Care Home: Corbett House Nursing Home

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What the care home does well People who are thinking about moving in to the home are given information about the home so that they know what to expect if they choose to come and live there. A pre admission assessment is carried out before some one comes to live at the home so that the home can decide if it can meet the person`s needs before they are offered a place in the home. Individual care plans are available for all people living at the home so that staff have information about people`s health and personal care needs. All people using the service are registered with a doctor so that they have access to advice about their health care to help keep them well. The home has no restrictions on visiting which means that people can see their visitors as they choose and maintain relationships that are important to them. Robust recruitment procedures are carried out before staff come to work at the home so that people can be confident that staff employed are suitable to work with older adults. New staff receive induction training so that they have some of the basic skills they need to meet people`s needs. Arrangements are in place to seek people`s views about the home and the service they receive so that this information can be used to improve the service offered. The management of the medication is good and ensures that the people living there receive their medicines as required and the nurses assess and assist individuals to manage their own medication. The relationship between the staff, people who live their and their relatives is good and enables smooth communication. Staff try to make sure that the house is clean and tidy, so that residents can feel comfortable and safe at home. What has improved since the last inspection? A member of staff shows people the planned menu on the night before it is due to start the next day so that each person is able to choose their meals. Fresh fruit is provided each day and this can be found in bowls in the lounge on the day of inspection the cook replenished this with some new fruit. We also saw some fruit in bowls in a person`s bedroom. This shows that a variety of fruit is provided for people. We were told that the refrigerator where the medications are stored is regularly defrosted. Information about how people who live in the home and relatives can raise their complaints is noted in the statement of purpose and service user guides. There is also a notice displayed in the entrance hall of the home. There are also resident and relatives meetings where individuals are able to raise their complaints. The home has good policies and training for the protection of vulnerable people and all staff have received protection of vulnerable adults training which is documented on the training matrix. There is not now a dedicated smoking room for all people who live in the home but individuals who smoke do so in their rooms and there is a risk assessment which details this for staff to follow. The registered manager told us, `Water temperatures in rooms are checked and recorded at least monthly and thermostatic control valves have been fitted`. This should ensure that people are safeguarded from scolds. Hoists continue to be stored in the hall way of the home but the registered manager as developed risk assessments which provide details to ensure people remain safe within their home. Bed rails are used where appropriate with risk assessments in place and staff receive guidance to ensure people are safeguarded from their limbs becoming trapped and injured. The registered manager audits accident reports so that any trends and or patterns are highlighted so that action is taken to reduce any risks. The registered manager has now obtained their Leadership and Managers Award so they have further knowledge and skills required running the home. Also the registered manager has told us that they have also completed a distance learning course in healthy eating. What the care home could do better: Information in the statement of purpose and service user guide should be made readily available and accessible in alternative formats, such as, audio visual. This will make sure all people are able to understand the information provided regardless of their abilities. Staff practices need to ensure that people`s concerns are listened to and action taken so that peoples dignity is upheld at all times. People`s social histories should be further developed so that staff can have meaningful conversations with individuals and activities hold some value. Some consideration should be given to employing a dedicated activities coordinator so that one to one and group activities are promoted. This should ensure people receive the support needed to lead meaningful lives.The practice of putting blue plastic aprons on people at meals time should be reconsidered. This is to make sure that people`s dignity is fully respected. Consideration is given to involving people who live in the home in their own menu planning for the week to promote their choices and impendence. The garden area of the home is not secure garden so people using the service can benefit from fresh air if they wish. Key inspection report Care homes for older people Name: Address: Corbett House Nursing Home 40/42 Corbett Avenue Droitwich Worcestershire WR9 7BE     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: Sally Seel     Date: 2 1 0 8 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 37 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 37 Information about the care home Name of care home: Address: Corbett House Nursing Home 40/42 Corbett Avenue Droitwich Worcestershire WR9 7BE 01905770572 01905779179 chris.bradley@redwoodcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Corbett House Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 25, Physical disability (PD) 25 Date of last inspection Brief description of the care home Corbett House is a large, detached, Victorian property, which has been extended and adapted for its present use as a care home. It is situated in a quiet residential area in Droitwich. The home is registered to provide either personal or nursing care for a total of 25 people over 65 years of age who may have a physical disability. The home may also provide care to a maximum of two people over the age of 65 years who are terminally ill and one named person with a physical disability who is below 65 years of age. Care Homes for Older People Page 4 of 37 Over 65 25 0 0 25 Brief description of the care home The residents are accommodated on two floors. A vertical passenger lift is provided. An experienced registered manager manages the home on a day-to-day basis. The aim of the home is to provide a high standard of care in a safe, comfortable and homely environment in which residents are treated with dignity and respect. The fees at Corbett House currently range from 508.00 for a single room