Care Home: Colonia Court

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What the care home does well All the residents and relatives we spoke with during the inspection were complimentary about the standards of care at Colonia Court. They told us that staff were very caring and helpful and encouraged them to be as independent as possible. One resident told us "The staff are very caring and display a lot of warmth. You feel that they try to help you as an individual. I`m happy with everything, I`ve had no complaints". Another resident said "I`m very happy here. I can`t think of anything they could do better". A relative described the staff as "excellent" and added "some go that extra mile. They give very individual care and know all the residents` personal needs". Residents were generally very complimentary about the standard of food and the choices available and residents were given additional snacks or supplements if there were concerns about their weight. The home was clean, well decorated and comfortably furnished with good standards of infection control in place. Each of houses were welcoming to visitors, provided good information about the home and other services. Equipment and fittings were provided to meet the individual needs of residents. Residents` rooms were well personalised with their own belongings as they had chosen. There were robust recruitment procedures in place and a comprehensive training programme in place. Good standards of health and safety were in place that were well monitored. What has improved since the last inspection? Since the previous key inspection the home has been completely refurbished and extended. Care plans are regularly audited and are more person centred. Menus choices have increased and suppliers changed. The records of medicines received into and managed by the home were in the main well recorded and accurate. Staffing levels were observed to meet the needs on the day of the inspection and records showed these were maintained. Agency staffing has been reduced and diversity training offered on request. What the care home could do better: Some of the care plans we looked at were focused on the residents` preferences, wishes and abilities in relation to their care but others focused more on staff tasks and did not give the impression that residents, and their relatives where appropriate, had been fully involved in drawing up the plans. The heads of care of the houses said that they would revise the plans with more direct input from residents. The standards of medicine administration were in the main good with appropriate monitoring, investigation and prompt action taken to address any adverse incidents. One omission was found that had not been followed up and the CD register did not record the full details on receipt and disposal of CD drugs.There had been some confusion as to what type of incident constitutes a safeguarding referral. The service was not proactively referring safeguard alerts resulting in these being referred from other agencies. When the manager was on leave there were delays in referrals being made. This does now appear to have been addressed. The number of staff with NVQ level two training was less than the recommended standard for 50% of staff to have an NVQ level 2 qualification. A residents` smoking room in Amber Lodge required staff to supervise residents. There was no extractor fan in the room and no risk assessment for the risks associated with passive smoking had been undertaken. Fire drills were regularly undertaken and the number of staff attending recorded but not the names. This would enable appropriate monitoring to ensure all staff attended at regular intervals in order to safeguard residents. Key inspection report Care homes for older people Name: Address: Colonia Court St Andrews Avenue Colchester Essex CO4 3AN     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: Diana Green     Date: 1 9 0 7 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Colonia Court St Andrews Avenue Colchester Essex CO4 3AN 01206791952 01206794230 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.bupa.com BUPA Care Homes (CFHCare) Ltd Name of registered manager (if applicable) Harvey Newman Type of registration: Number of places registered: care home 123 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 physical disability Additional conditions: Amber Lodge - persons of either sex, who require nursing care by reason of Huntington`s Disease (not to exceed 28 persons) Blomfield House - persons of either sex, who require nursing care by reason of physical disability (not to exceed 30 persons) Mumford House - persons of either sex, who require care by reason of dementia (not to exceed 30 persons) Paxman House - persons of either sex, who require nursing care by reason of physical disability (not to exceed 35 persons) Care Homes for Older People Page 4 of 30 Over 65 0 0 123 0 123 123 0 123 The maximum number of service users who can be accommodated is 123 The registered person may provide the following categories of service: 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 Mental Disorder, excluding learning disability or dementia - Code MD Physical Disability - Code PD Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Colonia Court is registered to provide nursing and care for up to 110 residents. The site is separated into four houses. Residents are accommodated in single rooms, all with en-suite toilet and basin. Each house has a good range of communal rooms and the