Care Home: Downside House

What the care home does well The home has a comprehensive preadmission procedure, which ensures that the home only admits people whose needs it can meet. All evidence indicates that the home ensures that people`s health and care needs are met. People who live at the home stated they were happy living there. Activities are provided and the home has an activities organiser. People enjoy the meals at the home. The home employs appropriate numbers of nursing and care staff that ensure that people`s needs are met. Staff receive the necessary training. People who live at the home stated that care staff are nice. The environment is suitable for the people who live at the home and is well maintained. The home is well managed in the best interests of the people who live there. What has improved since the last inspection? One requirement was made following the previous inspection in July 2007. This required the home to have a system in place to monitor the quality of the service provided. The home now has a variety of quality monitoring procedures in place including, visits from one of the directors, surveys of people who live at the home, staff and service user meetings. Also since the previous inspection the home has completed the work on the garden and balcony which are now safe and appropriate for people to use. The home has also redecorated and improved the older parts of the home with all bedrooms now having ensuite facilities and communal areas of the home having had new carpeting. At the time of the previous inspection the home had a competent registered manger who continues to be a director of the company however she is no longer in day to day charge of the home. The home has successfully recruited an experienced manager who is now registered with the Commission. What the care home could do better: Three requirements are made following this inspection and within the report there have been identified some other areas that the home could improve. Although the home has sought two written references for new staff one of these has not always been from a current or previous employer. This could place people at risk if there were concerns at the person`s previous place of work. A requirement is made that the registered person must ensure that full pre-employment checks must be undertaken on all new staff and references must be taken from the persons current or previous employer. In some bedrooms there were stand alone heaters that were not covered or guarded. The inspector felt some of the stand alone heaters which were very hot to touch and could present a risk to people using the rooms. This person in charge was asked about risk assessments for the stand alone heaters however none had been completed. A requirement is made that the home must ensure that risk assessments are completedfor all stand alone heaters and equipment in use in the home. Whilst viewing the home the inspector noted a sluice room containing a range of cleaning chemicals hazardous to health had been left unlocked. This was locked immediately but a requirement is made that the home must ensure that substances hazardous to health are stored securely at all times. Care staff were observed taking lunchtime meals to people in their rooms. The meals had not been covered when being carried around the home. Plate covers ensure that meals stay hot and are good food hygiene practice. This issue was identified in the previous inspection report and the person in charge stated that the home does have plate covers which had not been used on the day of the inspection visit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Downside House 3 - 4 St Boniface Terrace Ventnor Isle Of Wight PO38 1PJ     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: Janet Ktomi     Date: 2 7 0 5 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: Downside House 3 - 4 St Boniface Terrace Ventnor Isle Of Wight PO38 1PJ 01983854525 01983853606 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Downside House Ltd Name of registered manager (if applicable) Mrs Elizabeth Margaret Pearson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) Dementia (DE). Date of last inspection Brief description of the care home Downside House is situated on St Boniface Terrace, Ventnor, and has wide sweeping views across the English Channel and St Boniface Down. The home is a combination of two Victorian town houses joined to create one home and has recently been extended to increase the number of bedrooms to 21. Accommodation is split between three floors all serviced by a passenger lift. There is Care Homes for Older People Page 4 of 34 care home 21 Over 65 0 21 21 0 Brief description of the care home an additional top floor, accessed by stairs, with storage, office space and some staff accommodation. The home is fully accessible and there are steps and a ramp to the front entrance. The amenities of Ventnor are not easily accessed on foot, given the local geography, although public transport is accessible at the end of the road and the manager and staff often provide transport to the town if required. The home is currently registered to provide care and accommodation for up to 21 older people who may or may not have dementia. The home is able to provide day care and short stay/respite care if a suitable room is available. Fees range between 385 - 473 pounds per week depending on assessed needs, with additional charges for hairdressing and chiropody. Up to date information about fees is available from the homes registered manager. The home is owned by Downside House Limited and managed by registered manager Ms Elizabeth Pearson. 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: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 27th May 2009. All core standards and a number of additional standards were assessed. Compliance with the one requirement made following the previous inspection was also reviewed. The home was previously inspected in July 2007 and had an Annual Service Review in June 2008. