Care Home: Douglas Bank Nursing Home

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What the care home does well People wishing to move in to Douglas Bank were given enough information about the home to enable them to make a decision about if it was where they wanted to live. A wide range of risk assessments had been conducted and a variety of external professionals had been involved in the care of people living at Douglas Bank to ensure that their health care needs were being appropriately met. The management of medications was good so that people living at the home were protected from possible medication errors and drug misuse. When asked what the service does well one staff member wrote on the comment card, `it provides a high standard of care` and another commented, `I think we have a good quality of service in our home. The way we accommodate all service users is one thing we do well`. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the Service Users` Guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. It was evident that some areas of the home had been decorated and refurbished since our last visit to Douglas Bank so that more comfortable surroundings were provided for those living at the home. The premises, both internally and externally were well maintained providing those living at Douglas Bank with a safe and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staff were well trained to provide the care and support which people needed and over half of the care staff had achieved a recognised qualification in care, which was pleasing to note. The health, safety and welfare of residents was protected by the policies, proceduresand practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. What has improved since the last inspection? Three of the four requirements made at the last inspection had been addressed showing that the manager and her staff team had worked hard to improve the quality of service provided. People`s needs were assessed before they were admitted to Douglas Bank so that the staff team were confident that they could provide the care and support required by each individual living at the home. The plans of care provided staff with clear guidance about how all assessed needs of people living at the home were to be met and how people were to be supported to maintain their independence, privacy and dignity. The Service Users` Guide had been updated since the last inspection, which included the fee structure so that people knew how much it would cost to live at the home. What the care home could do better: People living at the home or their relative had not always been given the opportunity to be involved in the planning of their own care so that they could decide how they would like to be supported. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including Criminal Record Bureau disclosures and two written references so that the home was sure that people living there were protected. Written references should have been sought by the home and not accepted from the prospective employee so that information provided about new staff was current and authentic. The home could have checked with the Nursing and Midwifery Council that all registered nurses employed by Douglas Bank were eligible to practice by keeping up their registration. The management of meals could be audited so that the points made within the body of this report are considered and addressed if necessary. The bedroom doors on the dementia care unit needed to be adjusted so that they close more slowly in order to protect the safety of those living at the home. The service could have sought the views of the people working at Douglas Bank to find out what it is like working at the home. The views of stakeholders in the community could also have been obtained about how the home is achieving goals for the people living there. The manager of the home had not submitted an application for registration to the Commission. This needs to be done as a matter of urgency as the home has been without a registered manager for some time. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Douglas Bank Nursing Home Lees Lane Appley Bridge Wigan Lancashire WN8 0SZ 01257255823 01255255467 douglasbanknh@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tudor Bank Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 0 30 dementia old age, not falling within any other category Additional conditions: 10 0 The registered person may provide the following category of service only: Care home only: Code N, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places 10) The maximum number of people who can be accommodated is: 40. Date of last inspection Brief description of the care home Douglas Bank Nursing Home provides personal and nursing care for up to 40 elderly people, including up to ten people requiring dementia care, who live in a dedicated wing of the home. Douglas Bank is situated on the outskirts of the rural village of Apply Bridge, although there is easy access by road and rail. The home is surrounded by scenic countryside, overlooking the picturesque village itself. Care Homes for Older People Page 4 of 34 Brief description of the care home Private accommodation is provided on two floors, served by a passenger lift and comprises of 32 single rooms and 4 shared rooms, the majority of which have ensuites. There are a range of bathrooms and toilets situated throughout the home. Two large lounge areas are available as well as a conservatory and separate dining area. People living at Douglas Bank are able to spend the day in the area of the home, which they choose and they can eat their meals within the privacy of their own rooms, if they wish. A variety of leisure activities are available for those wishing to take part and families are welcome to join in. The fees charged for the service as at 7th April 2009 ranged from £386:50 to £588:50 per week. Additional charges were being incurred for hairdressing, chiropody, trips, newspapers and magazines. The Service Users Guide gives people information about what it is like living at Douglas Bank, which includes the annual range of fees. Other suitable formats of the Service Users Guide are available on request, such as talking books and large print copies for the visually impaired. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 last key inpection to this service took place on 9th April 2008. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Douglas Bank formed part of the inspection process and was conducted over one day in April 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private Care Homes for Older People Page 6 of 34 accommodation was viewed and all communal areas were seen. Comment cards were received from five people who were living at the home and four staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. Some of this information is incorporated in to this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Douglas Bank. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the care home does well: People wishing to move in to Douglas Bank were given enough information about the home to enable them to make a decision about if it was where they wanted to live. A wide range of risk assessments had been conducted and a variety of external professionals had been involved in the care of people living at Douglas Bank to ensure that their health care needs were being appropriately met. The management of medications was good so that people living at the home were protected from possible medication errors and drug misuse. When asked what the service does well one staff member wrote on the comment card, it provides a high standard of care and another commented, I think we have a good quality of service in our home. The way we accommodate all service users is one thing we do well. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the Service Users Guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. It was evident that some areas of the home had been decorated and refurbished since our last visit to Douglas Bank so that more comfortable surroundings were provided for those living at the home. The premises, both internally and externally were well maintained providing those living at Douglas Bank with a safe and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staff were well trained to provide the care and support which people needed and over half of the care staff had achieved a recognised qualification in care, which was pleasing to note. The health, safety and welfare of residents was protected by the policies, procedures Care Homes for Older People Page 8 of 34 and practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 34 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were thoroughly assessed before they were admitted to the home to ensure that the staff team could deliver the care and support needed. Evidence: The care of three people living at Douglas Bank was tracked during the course of our inspection. Information about Douglas Bank was given to people before they moved in to the home to help them to decide if it was the right place for them to live. The Service Users Guide was readily available in the home, which included the range of fees so that people knew how much it would cost to live at Douglas Bank. The needs of people wanting to live at Douglas Bank were assessed before they moved Care Homes for Older People Page 12 of 34 Evidence: in so that the staff team were confident that they could provide the care and support that individuals required. Comment cards were received from 5 people living at the home and 4 staff members. Three of the people using the service said that they had received enough information about the home before they moved in to allow them to decide if it was the right place for them to live. One of these people wrote, the home staff were fantastic. The brochure was hand delivered to me by the manager of the home. The brochure was good and was expanded on when I visited the home. A second visit was encouraged. The staff supported all of us through a difficult decision and a relative wrote on behalf of one person living at the home, at the time of taking residence in Douglas Bank my mother was able to choose for herself. However, we were given all the information needed at the time. The other two people who sent us comment cards felt that they were not given enough information and one of these people said that they had not received a contract, but the others said that they had. When asked what the service does well, the manager of the home wrote on the selfassessment, we have an open door policy with all prospective residents. They can visit the home at any time. We provide comprehensive information to prospective residents which includes a breakdown of fees. We encourage prospective residents to visit the home prior to admission. Our contract provides for a trial period. Prospective residents are assessed prior to admission to confirm we can meet their assessed needs. A written contract is provided to all privately funded residents. Terms and conditions of residence are provided to all Social Services funded residents with a copy of the local authority contract. We provide all residents with a Service Users Guide which contains a copy of the homes complaints policy. The manager supported these statements by giving some good examples of how they were achieved. Three of the four staff who sent comment cards to us indicated that they were always given up to date information about the needs of people they supported and the fourth said that they usually were. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. Evidence: The three plans of care examined were very well written documents and had been generated from the assessments conducted before admission to the home, so that staff were fully aware of the care and support individuals needed. However, the care plans had not been developed with the involvement of those using the service or their representative, so that those living at the home could have some input in to the care delivered. The care plans were detailed and person centered, clearly describing how peoples individual needs were to be best met, so that those living at the home received the care and support they required. The plans of care had, in general, been reviewed every month or more often, if Care Homes for Older People Page 14 of 34 Evidence: required and any changes in need had been reflected well so that staff were provided with up to date information about people in their care. However, the assessed needs of one person living at the home had not been reviewed as often as the care plan recommended to ensure that this individual was monitored more frequently. Records showed that a wide range of external professionals were involved in the care of people living at Douglas Bank to ensure that their health care needs were being consistently met. A variety of risk assessments had been conducted, which formed part of the care plans, so that any potential risks were identified and strategies implemented so that they were eliminated or reduced in order to keep those