and 479.00 for a shared room. However, interested parties should make contact with the home to confirm the correct fees at the time of their request. Fees do not include hairdressing, chiropody (private) or for items such a newspapers, dry-cleaning and taxis. Care Homes for Older People Page 5 of 37 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 care home is 2 Star, which means that the outcomes for people using this service are good. The last inspection on this service was completed on the 5th September 2007. This was an unannounced key inspection that took place over one day on the 21st August 2009. The purpose of this inspection is to look at all areas of the service to ensure that the outcome for people living there is good, safe and appropriate. This inspection also enables us to ensure that the service runs according to legislation and regulations. We case tracked three people who live in the home of which one person recently came to live in the home. Case tracking involves reading each persons care records, Care Homes for Older People Page 6 of 37 discussing their care with staff, visiting each person and discussing their experience where possible. We also looked at policies and procedures related to safeguarding, concerns and complaints and medication. Any new policies and procedures were also examined. Discussion with the registered manager and the quality assurance manager took place together with discussions with the nurses and care assistants. We have referred to these discussions throughout this report where it has been appropriate to do so. The registered manager supplied us an Annual Quality Assurance Assessment (AQAA). Each registered service is required to submit an AQAA each year, this is a form of self assessment. Information from this has been used in the following report. During the process of the inspection we viewed a variety of areas of the home including the kitchen, laundry and the communal and some private rooms of the people who live there. Thanks are due to people who live in the home, registered manager and staff for their co-operation and hospitality throughout the inspection process. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? A member of staff shows people the planned menu on the night before it is due to start the next day so that each person is able to choose their meals. Fresh fruit is provided each day and this can be found in bowls in the lounge on the day of inspection the cook replenished this with some new fruit. We also saw some fruit in bowls in a persons bedroom. This shows that a variety of fruit is provided for people. We were told that the refrigerator where the medications are stored is regularly defrosted. Care Homes for Older People Page 8 of 37 Information about how people who live in the home and relatives can raise their complaints is noted in the statement of purpose and service user guides. There is also a notice displayed in the entrance hall of the home. There are also resident and relatives meetings where individuals are able to raise their complaints. The home has good policies and training for the protection of vulnerable people and all staff have received protection of vulnerable adults training which is documented on the training matrix. There is not now a dedicated smoking room for all people who live in the home but individuals who smoke do so in their rooms and there is a risk assessment which details this for staff to follow. The registered manager told us, Water temperatures in rooms are checked and recorded at least monthly and thermostatic control valves have been fitted. This should ensure that people are safeguarded from scolds. Hoists continue to be stored in the hall way of the home but the registered manager as developed risk assessments which provide details to ensure people remain safe within their home. Bed rails are used where appropriate with risk assessments in place and staff receive guidance to ensure people are safeguarded from their limbs becoming trapped and injured. The registered manager audits accident reports so that any trends and or patterns are highlighted so that action is taken to reduce any risks. The registered manager has now obtained their Leadership and Managers Award so they have further knowledge and skills required running the home. Also the registered manager has told us that they have also completed a distance learning course in healthy eating. What they could do better: Information in the statement of purpose and service user guide should be made readily available and accessible in alternative formats, such as, audio visual. This will make sure all people are able to understand the information provided regardless of their abilities. Staff practices need to ensure that peoples concerns are listened to and action taken so that peoples dignity is upheld at all times. Peoples social histories should be further developed so that staff can have meaningful conversations with individuals and activities hold some value. Some consideration should be given to employing a dedicated activities coordinator so that one to one and group activities are promoted. This should ensure people receive the support needed to lead meaningful lives. Care Homes for Older People Page 9 of 37 The practice of putting blue plastic aprons on people at meals time should be reconsidered. This is to make sure that peoples dignity is fully respected. Consideration is given to involving people who live in the home in their own menu planning for the week to promote their choices and impendence. The garden area of the home is not secure garden so people using the service can benefit from fresh air if they wish. 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 10 of 37 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 11 of 37 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 living at this home have sufficient information made available to them in order to make an informed choice about whether the home is the right place for them. Each persons needs are assessed prior to living at Corbett House to ensure that these are able to be met. Evidence: On entering Corbett House there is a wealth of information for visitors to read if they wish and for people who live in the home as a reminder. For example, we found the book that is used for visitors to sign in and out of the home, complaints procedure, advocacy leaflets, certificates detailing the homes registration and public liability insurance. We also found information about the home which is detailed in the statement of purpose and service user guide. On closer inspection of the statement of purpose we found it was dated July 2009 and had information abut what people can expect if they choose to live at Corbett House. Care Homes for Older People Page 12 of 37 Evidence: The registered manager in their AQAA, (Annual Quality Assurance Assessment), informs us that the homes brochure which includes the service user guide, which we found to be