Care Home: Drumconner

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What the care home does well One professional who returned a survey commented that "the staff at the home have a good rapport with the residents and there is always a happy atmosphere when I go in." A GP commented in their survey that "the home usually notes what action they have requested to carry out although sometimes they need a reminder". People who live at the home were positive about the food that the home provided and the condition of the accommodation that they occupied. The home offers meals and snacks in people`s rooms and food and drink is available throughout the day and night with people being enabled to help themselves. Relatives and representatives of people who use the service commented on the reception of them as visitors and how the home accommodates families for special occasions and enables them to continue to be part of their loved one`s life. The home is clean and offers a choice of accommodation and equipment. What has improved since the last inspection? The home has started to review the contracts and agreements it makes with the people that use the service. The home discusses care plans with people who use the service or their representative and they sign the care plans to agree them. The home has been altered with modifications made to bathrooms, and bedrooms and new rooms have been built. The requirement made following the last visit regarding water temperatures has been met. What the care home could do better: There must be a plan of care to tell staff what they need to do to meet needs, there must be a record of action taken by staff and it must be evaluated to ensure that it is up to date and reflects the current needs of the individual. Medication must be administered, stored and managed safely following guidelines, standards and regulations. Staff must received mandatory training to enable them to care for the people using the service, this must be given in a timely way to protect them and people living at the home. Whilst the home has since given assurances of meeting requirements made these are the areas that must be imbedded Key inspection report Care homes for older people Name: Address: Drumconner 13 - 21 Brighton Road Lancing West Sussex BN15 8RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Val Sevier     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Drumconner 13 - 21 Brighton Road Lancing West Sussex BN15 8RJ 01903753516 01903851437 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Drumconner Ltd Name of registered manager (if applicable) Mr Roger John Kinsman (Jnr) Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 48 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Drumconner is a care home registered to provide personal and nursing care for up to 48 people who are over 65 years or people with a physical disability who are over 50 years. The home is a large detached building which has been extended. It stands in its own, Care Homes for Older People Page 4 of 36 Over 65 48 0 0 48 Brief description of the care home well-maintained gardens with a car park to the side. It is situated in a residential area on the main coast road from Worthing to Brighton in the village of Lancing. Local shops and other community facilities are close by. It is on a bus route. The accommodation is provided on two floors with a passenger lift allowing access to the top floor. Communal areas include three lounges, a dining room and a lounge/bar area for entertaining. There are 35 single and 6 double bedrooms. A number of rooms have en-suite facilities. Some have a sea view. The manager has advised us that the minimum weekly fee is #650, and the maximum weekly fee is #1100. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 27th January 2010 between the hours of 10:30am and 6:30pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in 4th February 2008. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 36 meeting the needs of people who live at the home. We met with the registered manager, two staff, two visitors and there were three people who use the service involved in the inspection visit. There were 47 people living in the home on the day of our visit. We looked at five pre admission assessments, five care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, ten staff and five professionals at the time of writing the report we have had twenty surveys returned. Care Homes for Older People Page 7 of 36 What the care home does well: 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 Care Homes for Older People Page 8 of 36 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. The current assessment record would prove more beneficial to the assessment and care plan process for the individual if the information is used as a basis for the care plan to meet identified needs. Evidence: The AQAA for the home said:Each service user has an individualised pre admission assessment to ascertain whether the home can meet their care needs, if the home cannot meet their needs an explanation is given to the service user. Where service users are referred through care management services the home obtains a full assessment of their care needs and a copy of the service users care plan. Service users are provided with terms and conditions of the home. Each service user is encouraged to visit the home, and maybe stay for lunch to get a feel for the home, Care Homes for Older People Page 11 of 36 Evidence: they can do this as many times as they wish until they feel settled. We feel that this is a major decision for the client and they should be 100 confident in the service. Drumconner employs a booking clerk receptionist to meet all new or potential clients to give them as much time as possible, this dedicated member of staff is greatly appreciated by the client as they can attend to their every need or answer all questions to give a smooth transition, which is very important. When a service user pays for all or part of support received they receive a written contract setting out their rights and responsibilities. When a service user pays for all or part of care received we charge the right amount at the time agreed. The care home gives notice of any changes regarding payment. Comprehensive brochure and web site giving all information needed for a preliminary enquiry. A requirement was made following the last visit