living at the home safe. However, nutritional risk assessments had been conducted for one person living at the home, but there was no indication of what staff needed to do as a result of the assessment. The plans of care showed that peoples privacy and dignity was respected and that those living at the home were supported to maintain their independence, whilst living at Douglas Bank. Those who lived at the home and who submitted comment cards said that, in general, they received the care, support and medical attention which they needed. One relative wrote, we have no problems at all with the care provided for mother or for us as a family, another told us, the staff do try to help my father but they are not consistent with the times he gets his medication and we feel that he is not supervised when he takes his tablets and a third person wrote, the GP is very supportive and the staff are very good. The manager of the home told us what the service does well and also areas that could be improved on in order to make the quality of service better for those living at Douglas Bank. When asked if there were enough staff to meet the individual needs of people living at the home those staff who sent us comment cards felt that, in general, there were. These members of staff also felt they always had the right support, experience and knowledge to meet the different needs of people who use the service. When asked if there was anything else they would like to tell us, one person wrote on the comment card, I think female staff should always be on duty in mixed homes. It is not nice for ladies to be taken to the toilet by young male staff. This practice was not observed whilst we were at the home. Care Homes for Older People Page 15 of 34 Evidence: The Service Users Guide told readers of the importance of respecting peoples privacy and dignity and how this was to be achieved. Staff were heard speaking to people with respect and offering them choices throughout the day. Staff were seen to be following guidance provided about how the privacy and dignity of people living at the home was to be respected. We noted that those living at Douglas Bank were able to have locks on their bedroom doors, if they so wished so that their privacy was maintained and the Service Users Guide reflected what peoples rights were whilst living at Douglas Bank. Staff were seen knocking on bedroom doors before they entered so that the privacy and dignity of people living at the home was maintained. The management of medications was good. Medication Administration Records were well maintained and detailed policies and procedures were in place, so that staff were provided with clear guidance about the safe storage, administration and disposal of medications. The receipt of drugs in to the home was recorded and controlled drugs were managed well to ensure that possible medication errors or misuse was minimised. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and activities whilst living there. The management of meals was, in general, good and visitors were made welcome to Douglas Bank. Evidence: The manager told us what improvements had been made in this area over the last twelve months and how the home intends to improve over the next year. The very well written plans of care provided staff with detailed information about peoples preferences, interests, likes and dislikes, so that they had a clear picture of the person as a whole to enable them to meet the social care needs of those living at Douglas Bank. It was quite clear that the daily routine of the home was very flexible and that people were encouraged to live the life they choose. People were able to spend time where they wished and people were seen going out to the shops or for a walk. At the time of our visit we discussed what leisure activities were available with people living at the home. An activities room was available at the home where some smaller activities took Care Homes for Older People Page 17 of 34 Evidence: place, but larger group activities were provided in the communal areas of the home. We saw that the home was a hive of activity with a range of different things going on so that people could join in with what interested them the most, or if preferred they could just sit and enjoy watching others participating. A range of resources were available for people to use and we were told that the home had just purchased a Wii. During the morning some people were involved in playing games and others were joining in with a keep fit class. It was evident that both activities were enjoyed by the fun and laughter coming from the lounge area of the home. During the afternoon people were very busy preparing for an Easter party the following day with elaborately decorated bonnets, fancy decorated Easter cakes, an unusual Easter egg tree and an Easter bonnet parade practice run, which was very entertaining. Relatives of those living at the home were enjoying the entertainment too and some were actively participating in the activities provided. People we spoke to were eager to tell us about how special events were celebrated at the home and they particularly enjoyed the traditional Christmas festivities and the who done it mystery Halloween party in which some people played an active role. One person living at the home said, special occasions are celebrated in style here at Douglas Bank. They (the staff) go that extra mile to make things special for us. Those spoken to confirmed that religious ministers visited the home regularly to conduct services, in accordance with the information provided by the home and that an Easter service had been arranged, in which some people living at the home would be doing readings in conjunction with the minister. The activities programme for the people living at the home was unique in that it provided some unusual and different forms of entertainment and stimulation, which had obviously taken a lot of thought and organisation. A variety of outings were arranged to local places of interest. One person living at the home said, the activities lady is marvelous. There is always something going on. We dont have time to get bored and another told us, there is always something to do. Even if we dont want to join in it is most enjoyable just watching what is going on, which you have seen for yourself dear. Comment cards sent to us by those living at the home indicated that, in general, there were suitable activities provided that people could join in and one of these people wrote on the comment card, the activities provided are excellent, but a