had been located subsequent to the last visit and had since been updated. Communal bathrooms and toilets throughout the home were tired, shabby and institutional in appearance. This had already been identified by the provider and manager as an issue of priority. Quotes were in the process of being obtained and the regional manager, who was present at this visit, told us that the capital expenditure had already been agreed for this project. There were plans to alter a 1st floor bathroom and a ground floor bathroom into walk in showers. Residents meeting minutes of 28th October 2009 confirmed that people had been consulted about these plans. Comments included very good and posh. The manager was able to demonstrate that a rolling programme of refurbishment of peoples bedrooms was underway. 2 bedrooms have been redecorated so far with some new furniture on order. Residents meeting minutes confirmed that people have been told they will be able to choose the colours of their rooms. We looked at the kitchen. This was a small space for the preparation of meals for 38 people. The homes kitchen had received a 3 star rating from the Environmental Health officer earlier this year. We noted this facility was also shabby and in need of refurbishment. This was already planned with expenditure agreed by Head Office. The manager was able to explain to us the plans for the kitchen to make it a cleaner, more organised and user friendly space providing more food preparation areas and a clear workflow. The manager provided us with a copy of the refurbishment programme for Colne House 2009 - 2010. This was comprehensive and prioritised with rooms that needed urgent attention with projected start dates for November 2009. We saw some of this work underway at this visit. We saw that radiator guards were fitted throughout the home. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by sufficient numbers of safely recruited staff. Residents would benefit from all staff receiving training to help them support the needs of people living with dementia. Evidence: The managers AQAA identified areas of improvement over the past 12 months as being: majority of staff are trained to NVQ level 2 in Care, have purchased DVDs for in house training, 2 staff members have been trained in Moving and Handling Train the Trainer and employed new senior to support manager and supervise staff members. Copies of the staff rota showed us that the main house was staffed with 1 senior carer and 4 care staff during the day with 3 care staff on duty at night. The annexe had one carer in the day and at night with 1 extra person on day shift to provide 1:1 for one individual, this 1:1 provision was funded by the Primary Care Trust. Staff rotas showed us that staff worked 12 hour day shifts. Some staff we spoke with said they felt this was good because residents benefitted from continuity of staff during the day. However, others said the day could often be quite challenging and they were tired by the end of a long shift and that residents could benefit from staff working shorter shifts and being less tired. Care Homes for Older People Page 25 of 34 Evidence: Residents and their visitors told us they were confident that staff were on duty in sufficient numbers to meet the needs of the people living at the home. A comment inlcuded in the homes annual quality assurance report was: Very satisfied with the care provided under difficult circumstances with a wide range of residents of different ages and health needs. Always appear to be high staffing levels. We looked at recruitment documents for two people recently employed to work at Colne House. These showed us that all the checks necessary to keep the residents safe from harm are made before people start to work at the home, including references and Criminal Record Bureau checks. The manager told us he constantly monitored and talked with new staff members to assess how they were settling in and progressing with their Common Induction Standards. However, this interaction was not recorded therefore there was no evidence of supervision for one of the newly employed staff members since they started to work at the home. We looked at staff training records. These showed us there were some gaps in the training provsion that may mean people dont always receive the support they need. For example, records showed us that 19 of the 31 people employed to work at the home had received training in supporting people living with dementia. More specifically, 11 of the 20 care staff members had received this training. 16 of the 31 people employed to work at the home had received training to give them knowledge about the Mental Capacity Act and 10 staff had received training to provide them with the skills to manage challenging behaviours. The Statement of Purpose stated All staff had received training in the latest thinking in Dementia care. Information available at this inspection did not concur with this statement. The managers AQAA told us majority of staff are trained to NVQ level 2 in Care, records showed us that 9 of the 20 care staff team were training to NVQ2 in care with 7 further people enrolled to undertake this qualification. Residents meeting minutes of October 2009 included the following comments about the staff team: Polite and very nice, Some are OK and some are not, Staff are very polite, always informative, Very dedicated people, No problems,some of them are very helpful and I dont know one from another. Care Homes for Older People Page 26 of 34 Evidence: Relatives told us: Staff are lovely, helpful and obliging, no problems. A visitor to the home told us how they had placed a suggestion in the box in the communal hallway that staff should wear name badges. Residents meeting minutes showed that the manager had embraced this suggestion, ordered name badges and was awaiting their delivery at this time. We noted that, for many of the care staff team, English was not their first language. While we noticed examples of good communication skills in the team, we also observed instances where residents did not comprehend what was being said to them and vice versa. We spoke with a member of staff, during the course of this inspection visit, who was unable to understand what we said to them. Health professionals told us that communication difficulties occasionally arose and that they now wrote down instructions for staff to follow to avoid misunderstandings. Relatives told us: They are very good with (Persons name) and The care is good most of the time, could be improved though, I cant always understand what the staff say to me so how can (Persons name) possibly understand them? This shortfall in relation to use of English language raises the concern that residents may not always be able to effectively communicate with the people that are providing their personal and health care support. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 home that is run in their best interests and well managed Evidence: The manager is a registered nurse and has worked in the care and nursing sector since 1997. He has experience of working with older people and those with mental health needs and has also completed NVQ level 4 in Management and holds a Bachelor Degree in Commercial Management. Throughout the inspection process the manager was very co-operative and demonstrated a knowledge and passion for the what he is working towards achieving at Colne House. A copy of the most recent annual quality report for October 2008 was provided at the inspection, which states what the service does well and highlights where they need to improve. Comments included, Creates a homely atmosphere, caring staff, home cooked food, attractive grounds. I am pleased to see that you encourage (Persons Care Homes for Older People Page 28 of 34 Evidence: name) in activities and they are happy to join in. My relative has improved in their health and appearance since they have been at Colne House. They also appear to be very happy, I owe this to the dedication of the staff and management at Colne House. It has given me great peace of mind knowing that I am leaving them in the hands of people who truly care about the residents in their care. Most of the services at Colne House are delivered in a satisfactory or better standard. The activities ladies deserve special mention for their patience and innovation. I also have never witnessed anything but compassion and gentleness in the way staff look after my relative. However other people suggested there could be improvements made to the provision of support for personal grooming and the laundering of clothing. My relative is not always clean shaven and their clothes often look like they could do with an iron run over them. My relatives room and shower room never looks very clean, also you keep losing clothes and socks. The manager told us that some residents monies were kept safe for individuals. The homes administrator was not available at the home on this day and the manager was not able to access the funds held or the documentary evidence relating to these funds. The manager told us these funds were purely held as a safety precaution and there was no actiual involvement with the monies by staff at the home. It was evident that the person would not be able to access their funds when the homes administrator was not available, this day was an example of this. Services such as chiropody, hairdressing, newspapers and toiletries were paid for by the service and relatives were invoiced monthly for these items. We looked at records held within the home relating to accidents and incidents. All reports available related to falls with one individual featuring regularly in these reports. The manager was able to tell us what actions had been taken to try to identify the cause of these falls, involving various healthcare professionals such as Psychiatrists, Physiotherapists, nutritionalist and occupational therapist, and what procedures were in place to try to reduce the numbers of falls. There was a risk assessment in place in place in the care plan for staff to follow to keep the person as safe as possible. We saw a supervision list on the office wall showing us that regular supervision took place with all members of the staff team. We looked at staff files, this confirmed that records of these supervision were available. However, there was no evidence of newly recruited staff members receiving initial supervisions. Manager told us these happened frequently but were not recorded. There were records available to show us that the manager undertook a monthly audit Care Homes for Older People Page 29 of 34 Evidence: of complaints, medications and accident/incident reports. We saw documentary evidence to show us that regular staff meetings and residents meetings were being held. The manager told us that, in general, relatives showed little interest in attending meetings therefore he had written to people inviting them to meet one to one with him as part of each persons care plan review. The regional manager undertook regular quality monitoring visits on behalf of the provider oprganisation. A monitoring visit had been undertaken the day prior to this visit. We were provided with a copy of the report, references to the environment and health and safety within the building included the following; Bathrooms and some bedrooms need refurbishment. Flooring worn near the toilets on the ground floor. The conservatory requires furniture and heating so that the residents can use this area. No emergency lighting in the corridor between rooms 23-24. This shows us that the service is aware of the improvements in needs to make to improve the quality of life and health and safety for the people living and working at Colne House. The service benefits from having a fulltime maintenance person. We saw a book outside the managers office for people to report issues as they arose. Records examined and information provided in the AQAA confirms the home takes steps to safeguard the health, safety and welfare of people living and working in the home. We saw safety certificates for Gas, Electrical systems, PATs testing, lift servicing, fire extinguishers and alarms, the call bell system and the water system. We saw evidence that a fire drill had taken palce on 7th October 2009 and that 7 had taken place year to date to ensure all staff members were involved. We saw a letter from Essex County Council Fire and Rescue service dated May 2009, this stated: Satisfactory standard of fire safety was evident. The most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly and regular fire training and drills take place. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 Persons employed in the care 31/01/2009 home must receive training appropriate to the work they are to perform. This will ensure staff have the knowledge and skills to support people with mental health needs, which is based on current good practice. Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A detailed care and support needs assessment must be undertaken prior to people entering the home. This needs to include the identification of peoples strengths, levels of independence and current skills. This is so that the prospective residents can be sure their individual needs will be met and they can be supported to maintain their independence and feelings of self worth. 30/12/2009 2 7 15 Care plans must contain sufficient detail about how each person requires their personal support to be delivered This is so that staff can consistently provide personalised support according to each 30/12/2009 Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action individuals needs and wishes. 3 19 23 Bathrooms and toilets throughout the home need to be refurbished. This is so that people have access to a sufficient number of toilet and bathing facilities that are in good working order and are pleasant places to be. 4 30 18 Staff need to receive training to enable them to meet all the needs of the people living in the home. This specificallty refers to dementia training This is so that people living with dementia can be supported to live as fulfilling and independent lifestyle as possible. 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 26/02/2010 29/01/2010 1 7 Daily records need to be accurately completed so that it is possible to assess what elements of care and support have been provided for each person. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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