dated February 2008, is given to all people who may be considering whether the home is right for them. We found details of when people are given brochures about the home in the care records that we looked at. The registered manager said that the service user guide has, copies of our residents charter, statement of purpose, complaints policy, scale of charges and Terms and Conditions for both Local Authority Funded and Privately funded residents. We also saw the current fees charged for living at the home which are £508.00 per week for a single room and £479.00 per week for a shared room. There is confirmation that these fees were correct as at April 2009. This will help people to consider the financial costs of choosing to live at Corbett House. We were told that the statement of purpose and service user guide can be made available in large print so that people with sight difficulties are able to read the information about the home. We now recommend that some consideration is made to ensure that these information booklets are available in audio visual formats. This should improve their accessibility to all people regardless of their abilities. The statement of purpose and service user guide indicate that people are welcomed to visit the home prior to moving in so that they can meet the other people who live their and staff. Visits also provide useful insights into what service and facilities are offered to meet a persons needs. Indeed in the care records we looked at we found details that informed us that some people do choose to visit the home. We looked at care records for a person who had recently moved to live at Corbett House. There is a preassessment completed for each person, prior to coming to live at the home. From this assessment initial care plans are developed and all equipment is put into place. There was also an assessment completed by a social worker that also provided some information about the persons life and range of their needs. This shows that peoples needs are assessed prior to them moving into Corbett House. This makes sure staff are able to meet a persons needs from day one of them moving into the home to promote peoples health and wellbeing. Care Homes for Older People Page 13 of 37 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. Personal and healthcare needs are clearly identified in care plans. These plans provide information to promote consistency of care and support for all people who use the service. Medication practices are good to ensure each person receives their medication as prescribed by their doctor to maintain their health. Evidence: We case tracked three people who live at the home which involved reading all the records related to these people, visiting them, discussing their care with staff and judging the outcomes of the care provided. In each care record it was found that there were care plans. These are plans that determine how each persons needs are met and provide staff with the necessary guidance. This makes sure that people have the help and support that they need. We found a variety of care plans to cover, personal hygiene, mobility, incontinence, communication, and nutrition. We looked to see if people are receiving personal care in the way they prefer and at times to suit them. One person care plan detailed, All help with daily living activities and experiences shortness of breath on exertion. In another we saw, Needs all help Care Homes for Older People Page 14 of 37 Evidence: with hygiene but able to wash face and hands. These reflected the variation that provides staff with the insight and guidance to meet each persons hygiene needs. Indeed on the day we visited we observed people to be dressed appropriately for the weather conditions that day which was sunny and warm. For example, some females wore skirt and others had trousers on with short sleeved blouse and tops. Males wore trousers and short sleeved tops. We also saw some people had their own particular likes in what jewellery they wore, such as, different styles of watches, bracelets and necklaces. People looked clean and staff were busily helping and supporting people to complete their personal hygiene tasks, such as, bathing and dressing to start their days. Care plans could be further improved by stating peoples preferences as to whether they would like a male or female staff member to help them with their personal hygiene needs. This should make certain that peoples choices are respected and their dignity upheld whilst completing personal hygiene tasks. All care is reviewed monthly or more often if needed. The evaluation explained if the care given had the desired outcome or if changes were required. Care plans were seen to reflect any changes. Later in the day one person was observed requesting some under wear as they could not find this in their room. The member of staff said that it was in the persons room. This person wanted to show me their room. The person opened all of their drawers and wardrobe searching for their under wear garments but they were not there. We advised the registered manager of this situation and a member of staff fetched the under wear garment from the laundry room. We recommend that staff support people by checking with them if the person is stating they are missing an item of clothing or any other item as it can cause the person some distress. Also if people are left without under wear garments and are in the communal parts of the home, such as, the lounge then their dignity is not maintained. Some people living in the home are able to walk around freely but others needed some assistance. For example, we discreetly observed staff hoisting people. This is a type of equipment that is used when moving people who are unable to stand and walk on their own. We saw people being hoisted out of their wheelchairs and into chairs in the lounge area so that individuals comfort would be maintained together with ensuring health and safety. We noticed that this was done with respect for each person, such as, reassuring the person as the maneuvers were completed taking into account of each persons mobility difficulties and listening to peoples feelings. Other people in the home were seen to move around as they chose in their wheelchairs. We looked at care plans for staff to follow in relation to assisting and supporting people when using hoists. Care plans and risk assessments, such as, mobility and falls, Care Homes for Older People Page 15 of 37 Evidence: moving and handling, skin breaking down and developing sores. There were people who needed other specialist equipment to maintain their skin care, health and safety. For example, there are pressure mattresses in place and bed rails. Following the last inspection a requirement was made to make certain staff are following care plans in relation to and that bed rails are safely in place with bumper cushions. Pressure mattresses are part of peoples skin care needs so that skin is not sore for individuals