in relation to the contract or terms and conditions given to people who use the service. The manager showed us the draft version of the terms and conditions and contract that are being looked at by the homes solicitor. We saw examples of the contracts that had been issued to people in 2009 and saw that the home had the Commission for Social Care Inspection as the authority with which the home was registered these contracts were after the date of the changing of the commission, this had been discussed with the manager at the previous visit as the name of the registering authority had been wrong then also. There have been several admissions since we last visited in 2008 we looked at five of them. The manager told us that there is one dedicated person who carries out the pre admission assessments, if they are not available then he does them. We saw that there was information on individual needs, based on their present and past medical history for example, nutrition and food likes and dislikes. The assessment noted where individuals had particular needs such as weight and mental well being. We also saw examples on how staff are to offer support for an individual to remain as independent as possible. The assessments had spaces for additional comments we saw that these had been used in some areas of the assessment in two cases. We saw that there was not always a date and signature of who had carried out the assessment and when. We saw that there was information from other health professionals to assist in making the assessment as to whether the home can meet the individuals needs. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. One comment we received in a survey said, the staff at the home have played a vital role in enabling my father to make a successful transition from his home to living at Care Homes for Older People Page 12 of 36 Evidence: Drumconner. Care Homes for Older People Page 13 of 36 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 care plans and other records about individuals must always clearly demonstrate how care is planned and delivered as well as evaluated. Medications records and administration practices that have been improved must be imbedded to reduce risks to individuals. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that:Each service user is supported to make their own decisions, Drumconner uses a person centred care planning approach, which is regularly evaluated. The care team work with both the service user and their relatives to provide the best possible support for the individual. Care workers encourage client choice i.e what clothes they want to wear, this process helps clients keep their independence. Staff are well trained in all aspects of care, with both in house training, DVDs and our new training officer, this improves staff knowledge, thus providing a better quality of care. We have care plans and risk assessments,to cover all the clients care needs e.g pressure area care, malnutrition, falls, lifting and handling. Service Care Homes for Older People Page 14 of 36 Evidence: users within reason and with the doctors agreement can keep their own GP in the case that this is not possible a GP can be organised. Service users privacy and dignity is respected by all employees, for example knocking on the door before entering a service users room. The home works very closely with other agencys to give the best possible care for example St Barnabas local palliative care and clinical skin specialists Any changes in clients mobility, we use our own physio to reassess their needs and introduce an exercise programme so that the client can regain independence they had. All documentation is kept in service users rooms so that clients and relatives can read about their care needs and correct them with our help when necessary or when they feel care needs have changed. This we believe makes our whole care planning procedure totally transparent and fully involves the service user and their family. The home has a policy for the receipt, storage and handling, administration and disposal of medication and the registered manager ensures that it is adhered to. Equipment is freely available for all aspects of care i.e hoists, air mattresses, profile beds. A requirement was made following the last visit for the home to involve the individual and or their representative in the care planning process. This part of the requirement was seen to have been met with the individual and or their representative being able to see the care plan, sign it and be able to read and comment on it as it is kept in the individuals room. The second part of the requirement was that the care plans should have a record of all needs, and how the staff will meet those needs. It was found that this part had not been fully met in the care plans we saw and a requirement has been made specifically for this. As part of our site visit we look at pre admission assessments and the care plans for a sample of individuals who live at the home. We do this to track through what happens for the individual before they come to the home and how the home plans the care that it will deliver. We assessed whether individuals have a plan of care, that clear instructions were in place for staff to follow, that there was a record of delivery, and that record matches the plan of care, which is regularly reviewed or as needed to ensure that it continues to meet individual needs. Following the visit the service supplied additional information and this has been included in the report and is acknowledged in the appropriate paragraphs. The information supplied by the home reflected information we saw on the day of the visit. At this visit we looked at five plans of care and their related pre admission assessments and other supporting documents for example blood sugar monitoring for diabetes and wound care. Care Homes for Older People Page 15 of 36 Evidence: The first care plan was for an individual who was admitted to Drumconner from another service, following a protection of vulnerable adults review which had taken place due to the person having pressure areas that needed treatment. We saw on the pre admission assessment that moving and handling was to be supported with a hoist until the pressure areas had healed and then a banana board could be used. The moving and handling care plan stated that a banana board was used to be assist movement. The