accommodation is all on one level. The houses are staffed on an individual basis and the central services include administration, laundry and kitchen. The home has car parking facilities and gardens attached to each house. Colonia Court is set in a residential area and is approximately one mile from Colchester town centre and two miles from the railway station. Buses run along St Andrews Avenue outside the home. The range of fees at Colonia Court in July 2010 were: personal care £390.39- £810, nursing care £441.30 - £890.00, care for Huntingtons Disease £1100 - £2400. The fees were dependent on assessments. The higher range of fees on Amber Lodge for Huntingtons Disease was for 1:1 or 1:2 care. Items such as toiletries, newspapers, hairdressing and private chiropody were charged for separately. The home had a range of information for potential residents and their representatives. 1 8 0 9 2 0 0 8 Care Homes for Older People Page 5 of 30 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: The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This was an unannounced key inspection that took place on 19th July 2010. The inspection was instigated following a number of safeguarding alerts referred by other agencies and complaints about the service received by the Commission. Two inspectors were present on the inspection. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The report has been written using accumulated evidence gathered prior to and during the site visit, including the agencys Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are Care Homes for Older People Page 6 of 30 being met for people using the service. This had been returned by the registered provider on the due date. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included a tour of the premises and reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, their relatives, staff, the Deputy Manager and Operational Manager who were welcoming and helpful throughout the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Some of the care plans we looked at were focused on the residents preferences, wishes and abilities in relation to their care but others focused more on staff tasks and did not give the impression that residents, and their relatives where appropriate, had been fully involved in drawing up the plans. The heads of care of the houses said that they would revise the plans with more direct input from residents. The standards of medicine administration were in the main good with appropriate monitoring, investigation and prompt action taken to address any adverse incidents. One omission was found that had not been followed up and the CD register did not record the full details on receipt and disposal of CD drugs. Care Homes for Older People Page 8 of 30 There had been some confusion as to what type of incident constitutes a safeguarding referral. The service was not proactively referring safeguard alerts resulting in these being referred from other agencies. When the manager was on leave there were delays in referrals being made. This does now appear to have been addressed. The number of staff with NVQ level two training was less than the recommended standard for 50 of staff to have an NVQ level 2 qualification. A residents smoking room in Amber Lodge required staff to supervise residents. There was no extractor fan in the room and no risk assessment for the risks associated with passive smoking had been undertaken. Fire drills were regularly undertaken and the number of staff attending recorded but not the names. This would enable appropriate monitoring to ensure all staff attended at regular intervals in order to safeguard residents. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into this home can be assured they will be provided with information and the opportunity to visit, before making a decision if Colonia Court is suitable for them. Evidence: The home had a range of information for potential residents, their relatives and representatives. The statement of purpose clearly set out the objectives and philosophy of care, specialist services, qualifications and experience of the staff and how to make a complaint. A choosing a home leaflet was also included. Each person moving into the home was also given a welcome pack, which set out the services provided, including catering arrangements and access to health care services. The AQAA informed us that regular mystery shops are conducted to ensure the home is providing the correct information to enquirers and that relevant staff receive enquiry training. This showed that the home aimed to provide full and appropriate information to potential residents and their representatives. Care Homes for Older People Page 11 of 30 Evidence: The pre-admission assessments were carried out by the home manager, deputy manager or one of the heads of care of the four individual houses at Colonia Court. We looked at the pre-admission assessments for a number of people who had moved into the home since the last inspection. These gave a good indication of the health and care needs of the potential residents to enable the managers to assess whether the home could meet their needs. The amount of information contained in the assessments, that was additional to the tick box system, was variable and some would have benefited from more detail of the potential residents individual needs and expectations. Once a resident had moved into the home the information in the initial assessment was reviewed and amended where there had been any changes. This ensured that there was up to date information about each person from which to develop a plan of care. A number of relatives told us that Colonia Court was of a much better standard than the previous homes that the residents had been in. One resident told us They made me feel very welcome when I first came in. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents were generally well met through robust care planning, good standards of medicines administration and appropriate access to other health professionals. Further development of person centred care planning that includes end of life care preferences will enhance residents experience. Evidence: All the residents and relatives we spoke with during the inspection said that they were very happy with the standards of care at Colonia Court. They said that staff were very caring and gave individualised care. Observation and discussion with staff confirmed that they were aware of residents needs. We looked at the care documentation for two residents on each of the four houses. The care plans we looked at were detailed and generally covered residents care needs, as identified in discussion with residents and staff and from evidence in the other records. Some of the care plans we looked at were written from the point of view of the resident and described their preferences, choices and abilities and provided evidence that staff were very familiar with their individual needs. Others were written more as tasks for nurses or care staff to carry out and did not give the impression that residents or relatives had been directly Care Homes for Older People Page 13 of 30 Evidence: involved in drawing them up. The managers on each of the houses said that they would provide some guidance for staff to enable them to revise the care plans and make them more personalised. Staff had carried out a range of assessments which included assessments of the risk of falls, of developing pressure sores or malnutrition and the potential risks associated with moving and handling. There was also evidence that staff were taking steps to reduce the potential harm to residents once a risk had been identified. For example providing pressure relieving mattresses if they were identified as at risk of developing a pressure sore or providing pressure mats by a residents bed to alert staff if they were at risk of falling when unsupervised. However, some of the risk assessments were not relevant to the individual residents and appeared to be involving staff in unnecessary additional paperwork. When we discussed this with the operations manager they told us that BUPA was revising their policy on risk assessments so that in future only risk assessments that were relevant to the individual resident would be carried out. The care plans and risk assessment were evaluated on a monthly basis and good detail was recorded when evaluating care and care needs over the previous month. Staff used a flip chart with pictures to assist communication with residents who were not able to speak, for example following a stroke. We observed that residents who remained in their room had a call bell within reach. Staff monitored residents weight on a monthly basis and if there was unplanned weight loss and health concerns they monitored their fluid and food intake. There was evidence that action was taken if residents lost weight (see section on meal and mealtimes). Residents with a pressure sore were on pressure relieving mattresses and were being turned regularly. The charts for monitoring fluid intake, turns and application of creams were being held in the office rather than the residents rooms. This would make it more difficult for staff to keep accurate records. Following the inspection staff said that the records would be held in residents rooms if they were in agreement. Staff told us that they had very good support from local GPs and nurse practitioners from the surgeries. Residents on Amber Lodge who had been diagnosed with Huntingtons disease also had input from a consultant psychiatrist on a fortnightly basis. Residents confirmed that staff arranged for them to see the GP when they had health concerns and that there were systems in place for them to have regular chiropody and optical and dental check-ups in the home. Residents on the two residential houses Mumford and Blomfield received their nursing support from the district nurses. There was evidence that residents were referred to the NHS for diagnosis and treatment when necessary. However, two residents on Mumford had Care Homes for Older People Page 14 of 30 Evidence: longstanding pressure sores that were not healing. Staff told us that following the inspection they would arrange for a referral to be made to the tissue viability specialist nurse for advice on their treatment. Relatives told us that staff contacted them if residents had an accident or health concerns. There were good records of communication with relatives. One resident on Amber Lodge had particularly challenging behaviour. Staff had been working with the GP, consultant psychiatrist, the mental health crisis team and had involved the police to help them manage the residents behaviour. The resident was receiving 1:1 supervision at the time of inspection in order to ensure other residents remained safe. A restraint form had been completed following discussion with the residents family and social worker. This clarified that the restraint used was the minimum possible to protect other residents, relatives and staff. The medication