relative wrote, Dad finds most of the activities not to his taste. The Service Users Guide told people about the visiting arrangements within the home Care Homes for Older People Page 18 of 34 Evidence: and how people were able to access an independent person to act on their behalf, should they so wish. We established that one person living at the home was using an advocate to act on his behalf, so that he was supported to make decisions and therefore given the same opportunities as others living at Douglas Bank. We spoke to two relatives who told us that they were very happy visiting Douglas Bank and that they felt comfortable visiting the home. They confirmed that they could visit their relatives within the privacy of their own room if they so wished. We saw that relatives and friends had a really good rapport with the staff and that they were made very welcome to the home. One relative said, what you see today is normal at Douglas Bank. Theres always something going on and a lot of good, clean banter, which provides a fun environment. We observed lunch being served, which was, in general, managed well. The dining tables were pleasantly prepared with linen tablecloths, flowers, condiments and nice place mats. Age appropriate background music was playing and people seemed to be enjoying the dining experience. The meals were well presented and looked appetising. Those requiring soft diets were served with the different tastes separated on their plates, which was pleasing to see. However, one person living at the home said that the vegetarian option was not always of good quality as the vegetables were sometimes over cooked. Those living at the home were offered tea only at lunch time. One member of staff was going round the dining tables pouring milk in the cups from a large jug and then tea from a large tea pot. Those served were not all asked if they would like sugar and quite a number of people were sitting at the dining tables in their wheelchairs who looked as if they were capable of sitting in a dining chair. This was discussed with the manager of the home at the time of our visit who said that she would determine if these people chose to remain in their wheelchairs or if they would prefer to sit in dining chairs whilst having their meals. People were given assistance with their food as was needed in a discreet manner. We saw one person being given an explanation of where the different foods were on their plate and another person did not like what was on the menu so was provided with an alternative meal, which he enjoyed. The menu of the day was displayed on the notice board in the dining room, which provided a choice of meals, one of which we sampled and found it to be very tasty and of excellent quality. We spoke with catering staff who told us that they were very happy with how things were at present at the home. There were no shortages of equipment, utensils or food. People living at the home told us that, in general they liked the meals served. One Care Homes for Older People Page 19 of 34 Evidence: person wrote on the comment card, the meals are very good and my family have been able to have meals with me too and a relative commented, the meals are excellent and there is a choice if mother does not like what is on the menu and another told us, occasionally Dad dislikes some elements of the meal, but the food is excellent. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were managed well and people living at Douglas Bank were adequately safeguarded by the robust policies and procedures adopted by the home. Evidence: A detailed policy and procedure was in place telling people how they could make a complaint, should they wish to do so. This information was included in the Service Users Guide, which was given to all those thinking about moving in to Douglas Bank and it was clearly displayed in the reception area of the home. Although no complaints had been received by the home since the last inspection there was a system in place so that any complaints could be recorded to enable the manager to conduct an audit trail of complaints received. The Commission had not received any complaints about this service since the last inspection. Policies and procedures were in place in relation to the Protection Of Vulnerable Adults (POVA) so that those working at the home were aware of how people living at the home should be protected. All staff were given a POVA work book, which had taken them through a variety of activities and scenarios to complete connected with the protection of people, which was good practice. Staff spoken to were familiar with the policies and procedures of the home and were aware of what they needed to do if they felt that someone in their care was being abused. Care Homes for Older People Page 21 of 34 Evidence: Three of the five people who sent us comment cards and who lived at the home told us that the staff listened to them and acted upon what they said. One of these people wrote, the staff are always willing to listen to us. One person did not respond to the question and a fifth felt that staff did not listen to them and act upon what they said. Four of these people said that they would know how to make a complaint, but one said that they would not. In general people told us that they would know who to speak to if they were not happy with something at the home. One relative wrote, Dad has a key worker. All four staff members who sent us comment cards told us that they would know what to do should a person living at the home, their relative, advocate or friend be concerned about something at the home. When asked what the home could do better the manager told us, The Mental Capacity Act gives the need for the home to be using Independent Mental Capacity Advocates (IMCA). To fully comply with standard 17 we need to look at our residents and those whom lack capacity and have no relatives or friends to consult. We need to consider the use of an IMCA. We should consider the use of an IMCA for care reviews or adult protection situations. We need to give thought to the impact of the act and what changes are needed within the home and how we implement them. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home in general provided a safe, comfortable and hygienic environment for the people living there. Evidence: The environment was warm and comfortable and there was evidence that many areas of the home had been painted, decorated and refurbished since the last inspection so that pleasant surroundings were provided for those living at Douglas Bank. The dementia care unit was in the process of being painted and the handyman told us that he was decorating bedrooms as they became vacant so that they would be nice and fresh for people moving in to them. The home, in general, was pleasant smelling and clean, providing a homely environment for people to live in. One person living at the home said, I am very satisfied with my bedroom. It is lovely, very spacious and I have my own things in it. We noted that a lot of the bedroom doors on the dementia care unit needed adjusting as they were slamming shut and this was a potential hazard for the people living in this area of the home. Policies and procedures were in place in relation to infection control and clinical waste was being disposed of correctly so that the risk of cross infection was minimised. Care Homes for Older People Page 23 of 34 Evidence: Training was provided for staff so that they were aware of measures to take in order to control the risk of infection within the home. The laundry department was organised and fit for purpose with enough equipment to meet the needs of the home. When asked if the home was fresh and clean those who sent us comment cards and who used the service indicated that, in general, it was. One relative wrote, the home on the whole is fresh and clean. My fathers bedroom could be better, but this has improved in the last few weeks. The manger told us what the home does well by writing on the self-assessment The home provides a safe and secure environment for our residents to live in. The home is always clean and free from odours, thereby reducing the risk of infection. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number and skill mix of staff on duty met peoples needs, but the recruitment practices could have been better. Evidence: At the time of our inspection there were 38 people living at Douglas Bank. We examined the duty rota and established that the number of staff on duty was being calculated in accordance with the assessed needs of those living at the home and that additional staff were deployed as deemed necessary. One person on the dementia care unit was receiving individual care and support by an additional member of staff so that they would not come to any harm. We established throughout the inspection process that the outcomes for those living at the home were good so that individual needs were being met. Two staff files were examined at the time of our visit to this service. One of these showed that the home had conducted appropriate checks and had obtained relevant information before the person started to work at Douglas Bank, so that those living there were protected by the recruitment practices adopted by the home. The second staff member whose file we examined had been recruited from overseas through an employment agency. In this case the recruitment practices could have been better. Records showed that this member of staff commenced his induction programme three Care Homes for Older People Page 25 of 34 Evidence: days before relevant checks had been completed. However, the period of induction did not finish until after such checks had been received by the home, during which time, we were told he was constantly supervised, although we did not see any supervision records to support this information. There was only one written reference on file for this member of staff, which was dated more than one year before he started working at the home and it was addressed to whom it may concern, which suggested that this reference was brought by the employee himself and therefore it was not current and authenticity was not evident. The records of a registered nurse were briefly examined, which showed no evidence to demonstrate that the home had checked her registration status with the Nursing and Midwifery Council to make sure she was eligible to practice as a nurse. At the time of our visit to this service there were 18 care assistants working at the care home, 11 of whom had completed a recognised qualification in care, with a further six currently undergoing this training. A wide range of training was available for those working at the home. Individual training profiles and certificates showed which courses staff had completed and where staff required additional training and updates on specific courses. A range of mandatory training was provided so that staff were kept up to date with any changes and with new ways of working. All new employees had been assisted through a detailed induction programme so that they were competent to do the job expected of them. Records showed that specific training was provided so that carers knew how to meet peoples individual needs. The five people who sent in comment cards and who lived at the home felt, in general, that staff were available when needed. One person wrote, but not at night and another commented, occasionally they seem understaffed. All four staff members who sent us comment cards told us that their employer had carried out checks, such as Criminal Record Bureau disclosures and references before they started work. Two of these people said that their induction covered everything they needed to know very well. The other two felt that it covered all areas but only partly. All four staff members who submitted comment cards said that they were given training which helped them understand and meet the individual needs of the people living at Douglas Bank and which kept them up to date with new ways of working. Three of these staff members said that the training was relevant to their role and one said that it was not. Care Homes for Older People Page 26 of 34 Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well so that the health, welfare and safety of the people living and working there was protected. Evidence: The manager has been in post at Douglas Bank for a year, during which time she has made a lot of improvements and has achieved the Registered Managers Award. She also attends relevant training sessions to up date her knowledge and skills whilst managing the home. The manager has not yet submitted an application to be registered with the Care Quality Commission. This must be addressed as a matter of urgency so that the registration process can be commenced. A wide range of audits had been conducted so that the quality of service provided could be closely monitored. The current manager of the home had worked very hard to improve standards for those living at Douglas Bank. The shortfalls at the previous inspection were mainly in relation to the written care planning process and the Care Homes for Older