and bed rails help people to remain safe in bed when they have been assessed as at risk of falling out. The registered manager said that bed rails are checked regularly so that there are no inappropriate gaps where peoples limbs are able to become trapped and injured. There are maintenance records in rooms to make certain this practice is documented. Also there are guidelines for staff to follow which are displayed on walls as reminders and information purposes. In some care records there was clear written evidence in that staff have an understanding of how to assess and manage aggressive and challenging behaviour, which can be experienced with people who have dementia and other forms of mental health difficulties. The registered manager in their AQAA said, Introduced distance learning in dementia awareness for all care staff to enhance knowledge of dementia and highlight differences in person centered care rather than task oriented. It was observed that the nurses and care assistants knew each person and in the main managed their frustrations and distress appropriately minimising the effects and ensuring a good outcome. Discussion with three staff told us that they had received some training and were looking forward to further training to assist them to deliver good care. In one survey received from a relative they responded to what the service does well by stating, Looking after residents. In one staff survey it said, I think the care in the home is very good and in another one it confirmed, Palliative care is very good and I feel that communication between the home and outside agencies is always good e.g. chiropodist, physio, continence nurse, stoma care nurse, district nurses, ordering air beds, dietician, GP reviews. All people in the home have access to other professionals such as the GP, district nurses, tissue viability nurse, community mental health nurses and consultants. They also have access to the optician, dentist and chiropodist. All medications are kept locked in an appropriate trolley which is secured to the wall on the upstairs landing of the home. The nurses give people all of their medications and are trained to do this. Care Homes for Older People Page 16 of 37 Evidence: We sampled the medications of people we case tracked with the registered manager. The medication is prescribed by the persons doctor and made up by the pharmacist into Monitored Dosage System (MDS). The pharmacist completes regular audits of medications. We looked at the Medication Administration Records (MAR) and found that the nurse who gives the person their medications signs when this has been done to make certain people are receiving their correct dose of medication at the times prescribed by their doctor. The MAR tallied with the amount of medications that were in the MDS and in any separate original containers which clearly illustrated on them how many tablets were in the container. We only found one container that did not have the number of tablets documented on it but the registered manager will ensure that this is done. During the day we saw that staff spoke appropriately to each person and addressed him or her, as they would wish. We also saw a member of staff recognising that a person required some support for their arm whilst they were sitting in a chair. The member of staff got a cushion to ensure the persons arm was supported in a comfortable way. This shows that staff are working hard to provide good care for people living at Corbett House. Care Homes for Older People Page 17 of 37 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. People who use the service receive help and encouragement to lead active and interesting lives and are supported to access facilities within the wider community. These activities are however, dependent upon there being enough staff to provide adequate support. There is a well balanced menu and promotes healthy eating for the welfare of people who use the service but individuals could be involved more in menu planning. Evidence: On the day we visited we observed people taking part in throwing and catching a large dice and looking at photographs that had been taken which are then either displayed in the home on the walls or placed in photograph book as memory reminders. We looked at the photographs displayed around the home in the lounge areas and hallways. These were taken when people living in the home were enjoying a particular event. We found that Christmas, Easter, Halloween, Remembrance Sunday and birthdays are celebrated. We also saw photographs of people enjoying days out at the local Jinney Ring Centre, Lido Park and picnics. We looked at the timetable of events which we found on display in both the lounge and by the front entrance to the home. This showed us the forthcoming events that are planned, Droitwich Salt Day, sing a long, resident and relatives meeting, Harvest festival, keyboard player and Christmas Care Homes for Older People Page 18 of 37 Evidence: shop. We observed some staff take time to have a chat to people who live in the home but this was not easy to achieve in the morning due to how busy staff were. Also the homes rear garden is not secure so people are only able to use this when staff have some time to accompany and supervise individuals. It was a nice day when we visited and some people would have liked to go out into the garden area. However, from our observations staff were too busy to do this in the morning period. One person told us that they used to be outside a lot as they kept goats and ducks. Therefore it would be good if the provider gave some consideration to securing the homes rear garden so that people are able to go outside to sit as they choose particularly in the warmer weather so that they are able to get some fresh air which is beneficial to peoples sense of wellbeing. We spoke with a member of staff who provides and support people with their care needs but also spends some of their day in ensuring individuals gain social stimulation and activities they enjoy. The staff member told us that they spend about hour and a half in the morning and afternoons providing and supporting people with some social activities. We discovered through our observations and from speaking with people who live in the home and other staff that the social stimulation and activities that are provided may not at all times meet the individual needs of people who live at Corbett House. For example, some people do not join in activities in the lounge area which is either by choice and their own abilities. There is some room for improvement to make certain that all individuals whatever their abilities and individual interests these are being met on a daily basis. This should then be documented within individuals daily records which can then be reviewed in line with care plans that support people with their social activities and stimulation. On the day we visited some people remained in their rooms through their own choice and