systems were discussed with the registered nurses from Paxman House and Amber Lodge. Medication was provided from Bupa Homehealthcare in monitored dosage systems and in individual containers and was administered by the registered nurse or senior care assistant in charge of each house. Each nurse/senior had responsibility for the ordering, administration and disposal of medicines for their designated house. We were informed that the supplying pharmacy provided staff training and all staff undertake level 2 medication training (confirmed from the records) and an external tutor assesses competencies. The home had a medication policy and procedures for staff guidance which included protocols for PRN (as required) medication. A list of staff signatures and initials was maintained to enable appropriate follow up in the event of an adverse incident. Medication was stored on each house of the home. The medication for Paxman House was inspected. Appropriate procedures were in place for the receipt and disposal of medication that were seen to be well adhered to. Medication was stored in a locked clinical treatment room in two locked trolleys (not secured to the wall) and in locked cupboards and a controlled drugs cupboard. A drug refrigerator was also available for medicines requiring cold storage. An air controlled unit was fitted to the room to stabilise the temperature. Room temperatures were monitored and recorded to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade). Refrigerator temperatures were also monitored and recorded and were noted to remain within safe limits. The medication storage and medicines administration records for four residents were examined. All medication was available as prescribed and records were well recorded. There was evidence of some monitoring of records, however one aspirin tablet was still in the dispenser although signed as having been given. The records for a medication for another resident appeared to Care Homes for Older People Page 15 of 30 Evidence: indicate that it had been refused but there was no reason recorded. There was a cupboard for Controlled Drugs (CD) Storage that met requirements. The CD register was generally well recorded. However entries included only the name and not address on receipt and disposal. One resident had chosen to self medicate and a risk assessment had been undertaken and recorded. There was also evidence in care records that staff carried out a risk assessment if residents wish to take their own medicines and monitored their continued ability to do so safely. Amber Lodge medication systems and storage were found to be satisfactory and records well recorded with no issues identified. Residents told us that staff treated them in a respectful manner and respected their privacy and dignity. It was good to see that a privacy screen was provided in bathrooms to enable residents privacy to be upheld when receiving personal care. There was a record of whether residents preferred to have their care provided by female or male staff. However, staff have to be aware that the manner in which they ask the question can make it difficult for some residents to state their genuine preferences. One female resident had a record that they were happy to have their care provided by a male carer but in discussion with us they twice referred to the fact that they preferred to have their care provided by a female carer, despite the fact that we had not raised the issue with them. This same resident had a considerable amount of facial hair but there was no record of whether they wished staff to assist them with this. On enquiry their razor was found to be broken but staff had not taken action to address this. The head of care said that it would be promptly addressed following the inspection. In some care documentation we saw evidence that staff had discussions with residents, and relatives where appropriate, about their end of life wishes. This included preferences as to whether they would wish to be admitted to hospital if they became terminally ill or would prefer to receive their care at Colonia Court. The GP who regularly supported residents on Amber Lodge had written to relatives offering to discuss end of life care. However, some staff at the home obviously found it very difficult to broach the subject or considered that they could not have the discussions with a resident if relatives and the GP were not present. On Amber Lodge, it was particularly important to try to ascertain residents wishes in relation to receiving their food via a PEG when they developed swallowing problems, whilst they still had the mental capacity to be involved in the decision making process. The operations manager said that staff would be given some additional training on how to handle this sensitive subject. Care Homes for Older People Page 16 of 30 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. Residents can be assured they will receive well balanced and nutritious meals and be supported to keep in contact with their family and friends and have opportunities to take part in social activities that satisfies their cultural needs and expectations. Evidence: Each of the houses had their own activity co-ordinators who arranged group activities and outings, as well as spending one to one time with residents who were very frail or preferred to remain in their rooms. The activity co-ordinators arranged activities to suit the residents tastes and preferences. These included games, bingo, quizzes, walks in the gardens and