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 10.00am and being completed at 5pm. Care Homes for Older People Page 6 of 34 The inspector was able to spend time with the staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the registered manager completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Information was also gained from the notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to people who live at the home and staff on duty. What the care home does well: What has improved since the last inspection? What they could do better: Three requirements are made following this inspection and within the report there have been identified some other areas that the home could improve. Although the home has sought two written references for new staff one of these has not always been from a current or previous employer. This could place people at risk if there were concerns at the persons previous place of work. A requirement is made that the registered person must ensure that full pre-employment checks must be undertaken on all new staff and references must be taken from the persons current or previous employer. In some bedrooms there were stand alone heaters that were not covered or guarded. The inspector felt some of the stand alone heaters which were very hot to touch and could present a risk to people using the rooms. This person in charge was asked about risk assessments for the stand alone heaters however none had been completed. A requirement is made that the home must ensure that risk assessments are completed Care Homes for Older People Page 8 of 34 for all stand alone heaters and equipment in use in the home. Whilst viewing the home the inspector noted a sluice room containing a range of cleaning chemicals hazardous to health had been left unlocked. This was locked immediately but a requirement is made that the home must ensure that substances hazardous to health are stored securely at all times. Care staff were observed taking lunchtime meals to people in their rooms. The meals had not been covered when being carried around the home. Plate covers ensure that meals stay hot and are good food hygiene practice. This issue was identified in the previous inspection report and the person in charge stated that the home does have plate covers which had not been used on the day of the inspection visit. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. Evidence: The person in charge explained the homes admission procedure and the preadmission assessments for two people admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and with some people who live at the home. The service users guide and other information available to prospective service users or their relatives was viewed. The person in charge explained the homes admission procedure and was clear about the level of care needs the home can accommodate. Care Homes for Older People Page 11 of 34 Evidence: The person in charge stated that if an initial inquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the home will invite the person or their relatives to visit the home to view the facilities and room available and arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where appropriate members of the persons family and professionals involved in their care. Copies of social services assessments were seen in care plan files viewed. The person or their relative is provided with information about the home. Also seen in care files were discharge information from the hospital. The pre-admission assessments viewed had been completed by the registered manager and contained information about the persons needs that should enable the home to decide if they are able to meet the persons needs following admission. Following admission the home had completed further assessments including a body map for marks or injuries on admission and relevant risk assessments such as for nutrition, falls and specific health or behaviour needs. Discussions with people who live at the home confirmed that people or their relatives have visited the home prior to a person moving in. Nine comment cards were received from people who live at the home. These stated that four could not remember, two had received respite or day care prior to moving into the home and the others had received enough information. Discussions with care staff confirmed that they felt they had enough information about new people admitted to the home and that they had the training and time to meet peoples needs. People living at the home tend to be long term, however the home could provide respite or short stay accommodation if a suitable room were available. The same admission procedures would be used for respite or short stay admissions as for long-term admissions. Care plans were also present for day care service users. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which a person receives, are based on their individual needs. Medication is appropriately stored and administered as prescribed by the persons medical practitioner. People are treated with respect and their dignity and privacy is maintained. Evidence: Four care plans were viewed, two for people recently admitted to the home and the the others for people who have been living at the home for a longer time. The inspector discussed with staff and people who live at the home how care needs are met. The arrangements for the storage, administration and records relating to medication were viewed. Comments from service user, staff and external professionals comment cards and the homes AQAA are also considered. The AQAA stated that all people have a care plan and appointments are made with relevant professionals. People have a plan of care that related to the persons preadmission assessment. The care plans follow a comprehensive format and are Care Homes for Older People Page 13 of 34 Evidence: individualised, written in plain language, providing sufficient detailed information as to how needs should be met. Care plans are written by one of the homes senior carers who is also responsible for reviewing care plans and risk assessments on a monthly basis. Plans were seen to have been reviewed on a monthly basis and when needs change. It was not clear from care plans if these had been discussed with or agreed by the service user or their relative. Care plans are held in the carers office which is locked when not in use. Care plans contained relevant risk assessments and management plans including nutrition, manual handling, falls, bed rails and any individual risks. Risk assessments viewed appeared appropriate to the persons needs and had been reviewed monthly or when risks changed. There were no risk assessments for pressure injuries in any of the service files viewed. Other information in one of the care plans viewed would indicate that the person was at risk of pressure injuries and an assessment and management plan should have been in place. The home undertakes nutritional risk assessments for people. A separate file contained records of peoples weights and these