or physical health. One person whose permission we sought to go into their room said that they were a little bored and would like to be supported to leave their room for awhile. The registered manager confirmed that they would make sure a staff member was able to give this person some time later. Another indication that staff members in throughout the morning period are busy in the home with personal care tasks and the nurse on duty is also giving people their medications. When some staff were spoken with they all said one more member of staff in the morning periods would be helpful in meeting peoples individuals needs. Also some people who live in this home have varying levels of confusion and short term memory loss. Staff told us that they volunteer some of their own time to take people out on outings which mean that the management team are relying on the goodwill of staff. Some consideration should Care Homes for Older People Page 19 of 37 Evidence: be given to employing a dedicated activities coordinator who is able to devote more time to both one to one and group activities. This will ensure that all people living in this home have help to maintain their individual social activities and stimulation which is so important in enhancing peoples sense of wellbeing. We also reviewed some peoples life histories that provide staff with useful insights into peoples past lives, relationships, work, interests and pastimes. This is a good tool that then can be transferred into a persons care plan so that staff can provide assistance and support in meeting an individuals social stimulation and activities. It also acts as a useful reminiscing guide. The registered manager has also recognised in their AQAA, Develop life history details in particular for those residents who have dementia as previous life events may affect current life experiences. We were told that people have the choice of participating in Holy Communion on a fortnightly basis within the home. We saw on the activities planner that songs of praise features every month and the AQAA informs us, Monthly communion service, plus hymns and prayers by Witton Chapel monthly. Salvation Army also visits twice yearly. This demonstrates that individuals are supported to maintain their own religious beliefs whilst living at Corbett house. The registered manager shared with us that recently a memorial service for residents who have died has been held which is a nice touch. The AQAA states that the memorial service was a huge success. On the day we visited people were choosing to have their hair styled by the visiting hairdresser. One person said that they chose not to have their hair styled. We saw visitors coming in and out of the home. People told us that their families and friends are welcomed at any time. In the statement of purpose it says, Service users family, relatives and friends will be encouraged to visit the service user regularly and maintain contact by letter or telephone when visiting is not possible. In the AQAA it confirms, Relatives are encouraged to take residents out particularly to attend family events to enable the resident to maintain their status within their family. Menus are planned on a four week rotating basis by the cook who has worked at the home for many years some staff said since the home opened. We reviewed these and found that a good variety of meals is on the menu planners with fruit and vegetables. We found it a little confusing to see any documentation that would tell us that people living in the home are having their say on what food they would like to see on the menu. We did look at the resident and relatives meetings to see if it was an agenda Care Homes for Older People Page 20 of 37 Evidence: item but could not find it noted there. Some staff told us that the cook plans the menus. Therefore we recommend that there is some planning of menus that takes place with the people who live at the home to make certain individuals choices are being respected throughout the four week menu planner. On the day we visited we observed the cook removed one old piece of fruit from the fruit bowl in the lounge and bring it back full of fruit. One of the people who live in the home showed us their room and they had two fruit bowls with fruit. Later in the day the inspector observed this person choosing to eat a banana. Therefore people living in this home seem to be being offered fruit and vegetable to maintain their recommended five a day as part of a nutritious and healthy diet. This also meets a requirement that was made following the homes last inspection in respect of fresh fruit should be made available to people each day. Staff told us that people are able to choose what they eat and if individuals do not like what is on the menu then their preferred choice will normally be met. Later in the day we observed a staff member going round to each person asking them their choice of food for the following day. This meets a requirement that was made following the last inspection which was to demonstrate that service people receive choice of menu for each meal. We discreetly observed from afar lunch being served to people. In the dining area that is off the one lounge area people chose to sit at the tables to eat their meals with others. Others had their meal in their rooms and some were assisted by staff to eat their meals. We saw staff planning blue plastic aprons on people at lunchtime which did not respect their dignity. We discussed this with the management team and we therefore now recommend that some consideration is made to another type of clothing covering is made available to individuals. The meals on the day were colourful, tasty, hot and filling. Two people told us that the food is lovely and we can have more if we want. Staff that we spoke with also told us that the meals were good. In one relatives survey in response to what the service does well it states, Meals. We saw a staff member put one persons Fortisip (nutritional supplement) on their side table without a full explanation. As the staff member was walking away the person asked them what it was. We discussed this practice example with the registered manager and operational manager as for good practice and to respect individuals staff should always acknowledge to the person directly what they are placing in front of them particularly when this has not been requested by the person themselves at that Care Homes for Older People Page 21 of 37 Evidence: time. We also observed two peoples drinks being placed on a side table that was not directly in front of them. The one person had the insight to go and fetch their hot drink. This person also noticed that the person sitting next to them could not reach their drink and did not have the same insight. This meant that the drink was getting cold. One staff member did after awhile notice this and fetched a side table. Therefore it is recommend that staff always place individuals hot drinks on their side table