manual handling risk assessment was last reviewed in September 2009. The wound care plan said that the sore area was healing, however there was no information on the moving and handling plan linking these two plans, as to why the banana board was being used, when the pressure area although healing was still there and painful. Since the inspection visit we have been sent information that says that the individual wishes to use the Banana board because, if I used the sling with hoist it would be very uncomfortable for my sore area. This piece of information was not dated. One example of where instructions were not clear and no review had taken place was for this same individual. We saw in the daily notes that in December 2009 this individual was having difficulty with managing their diabetes. We saw on the Drs visit form a record that said that the person was to be reviewed by the diabetic nurse and the GP was to chase appointment details. We could not see in the daily notes that this had been done. We saw on the appointment records for this individual for November 2009, (the where and with whom section was blank), diabetic appointment six months, retinopathy. It is not clear whether this is an eye care appointment with a specialist or an additional follow up with a diabetes nurse. The care plan regarding nutrition also had information about the persons diabetes with a record on the 3rd October 2009 that diabetic control was poor at present, seen by diabetic nurse, medication altered blood sugars needs close monitoring. The care plan for diabetes said that medication was used to help with the diabetes, weekly blood monitoring was crossed out, and monthly written, then a record on the 3rd October 2009 said due to poor diabetic control, daily crossed out, weekly blood monitoring. The information on the medical care plan under delivery of care said monitor baseline observations, weekly blood sugar monitoring. Drug administrations, asthma as per MAR, monitoring BM stix weekly. The records we saw from 3rd October 2009 to the date of the visit did not reflect daily, weekly or monthly checks of blood sugars with gaps on occasion of 18 days. The additional information sent by the home after the visit supported the information we had seen for this individual. Another care plan we saw, the individual had suffered fractures of both hips, the first Care Homes for Older People Page 16 of 36 Evidence: in January 2009 the second in October 2009. There was a generic risk assessment in place which had been carried out on admission this had not been reviewed following the two fractures. We saw that care plans for example personal hygiene was last updated in September 2009 before the second fracture. We saw that a nutritional assessment had been completed but this was not dated. Since our visit the home has sent us a falls risk assessment in relation to this individual however, the assessment does not state what action staff are to take to lessen the risk of falls for the individual. The manager gave us a file in which all plans of treatment for wounds and pressure areas for example are kept. There were several people who were receiving care for pressure areas, four of whom were admitted to the home with areas that required treatment. We saw on the wound treatment file that, one of those had developed a second pressure area and three people have developed pressure areas since November 2009. We saw that one individual had suffered two skin tears when being hoisted; they are also receiving treatment for two pressure areas. We looked at the accident reports for this individual, we could not see that any follow up had taken place or that care had been reviewed. We discussed this with the manager at the time of the visit. The information in the plans for treatment that we saw stated what dressings were to be used, we could see that dressings were changed, there were no instructions on how often the areas were to receive treatment. This would include for example change after bath or shower, or if dressings damaged. Additional information we have been sent since the visit in the form of pressure area audits carried out by the deputy manager in November there was no year recorded, stated some pressure areas had reduced or healed. The audit tool was not fully completed for example dates of admission and Waterlow scores left blank. We saw on the care plans that when reviews had been undertaken by nursing staff these were usually monthly; there was no consistency in the records with dates and signatures missing so it was not possible to see when care was altered or who had reviewed it. Whilst there was some information for staff there was a lack of detail about individual needs and choices and how staff would support these. There is an expectation that individual nurses are responsible for the records relating to the care they provide and to comply not only with the Care Standards Act but also with the Nursing and Midwifery Council Code of Conduct. Care Homes for Older People Page 17 of 36 Evidence: Where possible we saw that staff enabled individuals to care for themselves and remain as independent as possible for example one care plan in the sample we looked at stated what the individual was able to do for themselves. We saw that the physiotherapist employed by the home assists where needed and keeps a record of what she does and what action and support she feels staff at the home can assist the individual with. This action and support had not been included on the care plans that we saw. Additional information has been sent following the visit in the form of two reviews that took place last year with social services both of which express that they are happy with the care provided at the home. I can see that the person using the service has benefited form nursing care provided by Drumconner. We looked at other information for example surveys returned to us from staff, which told us that they are not always given up to date information about the support they are to give people that live at the home. Surveys from people who use the service have been completed by their relative or advocate, or themselves. One respondent said that that their relative is usually dressed well with make up and jewellery, which they normally would have worn when able to do so themselves. Comments from relatives on the day were that the home is a homely and comfortable place