People Page 28 of 34 Evidence: management of medications. Since the introduction of medication and care planning audits both these areas were much improved. Customer satisfaction surveys were conducted from time to time and these were an important aspect of the forward planning of the home. The results of last years surveys had been audited so that any strengths or areas for improvement could be identified. Surveys could also be introduced for staff to enable them to give their views about what it is like working at the home and stakeholders in the community so that they can say how they think the goals for people living at the home are being met. The policies and procedures of the home had been reviewed and updated at regular intervals so that people working at the home were given up to date information. The home had achieved accreditation by an external company, which means that an external professional body periodically monitors the quality of service provided by the home. A variety of environmental risk assessments had been conducted and the last fire officers visit showed that the premises were satisfactory. A representative from the company conducted regular unannounced inspections, the reports of which were retained on site so that people concerned could address any shortfalls. Regular staff meetings were held with minutes retained so that information could be passed on to those working at the home and so they could raise any issues and discuss various topics related to the operation of Douglas Bank. An annual development plan was in place and the manager of the service had commenced a biweekly clinic so that people could drop in to see her in order to discuss any issues on an individual basis. This system was implemented because a relatives meeting was arranged, but no-one turned up. The home also operates an open door policy so that people can visit the home at any time to discuss any concerns that they may have. The management of peoples finances was good so that they were safeguarded against financial abuse. The records of expenditure and credit were clearly maintained with receipts kept for any expenditure. An administrator had been employed since our last inspection, which was considered to be good practice as this appointment had eased the pressure on the manager of the home so that she could concentrate on caring duties instead of administrative roles. A handyman was employed at the home and at the time of our visit he was busy improving the standard of the environment by painting the dementia care unit to make it brighter for the people living there. Records showed that internal checks were conducted regularly on systems and equipment within the home to ensure that they were safe for use. Care Homes for Older People Page 29 of 34 Evidence: Accidents were recorded accurately and documents were retained in line with data protection so that peoples personal details were kept confidentially. An audit of accidents had been conducted recently so that any significant patterns could have been easily identified. The Control Of Substances Hazardous to Health data sheets were available for staff reference so that they were aware of what action they should take if someone had an accident with any domestic product. We examined a random selection of service certificates and found that systems and equipment available within the home had been appropriately checked by external contractors to make sure that they were safe for use. When asked what the service does well the manager of the home wrote on the selfassessment, The Manager has over 30 years experience as a registered nurse and holds the registered managers award NVQ (National Vocational Qualification) level 4. All staff receive induction training supervisions and annual appraisals. The Home has a clear and accountable management structure. Through residents, staff and management meetings we continually appraise the care we offer, the service is also monitored through the audit system of the Quality Assurance. Residents are sent questionnaires twice yearly so we can get feedback on what we do and suggestions on change. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1) The resident or their relative 30/06/2008 must be given the opportunity to be involved in the care planning process, if they so wish, so that they can have some input into the care being provided. Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Any unnecessary risks to the 30/04/2009 health or safety of people living at the home must be identified and so far as possible eliminated. This includes adjusting the bedroom door closures on the dementia care unit to stop them slamming shut. This is so that people living at the home will be protected from injury. 2 31 9 The person running the care home must submit an application to the Care Quality Commission as soon as possible. The manager of the home has been in post for a year and needs to be registered with the Care Quality Commission. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 32 of 34 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 The plans of care should always be followed in day to day practice so that any written instructions are carried out in order to benefit the person using the service. The tool used for assessing peoples nutritional needs should include indications of what staff should do as a result of the assessment. It is recommended that the manager of the home audits the quality of specialised diets, such as vegetarian meals to ensure that these are of equal quality to the food served on the general menu. It is also recommended that the manager of the home determines if those sitting in wheelchairs at dining tables would prefer to sit in dining chairs if they are able to do so. 2 8 3 15 4 15 It is recommended that a range of hot and cold beverages be served with meals so that people are able to choose the drink which they prefer. It would have been better if tea pots, milk jugs and sugar bowls were available on the dining tables so that people could have helped themselves. However, we understand that individual risk assessments would need to be conducted before this is introduced. It is recommended that surveys be introduced for people working at the home so that they can say what it is like working at Douglas Bank. Surveys for stakeholders in the community could also be commenced so that they can give their views about how goals for people living at the home are being met. 5 33 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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