so they are able to reach for this as hot drinks do naturally go cold and we noticed that staff were very busy with other tasks. Environmental Health have recently visited and awarded the home 3 Stars Good for staff practices in the kitchen in relation to food and kitchen hygeine. Care Homes for Older People Page 22 of 37 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. Each person can be confident that any concerns or complaints will be listened to and dealt with. The policies, procedures and staff knowledge minimises the risk of abuse. Evidence: There is a complaints log book kept in the home which details all the complaints that the registered manager has received. The AQAA informs us that one complaint has been received by the registered manager in the last twelve months. The Care Quality Commission has received no complaints about the home. A requirement was made following the last inspection that the registered manager makes certain people know how to raise their individual complaints. We saw a copy of the complaints procedure in both the statement of purpose, service user guide which are hanging by the main entrance door. There is also a copy of the complaints procedure displayed and a large notice which the registered manager told us has been there for some time. We also saw copies of the resident and relatives meetings where individuals are supported to raise their complaints. People we spoke with appeared to know how to complain and would in the main approach the registered manager. This demonstrates that people living at Corbett House and any visitors to the home have knowledge around how to raise any complaints they may have. We have received a safeguarding referral which has been fully investigated under the local authorities procedures to ensure people who live at Corbett House are protected Care Homes for Older People Page 23 of 37 Evidence: from harm. Some staff that we spoke with showed that they had the knowledge in relation to recognising all forms of abuse together with how they would report this so that people living in the home are safeguarded from any potential harm. On examining the staff training matrix we saw that staff have received training in the protection of vulnerable adults and further training has been planned for August and September for some staff. The staff files that we reviewed demonstrated that there is a robust selection and recruitment process in place which ensures that staff who are employed are fit to work with vulnerable adults. Care Homes for Older People Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and offers a homely place for people to live. There is some areas that need to be considered for improvement so that it meets all of the needs of people who live there. Evidence: We viewed some of the bedrooms on the ground floor and first floor of the home which is a large Victorian house. These had been personalised with photographs and other small personal affects making these rooms individual and personal. The registered manager told us that they are happy for people to bring small items of furniture and any items that make them comfortable. We found this to be the case as one person showed us their room which has some of their own pieces of furniture, photographs of family members and pictures hanging on their walls which hold particularly meaning relating to their life. There are two lounges on the ground floor. One lounge is adjacent to the dining area of the home. There is a television, DVD, piano and music machine. We spent some time in this lounge which was clean, no smells, tidy but lived in. There are some recliner chairs available for those people who have difficulty sitting in normal seating. The dining area has small tables where people can sit in groups to share their meals if they choose. From our observations not all people who live in the home would be able Care Homes for Older People Page 25 of 37 Evidence: to choose to sit in the dining room for their meals due to lack of space in here. A recommendation was made at the last inspection for the registered manager to look at creating additional dining space. From our observations on the day we did not see anybody not having their choices respected in relation to wanting to sit at the dining tables and not being able to do so. The table is laid with a tablecloth, condiments, and small vase of flowers. Some people sat in the lounge area to have their meals and others had meals in their rooms. The other lounge on the ground floor is identified as a quiet place for people to sit if they choose and or see their visitors away from the main lounge area. There is limited storage space within the home, this means that hoists are stored in the hallway areas of the home and may get in peoples way. Following the last inspection a requirement was made to look at alternative storage spaces, such as, taking some of the room in the quiet lounge. It was agreed that this would result in people who live in the home not then having a choice of a quieter place to sit. Therefore we suggested that the registered manager completes risk assessments so that any identified hazards in relation to the storage of hoists in the hallway are acknowledged. This will also provide staff with guidance to follow in minimising any risks. The registered manager has now completed a risk assessments and sent this to us which shows, Following the last inspection a recommendation was made to colour schemes and signage so that people with confusion, memory loss or dementia can more easily orientate themselves around the home and maintain their independent. Although this service is not specifically registered for large numbers of people who have dementia and memory loss it was observed that if people did have dementia or memory loss they may not find it easy to find their way around themselves. We discussed this with the registered manager as some people living at the home do have dementia and memory loss. We recommended that some thought is given to colour schemes and signage is displayed on toilets, bathrooms and bedrooms to aid people in finding their way around the home independently. In one relative survey that we received they commented that there is wood rot on the windows. The registered manager confirmed that one window that could be the one that the relative is referring to as now been repaired which we were shown. Another relative survey said that the whole building inside and out could do with a general good clean. As mentioned earlier on the day we visited there were no smells and the registered manager confirmed that rooms are decorated on as soon as they become vacant and on the AQAA it informs us that ten bedrooms have been redecorated Care Homes for Older People Page 26 of 37 Evidence: within the last tweleve months. As commented on earlier there is a garden to the rear of the home is nicely planted and a ramp is now in place for wheelchair access. Some of the garden area does needs to