and Dad is obviously happy. One lady comes daily to visit her husband and has lunch at the home. Staff are friendly, food is an adequate amount. It is a nice place clean welcoming. The home was very amenable to having the family here at Christmas. Since the visit we have met the provider who gave assurances that all care plans are now updated and these alongside other recording methods include all needed information about individuals. Monthly reviews are taking place overseen by a designated person and all nurses are responsible to make updates as needed. We also looked at medication the records, administration and storage. The manager Mr Kinsman junior showed us a report from the care of medicines pharmacy adviser from the local chemist store, who offers advice locally to care services. They had made a visit to the home on 22nd January 2010. They felt that generally medicines were in a good condition. However there were several bottles of oral liquid medication that had expired and these should have been disposed of. They felt that a clinical room would make a big improvement to the storage of the homes medication. They also Care Homes for Older People Page 18 of 36 Evidence: found that where variable dosages were prescribed there was not a record of the amount given. They also said that handwritten medication details should include medicine name, whether liquid or tablet, strength and dose. This report was used as part of the evidence for the standard and regulations related to the homes safety regarding medication. We looked at the medication records for 21st December 2009 to the date of the visit. We saw that there were no staff names or signatures of people who administer medication. This is expected in order that should the need arise it can be shown who was deemed competent to administer medication. We asked the manager and he spoke with the nurse on duty who confirmed they were not in the medication administration record folders. Since the visit we have been sent a list of staff who administer medication. We have also been sent a certificate regarding medication handling system training, that took place on 3rd March 2010. The home has three medication trolleys which were attached to the wall in the main downstairs corridor. Other medication such as controlled medication and the medication fridge were kept in a small cupboard near an office. The home has Fentanyl patches, Morphine Sulphate, Buprenorphine patches, Midazolam, Tranexamic Acid, Morphine liquid and Temazepam stored controlled medication and this was kept locked inside a metal cupboard in the store cupboard near the office. We looked at the controlled drug register and did see that Morphine Sulphate was written in the book but it did not say who it was for and it was not indexed at the front of the book. We saw in the medication records kept by staff from the 18th January to the date of our visit that there were four gaps where medication was prescribed to be given and there was nothing to indicate if the medication had been offered, refused or destroyed. We saw that where there is a choice of dosage to be given for example one or two Paracetamol, there was not always a record of how many tablets had been given. Where a medication was as required there was no record of why it had been given and outcome for the individual. Where an individual is prescribed creams or lotions there was no record of whether this had been administered or not. Since the visit we have met the provider who gave assurances that medication training has been addressed. Staff are now meeting expectations for practice and recording. The community pharmacy have attended again on 30th April 2010 and acknowledged the changes and improvements. Further training is due to follow in May 2010 on the management and recording of the administration of prescribed creams Care Homes for Older People Page 19 of 36 Evidence: and lotions. Regularly monthly audits of medications began in February 2010 and will become usual practice and a protocol will be written. Care Homes for Older People Page 20 of 36 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. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs or as part of the local community. Dietary needs are well catered for freely available and food meets individual dietary requirements and choices. Evidence: The AQAA for the home said that: We encourage strong links with the community, so that we can support them in any activities and they can support us. The home has a very busy entertainment schedule as organised and discussed with past and present service users.This is discussed at service user review meetings. The home understands that each client has been used to their own routine, so as far as is reasonably practical we try to honour this and continue this in the home. We believe that this makes for an easier transition into the home and familiar for long term clients. The home operates an open visiting policy. The home offers the use of any of its facilities for client based functions ie family would like to hold a birthday party, the home can cater and staff the function. For comfortable living and a more homely room the home encourages service users to bring in any homely possessions, that may make their lives more comfortable. The home owns a tail lift mini van so that clients can go out on trips, shopping or any other journey, this is also used for doctors or Care Homes for Older People Page 21 of 36 Evidence: hospital appointments. The home offers 3 meals a day, breakfast includes cereal, full cooked breakfast, home baked fresh bread, fruits, pastries, kippers, cooked to order. Lunch is a choice of 2 hot meals with fresh vegetables and a huge sweet trolley, all diets are catered for and service can be for all meals served in the dinning room or room service, supper consists of a choice between a hot meal, soup, buffet and dessert trolley, all meals are flexible to the clients needs, if they dont like the choice the chef can cook an alternative meal. All meals can be served with a choice of wine, beer, sherry or a drink from the bar for no charge. Guests, relatives and friends are encouraged to stay for dinner with the service users for no extra charge. The home offers a 24 hour buffet bar in which clients and families can help themselves to food, drink and alcohol, this encourages family and friends to visit during the evening and