reading the newspapers. Some of the activity records we looked at related to groups rather than records for the individual residents. This would not enable residents response to activities to be monitored very easily. There was an activities room and an internet room on Amber Lodge. Two residents on Amber Lodge had treatment from a reflexologist, which they paid for themselves and two had music therapy that was arranged via the local hospice. A Huntingtons disease support group was held on Amber Lodge once a month, which relatives found very helpful. Staff on Mumford House had arranged a session for relatives with their dementia care trainer. Relatives told us that they were made to feel very welcome when they visited Colonia Court. Care Homes for Older People Page 17 of 30 Evidence: Entertainments were arranged approximately every two months, usually on Blomfield House and residents from different houses attended together. Residents told us that the home celebrated Christmas and Easter with parties and had a birthday cake on residents birthdays. There was a communion service held every week on Paxman House and residents from other houses attended if they wished. Staff told us that they arranged for residents to receive support from local clergy if they made a request. Some relatives brought their dogs into the home, which a number of residents very much appreciated. Outings included visits to the local supermarkets, garden centres, cafes and shopping in Colchester. The home had a mini bus that could take people in wheelchairs. Staff said that they tried to arrange an outing every week. The residents on Amber Lodge used individual taxis, which were more suitable for their condition. Residents told us that they were aware of the activities and chose whether they wished to join in. They said that they got up and went to bed when it suited them and chose where they spent their day and had their meals. They confirmed that staff encouraged and supported them to maintain their abilities and independence. The kitchen was viewed and was clean and very well organised with rigorous systems in place to ensure cleanliness and the safe storage of food. Supplies were seen to be plentiful. Menus were viewed and comprised a varied seasonal menu with alternatives offered and specialist diets catered for. We were shown a night box that was being prepared for residents in each house. This was stocked with bread, yoghurt, custard, sandwiches and soup for residents should they want a snack after supper. Residents were generally very appreciative of the quality of the food and choices available. One resident told us They do offer alternatives if you dont like whats on the menu but theres usually a good choice. A range of diets were catered for. Staff monitored residents weight on a monthly basis and provided additional snacks, enriched food or requested supplements from the GP. They involved a dietician if they could not reverse unplanned weight loss or residents in the home required feeding via a PEG. Residents on Amber Lodge had extremely high calorie needs and progressive problems with safe swallowing. A dietician and a speech and language therapist visited the residents on this house on a monthly basis to advise on their specific needs. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured their concerns and complaints will be listened to and acted upon and they will be protected by robust recruitment procedures. However delays in referring some safeguard alerts do not provide assurance they will always be taken seriously. Evidence: The complaint procedure was observed to be displayed in each unit of the home and was included in the statement of purpose. The procedure was seen to include timescales for a response and met regulatory requirements. The record of complaints was viewed. All issues, no matter how minor were recorded and acted upon. It was clear that issues were taken seriously and used to improve the service. A number of residents told us that they had not had any complaints about the home. One resident who had raised a complaint said that staff had dealt with the issue straight away. Numerous thank you cards and letters were observed on display in the units of the home, thanking staff for the care and attention. The Home had a safeguarding policy and procedures and a whistle blowing policy in place to ensure residents were safeguarded from abuse. We were informed that the registered manager was the designated trainer for safeguarding. The records viewed during the visit to the home confirmed that staff received training on abuse during their induction, through NVQ level training and updated training was provided annually. The home had copies of the Essex Safeguarding procedures available for staff guidance to be used in the event of an allegation being made. There had been Care Homes for Older People Page 19 of 30 Evidence: several safeguarding alerts made since the previous key inspection, some of which were delayed in being referred and a number referred by other agencies. We were informed that the manager had not been aware that pressure sores should be referred under safeguarding. It was also explained that the delays in referrals had occurred as the deputy manager had waited for the manager to return from leave as she was not confidant in completing the referral form to the local authority. We were informed that she was now confidant to make referrals in the absence of the manager. From an inspection of records and discussion with the operational