indicated that most people are weighed monthly. The home does not have scales suitable for people who are unable to stand and therefore some people had not been weighed. Care staff spoken with said that communication about peoples needs was good and that they always get a handover at the start of each shift. Eight comment cards were received from people employed at the home and all stated that they always get up to date information about the needs of people they care for and six stated usually and two always that the systems used to pass on information work well. An additional comment from a person who works at the home was the care plans are very good and full of information. The inspector was able to talk with people who live at the home who stated that they felt they received the care and support including medical care they need. Comment cards were received from nine people who live at the home. Eight stated that they always receive the care and support they need with one responding usually to this question. An additional comment from a service user being I am exceptionally happy here and I am content and have no worries. Records were available to demonstrate that people have access to a range of services such as GPs, District Nurses and Chiropodists. Records and discussions with people who live at the home confirmed that health professionals are consulted when necessary. An additional comment from an external professional stated the new manager is very experienced and skilled and her nursing experience has a positive Care Homes for Older People Page 14 of 34 Evidence: impact on individuals health care needs in particular. Three external health professionals completed comment cards none raised any concerns about the home or care people receive. An additional comment from an external health professional was that care staff didnt seem to use manual handling equipment. The home has a hoist and standaid. During the inspection visit manual handling equipment was seen in use by care staff. Of the four care plans viewed all contained manual handling assessments however only one required the use of manual handling equipment. The external professionals stated in comment cards that the home always/usually seeks advice and acts upon it to manage and improve individuals health care needs and that the home always/usually respects peoples privacy and dignity. People stated that they felt that staff always treated everyone who lives at the home with dignity and respect. Observations of staff interactions indicated that people are treated with respect and their right to dignity and privacy is maintained. All bedrooms are for single occupancy and have en suite facilities. Most bedroom doors are lockable. Care staff confirmed that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Observations of care staff indicated that they had sufficient time to meet peoples needs. At the time of the inspection visit one person was self administering their medication. All bedrooms have a lockable facility for medication if people are self administration. The person in charge confirmed that risk assessments are undertaken in respect of self administration of medication and that all staff who administer medication have completed medication training. Care staff confirmed to the inspector that they had undertaken medication administration training and training records and certificates viewed also confirmed this. The home has the necessary storage facilities and recording books for controlled medications and for medication that must be kept at cooler temperatures. The home has a medication trolley in which medication in use is stored and a secure cupboard for other medication not yet in use. The medication administration records were viewed and medication stocks checked for people whose care plans had been viewed. The medication administration records for the previous month were also viewed as the home had only just commenced using new sheets. Medication administration records had been fully completed and stocks of all medication prescribed were available. The medication administration records contained details of allergies people are known to have. The information on the medication administration record about allergies in respect of one person whose care plan was viewed were inconsistent with that recorded on the care plan. The person in charge stated that they Care Homes for Older People Page 15 of 34 Evidence: would check the allergies with the persons GP and ensure that correct information was recorded on all forms. The home has a locked upstairs office where the inspector noted some medication being stored that was awaiting return to the pharmacy as was no longer required. Some people were prescribed medication on an as needed basis. The home had some guidelines for these which were discussed with the person in charge who agreed that they required reviewing and additional details provided as to exactly when care staff should give as required medication especially in respect of one person who would be unable to request medication. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. People have access to a drink at all times. Evidence: The inspector spent time talking with people and observed part of the lunchtime meal. The inspector discussed activities with people who live at the home and viewed information about activities undertaken in records and related information in care plans and pre-admission assessments. Information in the homes AQAA and comment cards received is also considered. People living in the home are able to spend their time in the home where they wish, people were seen sitting in the homes groundfloor lounge/dining room and others chose to spend time in their bedrooms. The home also has a larger second lounge/dining room on the first floor however this was not in use at the time of the inspection. The person in charge stated that room is less popular with people who live in the home and is generally only used when parties or events are occurring. The home has accessible rear gardens that are now safe and suitable for use following the completion of building work. People who live at the home have been Care Homes for Older People Page 17 of 34 Evidence: included in discussions as to what should be planted and available in the garden as seen in service user meeting minutes. Care plans viewed contained information about peoples likes and dislikes and the home also seeks life history information from people or their relatives. People confirmed to the inspector that they are given choice over what time they get up and go to bed, as well as choice as to how and where they spend their time. Comment cards from service users confirmed that people have choice about activities with one person saying I dont join in activities, I dont want to and Id rather observe than join in. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, likes and dislikes, catering and religious needs. The home has recently appointed an activities organiser who provides a range of group and individual activities. The home also has visiting entertainment and special events are organised such as a fete planned for June. Information about planned activities was provided in the entrance hall. The home can arrange for newspapers to be delivered on a daily basis. Comment cards from staff had an added comment we try to do activities every day. During the inspection visit care staff were undertaking a range of activities in the lounge/dining room and activities equipment was seen in the upstairs lounge. Visitors are able to visit at any time and complete a visitors book on entering the home. The home does not have a private room for visitors although as mentioned the upstairs lounge is not used all the time and could be available for more privacy for visitors if required. Care plans contained nutritional assessments and information about specific nutritional needs of the people living at the home. The home has a dining table in both lounges and people were seen to have their lunch time meal in the ground floor lounge/dining room or in their bedroom. Care staff were observed taking meals to people in their rooms. The meals had not been covered when being carried around the home. Plate covers ensure that meals stay hot and are good food hygiene practice. This issue was identified in the previous inspection report and the person in charge stated that the home does have plate covers which had not been used on the day of the inspection visit. People living at the home informed the inspector that they enjoyed the food at the home. Comment cards from service users stated that they always/usually liked the meals provided at the home, one added the comment I am a funny eater but I do enjoy the meals I get, another added I dont always want all the meals, at my age my appetite isnt great. The inspector spoke with people who stated that they were happy with the meals. Care Homes for Older People Page 18 of 34 Evidence: When asked if alternatives were available people stated that they were. The inspector observed people being given morning and afternoon drinks and people in the lounge and their rooms had cold drinks available throughout the inspection visit. Daily records viewed stated that people are provided with tea and snacks such as sandwiches or toast whenever this is requested. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: Discussions with people who live at the home and staff as well as information in the homes AQAA, comment cards received and records viewed are considered. There was a copy of the homes service users guide in the ground floor office and this had information within it about the homes complaints procedure. People the inspector spoke with stated that they did not have any concerns or complaints, they stated they would raise any concerns if they had any and that they thought the home would sort things out. Service users who completed comment cards stated that they knew who to talk to if they were not happy and how to make a complaint. Staff comment cards all stated that they knew what to do if a service user or relative raised a concern or complaint. Comment cards from external professionals raised no issues about complaints or safeguarding. The homes complaints log was viewed and indicated that the registered manager investigates and aims to resolve any issues raised by people who live at the home or their visitors. Service user meetings also provide people with a forum to raise issues. The AQAA stated that the registered manager has attended the train the trainer for Care Homes for Older People Page 20 of 34 Evidence: safeguarding course and that staff would be completing safeguarding training. Training information shown to the inspector confirmed that staff have safeguarding training. Discussions with care staff confirmed that they would recognise safeguarding issues and raise these with the manager. They were less clear that safeguarding concerns should also be reported to social services. The home has reported a safeguarding concern to social services which would indicate that even if staff are not completely clear about procedures senior staff are aware of the actions they should take. The previous report identified that the home had improved its recruitment procedures. Although the home had evidence of pre-employment checks being undertaken, two of the three new staff files viewed the home had not sought a reference from the immediate previous employer, one of which was a care provider. Care Homes for Older People Page 21 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. People live in a clean, safe, new environment that meets their individual and collective needs. Evidence: The inspector viewed the home with a senior member of staff, viewed certificates related to equipment and discussed the home with the people who live there and with staff. The AQAA stated that new carpets have been provided in all communal areas and two bedrooms in the original part of the home have been redecorated and ensuite facilities added. In one care plan viewed was a letter signed by a person who lives at the home confirming that they had declined their room being redecorated and a new carpet being provided. The AQAA also stated that new towels had been purchased and future plans were to continue to redecorate the homes original bedrooms and replace televisions in preparation for the digital transfer. At the time of this inspection the home was found to be clean throughout with no unpleasant odours. The home employs cleaners with one on duty on the day of the unannounced visit. Comment cards from people who live at the home confirmed that the home is always fresh and clean. Two people added a comment I havent found Care Homes for Older People Page 22 of 34 Evidence: anything wrong yet - and I am a bit fussy, and another added the cleaners are very good. All bedrooms are for single occupancy with ensuite facilities. Bedrooms viewed contained all the furniture and equipment necessary for the occupant. Bedrooms contained personal