be cleared of items of broken wood anf furniture. The registered manager in their AQAA states, Garden if freely accessible to all residents. We did not find this to be the case as the garden is not enclosed which means that it is not suitable for people to use in the warmer weather without direct supervision as they can easily access the road. This places them at risk of harm. We saw that relatives surveys asked if there was a possibility of putting a gate on the yard to enable their relatives to go outside safely. Staff also confirmed that people who live in the home would not be able to go out in the garden independently due to it not being secure. We discussed this with the registered manager and quality manager who acknowledged this as some people who live in the home told us they would like to go out into the garden. However, from our observations in the morning period staff would not have been able to devote some of their time to accompanying and supervising individuals in the unsecured garden area. Therefore we recommend that some consideration is given to securing the rear garden of the home so that people are not restricted in their choices of using the garden. Also it is good for peoples sense of well being to gain fresh air particularly as one person told us they used to keep animals and liked to be outside. Following the last inspection there was a requirement for all rooms to have suitable locks and people to have keys as they chose with consents documented in care records. We found that there are now completed forms in the care records we sampled which indicated whether people chose to have a key and or whether some people could not hold a key due to their own safety. This is important as it demonstrates that peoples rights and responsibilities are being upheld with evidence of practice documented. We did find that some rooms did not have door locks provided but the registered manager assured us that if it was appropriate and the person wanted to have a key then a lock would be put into place. The bathroom and toilets have liquid soap and paper towels and the disposal of incontinence produces is appropriate. We saw on the staff training matrix that staff have received infection control training and the AQAA confirms that twenty one staff have received this training. This helps to maintain good infection control practices so that people who live in the home are protected against any potential cross infections. Care Homes for Older People Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team understand their responsibilities and are committed to their role. They are well supported and work together to provide people who use the service with quality care, although staffing levels should meet the changing needs of individuals and the service. The homes recruitment policy and practices make sure that suitable staff are employed and that all necessary checks are made to ensure the safety of all people who use the service. Evidence: On the day that we inspected there were twenty one people living in the home. We were told that there are four staff on duty in the morning and three staff in the afternoon periods together with a registered nurse on all shifts. Through the night period there are two staff members one being a registered nurse. We examined the staffing rotas and these confirmed what we had been told. Staff that we spoke with said that one extra staff member in the mornings would help with providing help and support to people in providing personal care when people get up. In one staff survey it said, There are times when we appear to be very short staffed and staff appear to be working long hours and long weeks. In a survey we received from a relative it stated what the service could do better as, Interact more Care Homes for Older People Page 28 of 37 Evidence: with each resident and in a survey received from a person who lives in the home it said, Speak more to the people in the home. The registered manager confirmed that there should be one member of staff to five people. We recommend that this is now reviewed to reflect peoples dependency levels particularly in the morning periods. As we observed staff to be very busy providing and supporting personal care tasks with people, breakfast is being served and the nurse is giving people their medications. At one stage we were the only person with people who were sitting in the lounge area when we saw a person picking up a small object from the floor and putting it in their mouth. We heard another person stating that the person had eaten their tablet. We told a staff member who confirmed this incident to the nurse. After some investigation we were told that it could not have been a tablet as the person had already had their medication. It does illustrate that peoples safety could be at risk without appropriate supervision. The manager is committed to ensure that staff are trained to meet the varied and complex needs of the people at the home. Staff spoken with told us that training is offered regularly and responses to what the home does well from staff surveys told us:Distance learning courses for staff Good training I think management are good with supplying us with the training to make us better at our jobs. We sampled the training matrix and found that all staff including ancillary staff are now receiving adult protection training as this was made a requirement at the last inspection. Other mandatory training consisted of, manual handling, health and safety, infection control, first aid, fire safety and protection of vulnerable adults. Other specialised courses have also been completed in, challenging behaviour, communication, continence, dementia and stoma care. The AQAA informs us that trained staff have received training in, Male and Suprapubic catheterisation. Dressing selection, Tissue viability conference and Diabetes. Three staff also trained to use public access defibrillator. This should ensure staff are skilled at managing various medical and health issues that may arise. The AQAA confirms that 71 per cent of care staff are trained to a minimum of National Vocational Qualification in Care level 2 or above but the relevant part in the AQAA has not been completed to identify the precise numbers. All new employees now have an initial induction programme to introduce them to the home and the homes policies. We saw induction programmes in all the staff files we Care Homes for Older People Page 29 of 37 Evidence: looked at which included one new staff member. We looked at three staff members recruitment files and found that all background checks had been completed as mentioned earlier in this report to make certain people living in the home are safeguarded from harm. Care Homes for Older People Page 30 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager monitors the home in various ways to ensure that the service continues to develop as people who live at the home want and that the home remains a