manager and deputy manager it was evident that appropriate action had been taken following the investigations. Care Homes for Older People Page 20 of 30 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. Colonia Court provides a clean, well decorated, comfortably furnished and well maintained environment for residents with appropriate aids and adaptations to aid their mobility. Evidence: A tour of the premises was made during the visit to the home. The main building comprised reception, management and administrative offices and services (kitchen, laundry, hair salon, maintenance etc). Each unit of the home (Paxman House, Amber Lodge, Bloomfield and Mumford House) was a separate single storey building that was secure with individual door entry systems in place. We were informed that each unit operated independently with designated staff. The units were welcoming with information on display for residents and visitors and a separate visitors book. Lounge/dining facilities were provided in each of the units with a small kitchen with fridge, dishwasher and tea and coffee making facilities. Staff facilities were provided in each of the units. All rooms were single en-suite toilets with a separate handbasin. Several residents rooms, communal rooms, bathrooms, a shower room, the kitchen and laundry were viewed. All accomodation was well decorated and well furnished. The home looked clean on the day of this unannounced inspection. Two relatives told us that they found the home very clean. However in Paxman House some chairs were observed to have stained arms and seats caused by spilled drinks. With the exception of one residents room in Mumford House and one in Blomfield House, there Care Homes for Older People Page 21 of 30 Evidence: were no malodorous smells. We were informed that it had been agreed to replace one of the carpets. The home had a programme of maintenance in place with full-time maintenance staff employed. The gardens were attractive and were laid to lawn with flowers and shrubs planted and were accessible to residents and wheelchair users. Fruit and vegetables were also planted to provide fresh produce. Some raised beds were provided for residents who were able to assist with light gardening. Mumford House (dementia unit) had an enclosed garden with a pergola, avery and seating. We were informed that this enabled residents, accompanied by staff to spend time in the garden and was of particular benefit for those who became agitated. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. Two relatives told us that they found the home very clean. Amber Lodge have a number of residents who smoke every hour and staff have to supervise them because of the danger to themselves and others. However there is no extractor fan in the room. A risk assessment of the environment should be undertaken to consider the concerns of passive smoking for staff. The home comprised ground floor accommmodation throughout. There were grab rails in corridors and aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. Profiling beds were provided in Paxman House to enable the nursing/palliative care needs of residents to be appropriately met. A range of specialist pressure relief equipment and hoists with a variety of slings were seen to be available to meet the needs of individual residents. There were infection control policies and procedures in place for staff guidance and the records confirmed that since the previous key inspection a distance learning course on infection control had been provided annually which most staff had attended. The laundry room was large and well organised with entry/exits for clean and dirty laundry. There were three washing machine that had the capacity to carry out sluice cycles (wash at minimum 65 degrees for not less that 10minutes) and two driers. Hanging rails and shelving was provided for sorting of laundry and arrangements were in place for labelling of personal items of clothing to reduce the risk of laundry not being returned to the rightful owner. A rotary iron and domestic iron and ironing board were provided. Personal protective clothing and alginate bags for safe handling of foul linen were observed to be available for staff protection. Care Homes for Older People Page 22 of 30 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 can be assured they will be cared for by skilled, experienced and well trained staff who are employed in sufficient numbers. Evidence: We were informed that each unit had designated staffing (registered nurse, care staff, activities coordinator and housekeeping staff) and that care staffing levels were increased to meet the individual needs of residents, for example to meet increasing dependency needs or to support residents going out of the home. Registered nurses were employed to supervise care staff in the nursing units (Paxman and Amber Lodge) and senior care assistants supervised care staff in the remaining units of the home. The manager was on leave and we were informed that in addition to the deputy manager there was an administrator, a receptionist, a maintenance person, three laundry assistants, a chef and two kitchen staff. During the visit to the home, staff were noted to spend time interacting with residents. Staffing appeared adequate to meet residents needs on the day of the site visit and duty rotas viewed confirmed that these levels were maintained. A relative spoken to told us the staff are great and x has everything x needs. The manager informed us that there were a total of 