items and care plans and had an inventory of items brought into the home. Appropriate bathing facilities are provided with supported baths or showers on each floor and WC located near to both lounges as well as ensuite to all bedrooms. The home has the necessary moving and handling equipment, the service records for which were viewed. Accommodation is provided on three floors each accessible via a shaft lift for which the home has a service agreement. Domestic and care staff confirmed that they have attended infection control training and have access to all the necessary infection control equipment such as disposable gloves and aprons. The inspector noted that in some bedrooms there were stand alone heaters that were not covered or guarded. Bedrooms did have other forms of heating. Bedrooms in the new part of the home have underfloor heating which can be individually controlling each bedroom and rooms in the original part of the home have covered radiators which can also be individually controlled. The inspector felt some of the stand alone heaters which were very hot to touch and could present a risk to people using the rooms. This person in charge was asked about risk assessments for the stand alone heaters however none had been completed. The home must ensure that risk assessments are completed for all stand alone heaters and equipment in use in the home. Whilst viewing the home the inspector noted a sluice room containing a range of cleaning chemicals hazardous to health had been left unlocked. This was locked immediately but the home must ensure that substances hazardous to health are stored securely at all times. The inspector also noted toiletries in one bathroom. Some of these were identified as belonging to a person who had had a bath on the morning of the inspection and had not been returned to the persons bedroom. The inspector was informed that the others were shared toiletries kept in the bathroom and used for people who did not have individual toiletries. Shared toiletries (including a backscrubber) present an infection risk and the home must discontinue this practice. At the time of the previous inspection the garden to the rear of the home and balcony to the front of the home was not yet ready for use by the people who live in the home following the completion of the building work. The inspector was informed that the balcony and garden are now safe for people to use and service user meeting minutes Care Homes for Older People Page 23 of 34 Evidence: confirmed that people were being involved in discussions about what should be provided and planted in the garden. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of staff that ensure that peoples needs are met. Staff receive the necessary training and at least fifty percent have an NVQ of at least level two in Care. The failure to always seek a reference from an applicants current or most recent employer may place people at risk. Evidence: Records relating to recruitment and training were viewed. Discussions with staff and people who live at the home as well as comment cards received are considered as well as information provided by the registered manager in the homes AQAA. All comments from people who live at the home were positive about the homes staff. People stated that they felt there were generally enough staff to meet peoples needs. External professionals stated in comment cards that staff appear to have the necessary skills and experience to meet peoples needs. One adding carers are always friendly and very good with the people who live at the home. All nine people who completed comment cards responded yes to the question asking if staff listen and act on what they say with one adding I am quite content here, they are nice. Duty rotas were seen during the visit to the home. Duty rotas stated that three care staff are provided throughout the day and two carers at night. Cleaners, activities Care Homes for Older People Page 25 of 34 Evidence: coodinator, and kitchen staff are also employed. Additional staff are provided on the days when the home is providing day care for up to five people. The manager is generally additonal to these numbers. During the inspectors visit staff on duty corresponded to those on the duty rota. Comment cards from staff stated that they usually/sometimes have enough staff to meet peoples needs. Care staff stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Service users stated in comment cards that there are always (3) and usually (6) enough staff available when they needed them. The registered manager provided training and qualification information on the AQAA and this was confirmed by the person in charge at the time of the inspection. The home has twenty-one care staff, thirteen of whom have an NVQ in care with four staff now undertaking a level 3 qualification. The inspector spoke with care staff most confirmed that they had an NVQ in care, and all felt that they had the necessary training to meet peoples needs. Training information and certificates in staff files were viewed during the inspection. The home has further training planned over the comming months that will ensure that all staff have completed basic and update training in all mandatory areas including food hygiene, health and saftey, fire awarness and COSHH. Newly appointed staff were all due to undertake all the above and manual handling. The home has also organised for some staff to attend dementia awarness, challenging behaviour and mental capacity act courses. The registered manager is a train the trainer for safeguarding and staff have recieved safeguarding training. An additonal comment on a staff comment card stated that training is compulsary at the home and all responded on comment cards that they have the necessary training to meet peoples needs. The inspector viewed the minutes from staff meetings held the most recent being held approximately two weeks prior to the inspection. The recruitment records for three staff recruited since the previous inspection were viewed. These contained all the required information and confirmed that all staff are checked including references, CRB and POVA checks prior to commencing employment at the home. The inspector noted however that although two references had been sought, for two of the new staff the persons current or previous employer had not been requested to give a reference. This may place people at risk. The person in charge explained the homes induction procedure that includes the Skills for Care induction. Induction workbooks were seen along with certificates for courses new staff had attended. New staff work initial shifts as supernumerary as part of their induction. New staff on duty at the time of the inspection confirmed that they had worked extra Care Homes for Older People Page 26 of 34 Evidence: to numbers for about two weeks. 