stop over during their lunch breaks. We endeavour to offer a warm, homely, family based establishment so that clients can feel relaxed and maybe even at home. We offer a salon, massage, aromatherapy, bar, keep fit classes, physio, reminiscence therapy, arts and crafts as well as regular musical entertainment. People we spoke with told us about the activities and we saw a notice board in the hallway. We saw that several people had magazines and newspapers some were offered by the home, for others family members or friends bought papers in for them. Visitors told us they always feel welcome and that this is a home from home. Some of the activities we saw on the notice board that occur weekly are exercises, games, music and movement, arts and crafts and communion. Surveys we received were generally happy with the meals available the quality and choice and with the activities that were offered. We noted that the home is relaxed at meal times with people choosing to have breakfast when they wished either in their room or in the dining area. One person was sat in the dining area between meals and was watching staff through the hatch in the kitchen. We saw the cold fridge with sandwiches and drinks and the manager explained that this was available to anyone; people who live at the home or families so that there were always a snack available. We saw tea and coffee making facilities. The home is divided into areas with one part having a country feel with pretend cottage walls painted along the corridor and plants painted on the walls. In this area is a bowed window within is the old shoppe and this has items that people may wish such as shaving cream, soap and sweets. This shop can be opened when people need something although the sign did say it was open for a period each day. Care Homes for Older People Page 22 of 36 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 who use the service are protected through the open complaints process and staff knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: The home has a clear and accessible concerns and complaints procedure and clients are told about this with their relatives on admission. Staff also are trained in how to assist and support a service user if they feel they have a complaint or concern. The home has a restraint policy, which the service user or relative has to sign before they can have any bed rails or wheelchair belts put into place for their safety. s care workers are aware that service users capacity to make decisions can change daily and that they must assess their capability each task. All care staff receive training in POVA, whistle blowing and adult protection. Drumconner has policies and procedures in place to respond to evidence or suspicion of neglect and abuse. Drumconner has introduced service review meetings, this gives clients and relatives a chance to air any views, raise any concerns and answer our quality assurance questions about our service, this time is also used to talk about the service users care and any modifications they might want. As a qualified nurse is present this is a good time to do it, with the support of a relative. The home has a complaints procedure, which is outlined in the Statement of Purpose and Service User Guide and on display on a notice board above the visitors signing in book. It includes the timescale of response and the address and phone number of the Care Homes for Older People Page 23 of 36 Evidence: Commission. Surveys we received from people who use the service all stated that they knew who to complain to. Professionals who returned surveys said that they know who to speak to if they were concerned and one said all residents carers and families have multiple roots to engage with the home management either directly or anonymously. The views are heard, responded to and acted upon. The homes safeguarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw statements about peoples capacity on some of the care plans we saw however, we could not see that staff had had training in assessing capacity under the Mental Capacity Act. Two concerns have been raised this year one about staffing the other about numbers of people living at the home. At the time of writing the report these issues are being looked into. We saw that staff are due to have training in safeguarding in January or February 2010 through a notice in the staff area however we could not establish numbers of staff as training records are kept on individual files. The homes trainer was not available on the day of the visit. Care Homes for Older People Page 24 of 36 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 who use the service have a clean pleasant living environment which is having redecoration and refurbishment to improve it, and which is maintained regularly. Evidence: The AQAA for the home said:Since the last inspection we now offer a Wi Fi lounge so that clients and families can use the Internet with their lap tops. Installed a new aerial system so that all service users have access to digital TV and free view if requested. Installed 2 new over head hoists for the parker bathrooms and installed a new spa parker bath with built in Jacuzzi and have built 4 new en suite wet rooms. In addition we have built 5 new rooms all with wet room en suites and under floor heating,also with over head hoists. Drumconner offers a clean,warm,well decorated environment, bedrooms, lounges, bathrooms and the dinning areas are furnished to a high standard. The home has a strict cleaning regimen, to reduce the risk of infection and cross infection, also all staff receive infection control training. In the home there is a routine maintenance work schedule kept by a full time handyman. The home complies with all requirements from the local fire service. The home has beautiful gardens which are fully accessible to the clients including those with mobility problems. The home meets all service user requirements for toileting and bathing with equipment to suit every mobility problem. The home provides all adapted equipment for service users for example air beds, profile beds, hoists, grab rails etc. The home has a call bell system with an accessible alarm for every service user which they can carry around Care Homes for Older People Page 25 of 36 Evidence: with them. The home provides private accommodation for each of the clients which are fully furnished to the clients requirements, they are also encouraged to bring in any of their own furnishings to make it feel more personal and homely. Each room in the home is centrally heated with controls in each service users room. New self service area with fully stocked cooler containing sandwiches, desserts, drinks fruit etc. for clients and families to use if they would like to have a family get together this is a totally free facility. Tea and coffee making facilities. Full room service available for all service users. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. The exception was some radiators n the lounge. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. We could see that many people who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. We saw that equipment was available for use where needs indicated that, with ceiling hoists and specialist nursing beds. Laundry facilities are sited away from areas where food is prepared and stored. The homes AQAA stated that there are policies and procedures in place regarding the control of infection. The home is checked as the regulations indicate to ensure that the machinery, electrics, plumbing for example are all in a safe working order to avoid any risk to them or the staff that use them. A requirement made following the last visit regarding the temperature of the hot water at point of contact was seen to have been met. Individuals commented to us that they were happy with their accommodation. They liked the lounges and dining areas where they could sit with others and chat, watch television, read or listen to music or just be quiet. Care Homes for Older People Page 26 of 36 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. Current recruitment practices at the home do not protect the people who use the service. There is not evidence that all staff receive all the mandatory training that is expected or training to meet specific needs. This places the people at the home at risk. Evidence: The AQAA for the home said:Qualified nurses PIN numbers are regularly checked with the appropriate body. The home ensures that all staff operate in a professional manner which promotes liberty which enables users to feel safe and secure whilst promoting independence. The home recruits staff in a fair and transparent way ensuring that we employ the right people. The home has a robust recruitment process and carry out all necessary checks on possible employees i.e. CRB, POVA, references and full employment histories. All staff when they start receive a contract, job description and handbook. All staff receive a full induction training and regular updates with our fully qualified training officer who is employed with us full time. The training officer also covers all training i.e, manual handling, food hygiene, infection control, first aid and health and safety. The training officer also assists the RGNs and management in providing full supervision and appraisals. The care home actively encourages care staff to undertake NVQ2 training of which we comfortably have over fifty percent qualified in our total care staff. The home operates a flexible and effective staff rota. The home listens to their staffs needs in monthly staff meetings and Care Homes for Older People Page 27 of 36 Evidence: implements changes they feel necessary i.e. modify routines. The home has a staff of the month award which encourages our staff to perform better and rewards hard work in all aspects of the home. At the time of the visit the manager told us that there were 47 people living at the home. The staffing structure at the home consists of the responsible individual, the registered manager, nursing staff, care staff and housekeeping. The manager works five days a week and this can include weekends Mr Kinsman told us that he also does visits at odd hours to manage the staff and any concerns that arise. We have received information since the visit that there is concern that one trained nurse is not enough at night for 47 people. We will look at this outside of the report. There have been several people employed by the home since our last visit and we looked at four of these files. We saw that for three staff there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out and they were dated before the employee commenced work at the home. On the file for the fourth member of staff we saw that the member of staff had begun work in September 2009 and the second reference was dated November 2009. We discussed this with Mr Kinsman who said that if only one reference has been received and that other information is available he assesses the risk and then commences employment. We asked to see the risk assessment however Mr Kinsman said he removes this once he receives the reference. We discussed with Mr Kinsman about keeping all information relevant to an individuals recruitment including the risk assessments. We saw that the new staff members had commenced or completed a basic induction into how the home runs and they had started the Skills for Life induction pack. The induction day includes four hours about the home and one and a half hours each for infection control and manual handling. The trainer for the home, who commenced at the home last year, had put a list of courses that were to be run in house throughout January and February for staff to see. There was also a list of staff names of those expected to participate in the training. We saw the trainers file with staff names and noted that there were a couple of people whose training page was blank indicating that they had not received or attended any training. We discussed this with the manager who said that some staff proved difficult to encourage to training sessions, and had not received certainly updates, he assured us that they would have received some training. A requirement has been made for this. Since the visit we have met the provider who gave assurances that mandatory training has been addressed Care Homes for Older People Page 28 of 36 Evidence: All staff information is kept at the home locked in the managers office. Staff surveys we received stated in four cases that they received training however one said that they did not receive training that is relevant to their role, helps them meet the needs of individuals and keeps them updated. This matches all five surveys which stated they either usually or sometimes had up to date information about the care needs of individuals. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and or their representative who responded to our surveys or who we spoke with are happy with the service provided at Drumconner. However the systems and procedures for example, care planning, medication and training do not always promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said:All staff have a thorough induction training with our Training Officer and also receive supervision and yearly appraisals to identify any of their learning needs. The manager has eleven years of management experience in this post and is now working towards his LMA. The home has a clear management structure. All records are saved for at least three years in the homes storage area. The home has an up to date policy and procedures manual. The home has a quality assurance system in place. The care home keeps all the service users records i.e care plans, assessments etc. in the service users room so that the client or family may look through them at any time and change them with an RGN if needed. The home has a full assessment and care plan package which is regularly reviewed. The home offers a Care Homes for Older People Page 30 of 36 Evidence: service to manage clients finances as far as purchasing any extra services in the home. Records can be checked by the service user or their family at any time. The home provides a safe place for service users to keep valuables and money if required. Drumconner has monthly management meetings. Following the last visit in 2008 three requirements were made, the ones for contracting and water temperatures and safety were found to have been met. The third which was made in relation to care plans was only partially met. We found that the care plans had been agreed and signed by the person or their relative or representative, and those we saw did have information in some areas on how the person wishes their care to be provided, in particular in relation to end of life care. However not all areas where individuals were assessed as needing support, in the plans we saw, had information on how staff will support the person. Other areas that were discussed with the manager were medication, staff training and fire safety. The manager has been at the home for several years and lives locally enabling him to visit the home out of hours and to support staff when necessary. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. The manager stated that he had written to the commission about altering the number of people the home can accommodate following the completion of extra rooms. This information has been passed to the relevant parties. There was concern raised with the commission that the home had gone over the numbers for which it is registered the manager said that they were currently using their double rooms as single ones to ensure that they did not do this. We saw that the manager has undertaken staff meetings. The home looks after what it describes as pocket money for people who live at the home. The money is kept in small money bags with a sheet detailing incoming and outgoing amounts. The small money bag is kept in a larger one in an ice cream container locked in the homes safe. The administrator explained that as money runs down she copies the administration sheet and sends this to the individuals family or representative. When money is received or paid out this is double checked and signed. It was noted that there were some outgoings on the three money bags we sampled that had no receipts. We were told that the chiropodist the home uses does not issue Care Homes for Older People Page 31 of 36 Evidence: receipts. There is also an in house shop, the staff member on shop duty writes down what individuals have bought, this list is given to the administrator who weekly looks at the list, takes the money owed and underlines and says paid. The registered provider carries out Regulation 26 visits each month and completes a report. We looked at some examples of these and noted that there was an issue repeated under complaints and concerns. We discussed this with the manager at the time of the visit. The home has monthly meetings for people who use the service and their representative and relatives. The manager carries out a quality audit on different aspects of the home monthly. We looked at the records for fire safety training and monitoring of equipment. We saw fire training dates on some staff files, the home was unable to confirm when and if all staff had had training. The records for testing the fire safety equipment had been completed weekly up until the week of the visit. Since the visit we have met the provider who gave assurances that the recording of fire training has been addressed and records are kept on individual files and are easily available in the home. Care Homes for Older People Page 32 of 36 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 33 of 36 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 7 15 15 Sch 3 (1)(b) 27/03/2010 The registered person must ensure that care plans are up to date and reflect the needs of individuals as their needs change, this includes treatment for pressure areas and moving and handling. This will ensure that staff have up to date information available to support individual needs. 2 9 13 13 (2) The registered person 27/03/2010 must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 3 9 13 13 (2) The registered person 27/03/2010 must ensure that a record is kept of the amount of Page 34 of 36 Care Homes for Older People 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 medication that is given where there is a variable dosage and why and when an as required medication is given and its effect. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 9 13 13 (2) The registered person 27/03/2010 must ensure that a record is kept of the amount of medication that is given, or a reason why it may have been omitted. This will ensure that the individual receives the correct medication and helps to monitor their health. 5 30 18 18 (c) The registered person 27/04/2010 must ensure that all staff receive mandatory training and any training that is needed to support individuals needs. To ensure the safety of people that use the service. 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 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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