safe place to live and work in. Evidence: The registered manager of Corbett House is, Ms. Donna Hales, who has worked at the home for nine years. Ms. Hales confirmed to us that she now holds an NVQ Level 4 and LMA (Leadership and Managers Award) and attends regular training which is suitable to the position they hold within the home. We were told that regular visits are undertaken by a person nominated by the provider to look at how the quality of the service is run. We looked at a sample of these reports and saw that people who live in the home and staff are spoken with, the environment is looked at to ascertain where any improvements could be made, care records and any complaints are looked at. Care Homes for Older People Page 31 of 37 Evidence: The registered manager has displayed the results of the surveys that they have received from residents, relatives and doctors which have been analysed. This shows another opportunity where peoples complaints and concerns are listened to. It also shows that the registered manager is maintaining open and transparency to all who visit the home by displaying the results of the surveys in the entrance hall of the home. This practice goes some way towards ensuring that the home is operated in the best interests of people who live there. The registered manager has an Open Door policy and people who live there, their families and staff can see her at any time to discuss concerns, issues or new ideas. As mentioned earlier there are regular meetings for all the people in the home and their families to discuss changes in the home, and to share ideas for further improvements. Three staff told us that they have received supervision and that this is helpful. The process was examined and two peoples supervision notes were read. This shows that the process is designed to look at areas of practice and to support staff with training and dealing with the people they care for. When we spoke with some staff members and in some of the surveys that we received we established that staff meetings have not taken place. The registered manager acknowledged that this had been the case but a meeting has now been held. We did not see the minutes for this meeting as they are being typed. It is important that these meetings do take place as they enable all those involved in the home to take part in the improvements and bring ideas to the registered manager. Therefore we recommend that staff meetings are held on a consistent basis and we will review the minutes of these when we next inspect the home. We were told that there is a maintenance person who is able when required to carry out basic repairs. Fire drills are carried out on a monthly basis and we saw that names of staff are documented when these happen. There is up to date information tells us that the gas, electric and fire systems are safe and appropriate for this service. Accident records are completed appropriately with all action taken documented. We were told that this are audited and any trends and or patterns are recognised so that accidents can be prevented and practices keep people safe from any potential dangers. As at the last inspection and confirmed in the AQAA individuals monies for safe keeping is not routinely held at the home preferring relatives to carry out this Care Homes for Older People Page 32 of 37 Evidence: function. Expenditure occurred for items such as hairdressing is therefore invoiced to individuals representatives. The registered manager had completed the AQAA as already mentioned in this report. This was detailed and gave some good examples of practice. However, we did confirm to the registered manager that they do need to take some care when completing their AQAA to ensure all points referred to are accurate as when inspecting we consider what has been documented in the AQAA. Care Homes for Older People Page 33 of 37 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 34 of 37 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 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 1 Consideration given to the statement of purpose and service user guide being made readily available and displayed in alternative formats. This will ensure people will have the information to hand and be able to understand the contents regardless of their abilities. Consideration should be given to documenting a persons choice of male or female staff to assist and support them with their personal hygiene tasks. This should further promote the preferred choices of people when planning how their care is delivered. Some care needs to be taken in relation to respecting individuals dignity and ensuring that staff practices promote this so that peoples requests are taken seriously and people are not left with uncertainties. Consideration should be given to further expansion of individuals social profiles so that staff have information available so activities and social stimulation is meaningful to each person. All drinks should be placed within reach of the person they are intended for with an acknowledgement to the person Page 35 of 37 2 7 3 10 4 12 5 14 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 that their drink is there for them. This will make sure people recognise their drink is there, have their choices respected and individuals drinks will not be left to go cold. 6 14 Consideration is given to involving people who live in the home in their own menu planning for the week to promote their choices and independence. The practice of putting blue plastic aprons on people at meals time should be reconsidered. This is to make sure that peoples dignity is fully respected and meal times are pleasant experience for people. Consideration should be given to finding out about and implementing the research that has been done about colour schemes and signage so that people with confusion, memory loss or dementia can more easily orientate themselves around the home and maintain their independence. Arrangements must be made so that the rear garden is suitably enclosed and secure so that people are able to choose to use this area freely to gain the benefits of fresh air to enhance their well being. Some consideration should be given to assessing the dependency levels of people who live at the home which will determine the appropriate levels of staff required to meet individuals needs at all times. This should be available for inspection purposes. Consideration should be given to employing a dedicated activities coordinator to ensure each person is gaining the social stimulation and activities to meet their needs as an individual and as a group of people. Staff meetings should now take place on a regular basis so that staff have the oppportunity of sharing information and ideas with the managemant team which should enhance good consistent practices in the staffing team. 7 15 8 19 9 20 10 27 11 27 12 36 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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