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 is appropriately managed and run in the best interests of the people who live there. Peoples financial interests are safeguarded. Staff are not supervised regularly however the home is addressing this issue and recognised it in the AQAA. Records are generally well maintained. The health, safety and welfare of people and staff are promoted however the home must ensure that substances hazardous to health are kept secure at all times and toiletries are not shared. Risk assessments must be undertaken on all equipment used in the home. Evidence: The homes AQAA, discussions with staff and people who live at the home, records viewed throughout the inspection and observations during the inspection are considered. Also considered is the commissions registration report for the new registered manager and other information provided to the commission. Care Homes for Older People Page 28 of 34 Evidence: Since the previous inspection a new manager has been appointed and was registered in July 2008. The registered manager has worked at the home for approximately one year. The registration report stated that the registered manager is a qualified nurse and has the Registered Managers Award. The registered manager has previous experience of managing a care service. Comments made to the inspector and in comment cards about the registered manager were positive and included about complaints I would talk to the boss, Liz shes very nice, and from an external professional the new manager is very experienced and skilled and her nursing experience has a positive impact on individuals health care needs in particular. Care staff stated that the home is a happy place to work with service users echoing this one adding on a comment card I am much happier here than in the other home, and another I am more than happy here, everyone treats me alright. The homes Annual Quality Assurance Assessment was completed by the registered manager and returned when it was requested. This was completed to a good standard and provided the information required. The AQAA identified that the home aims to appoint a deputy manager and this had occurred by the time of the unannounced inspection visit. Following the previous inspection a requirment was made that the home must have quality assurance system in place. The home now has a range of quality assurance procedures. These include the monthly care plan reviews, resident and staff meetings. One of the directors undertakes a monthly visit to the home and views a range of records and talks to people and staff to assess the quality of the service offered. A report is provided to the manager following these visits and the inspector viewed these. The director has also undertaken a survey of the people who live at the home the inspector again viewing the results of this survey. The home has not yet undertaken a survey of external stakeholders or staff. The AQAA identified that staff supervision was not yet at the required frequency. This was confirmed during the inspection however a requirement is not made as the home are addressing this with the person in charge at the time of the unannounced inspection showing the inspector some appraisals and supervisions that have been completed and lists of further supervisions planned. The home does not become directly involved with peoples personal finances but will hold small amounts of personal money for a few people. The storage arrangements and records relating to these were viewed and should ensure people are not at risk of financial abuse. Alternatively the home invoices people for additional services such as chiropody and hairdressing with the inspector viewing an itemised invoice which clearly Care Homes for Older People Page 29 of 34 Evidence: showed what the extras were for. A range of records were viewed during the inspection. All were appropriately stored with access only available to people who should have access. Records were generally well maintained. The inspector viewed records relating to the checks on the homes fire detection equipment which are completed at the required intervals and also servicing arrangements and certificates for equipment in the home. These evidenced that equipment in use should be safe. During the inspection a sluice room was found unlocked containing a range of hazardous substances, this was locked immediately but the home must ensure that substances hazardous to health are kept secure at all times. Also noted were shared toiletries in a bathroom which presents an infection risk as well as being potentially hazardous to health. The report following the previous inspection undertakn in July 2007 stated that it was recommended as good practise for meal plates to be covered as staff carry trays around, keeping meals hot and for infection control measures. It was again noted during this inspection that care staff carry plates of food around the home without any covers which represents an infection control issue and that action has not been taken by the home in respect of the issues raised in the previous report. The home must ensure that risk assessments are undertaken on all equipment used in the home. The risks associated with stand alone heaters that were hot to touch had not been assessed. Care Homes for Older People Page 30 of 34 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 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 38 19 The responsible person must 01/07/2009 ensure that full preemployment checks are completed before people commence working at the home. The previous employer must be asked to provide a reference as part of the pre-employment checks. So that people are safe. 2 38 13 The reponsible person must 01/07/2009 ensure that risk assessments are completed on all equipment used in the home. So that people are safe. 3 38 13 The responsible person must 01/07/2009 ensure that all substances hazadous to health are kept secure at all times. So that people are not placed at risk. Care Homes for Older People Page 32 of 34 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 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. 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