93 care staff employed of which forty four had an NVQ level 2 qualification or above. This equates to 35 which is below the recommended standard for 50 of staff to have an NVQ level 2 Care Homes for Older People Page 23 of 30 Evidence: qualification. A further 7 care staff were registered on the NVQ programme. We were informed that there had been difficulties with accessing courses and funding and that a number of staff had not been accepted on the course. The recruitment files for five recently employed staff were viewed. All files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. The files also included staff contract/terms and conditions detailing their legal rights of employment. The home had a comprehensive training programme that included mandatory training that was a requirement for all care staff (health and safety, manual handling, fire safety, first aid, COSHH, medication, basic infection control, food hygiene etc) and an extensive range of training to meet residents and staffs individual needs, for example dementia, safeguarding adults, medication, nutrition, introduction to activities, challenging behaviour etc. During the site visit staff were observed watching a fire safety training video. We were informed that these were recently employed staff who were on induction. The records for the same five staff were viewed and confirmed they had attended training in fire safety, health and safety, Control of Substances Hazardous to Health (COSHH), Safeguarding Adults, manual handling, infection control, basic food hygiene and Personal Best (a Bupa programme that encourages a person centred approach to all tasks). Care Homes for Older People Page 24 of 30 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 can be assured that the home is well managed, run in their best interests and aims to protect health and safety of residents and staff. Evidence: The home had a registered manager who was supported by a deputy manager and a team of administrative and ancillary staff. The manager was not on duty on the day of the site visit. We were informed that he had managed the home for a number of years. From records viewed and discussion with senior management and staff was evident that he had the skills, knowledge and experience to the care home. From observation and an inspection of records, the home appeared to be well managed. The quality assurance systems for the home were discussed with the deputy manager of the home. The home followed the Bupa QUEST system. Annual surveys were distributed to residents and their relatives and a report and action plan produced from the review. We were informed that arrangements had been made to contract with an external provider for a quality assurance review. A range of audits were undertaken at Care Homes for Older People Page 25 of 30 Evidence: the home comprising audits for health and safety, finance, medication and services (laundry, kitchen, housekeeping, maintenance) which were confirmed from the records viewed. This demonstrated that there were robust systems in place to monitor operational activities at the home in order to safeguard residents and staff and to continually improve standards. The homes arrangements for managing residents personal allowances was discussed with the administrator. All monies were paid into one residents account and a nominal amount of petty cash held at the home for their access. Additional charges for hairdressing and chiropody were invoiced directly for some residents, however some residents preferred to pay with cash. Records and receipts were held for transactions and a staff member acts as witness. Records held on behalf of residents were seen to be kept up to date and were stored safely in lockable facilities. Records viewed at this inspection included: the statement of purpose, assessments/care plans, medication records, staff recruitment and training records, policies and procedures, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms and emergency lighting etc.). Records were maintained of fire drills. Advice was given to also include the names of staff attending to ensure that all staff, including staff working at night, attended regularly. Maintenance checks on equipment did not include calibration of weighing scales to ensure they were accurate and this was brought to the attention of the maintenance person who agreed to take action. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 9 13 Omissions of medication 20/08/2010 must be followed up and the reason recorded. This will ensure residents are safeguarded. 2 9 13 CD registers must record the 20/08/2010 name and address on receipt and disposal of all CD drugs. This will ensure they are safeguarded. 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 7 Person centred care planning should be further developed to ensure residents views and preferences including end of life care are taken fully into account. Medication trolleys should be secured to the wall in lockable storage rooms. This will ensure they are appropriately safeguarded. Regular cleaning of chairs should be undertaken to ensure Page 28 of 30 2 9 3 26 Care Homes for Older People 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 stains from spilled drinks are removed. 4 38 Weighing scales should be calibrated to ensure they provide accurate readings. Care Homes for Older People Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - 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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