Care Home: Eastcotts Nursing Home

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What the care home does well The interaction between staff and people that lived at the home was friendly, caring and professional. People`s requests for assistance were promptly acted upon. People were provided with a programme of activities that was meaningful and of interest to them. Comments made in the service user surveys included `they look after me well and keep me safe and look after my medical needs and keeps me occupied` and `they make sure that I am kept well dressed, clean, washed, fed on time, as well as my medication`. What has improved since the last inspection? A new activities coordinator had been employed at the home. The medication records were kept up to date and clearly showed where medication had been administered, which safeguarded people. What the care home could do better: The home`s statement of purpose needed to be updated to show the current management arrangements of the home and the contact details of CQC (Care Quality Commission) should people wish to contact us. Where people`s care plans stated `needs assistance`, this needed to be expanded upon to identify the specific assistance that people needed and required. It is recommended that the arrangements for people ordering meals be considered, the current arrangements for people making their choices were on a weekly basis. Alternative arrangements to the chains that were across the door frames to people`s bedrooms to be considered for ensuring people`s privacy. Staff must be provided with the training that they need to ensure that people are safeguarded and that their needs are met. Notifications that adversely affect the wellbeing of people must be made to CQC without delay. Safeguarding issues must be reported appropriately and without delay to ensure that people are appropriately safeguarded. Key inspection report Care homes for older people Name: Address: Eastcotts Nursing Home Eastcotts Nursing Home Calford Green Kedington Haverhill Suffolk CB9 7UN     The quality rating for this care home is:   one star adequate 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: Julie Small     Date: 1 5 0 4 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 35 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 35 Information about the care home Name of care home: Address: Eastcotts Nursing Home Eastcotts Nursing Home Calford Green Kedington Haverhill Suffolk CB9 7UN 01440703178 01440763435 anjelina.silva@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Raveedha Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Eastcotts is a Care Home with Nursing, it is registered to care for a total of 59 older persons including people with dementia. Located in a small rural hamlet near Haverhill, Eastcotts is set in its own grounds with car parking. The home is a converted three-story period property, with a single storey extension. The home is divided into 3 areas, Main home, Jasmine and Lavender Unit, each with their own lounge and dining room. There are 33 single and 13 double bedrooms, with some of the newer rooms having en-suite toilets and showers. Care Homes for Older People Page 4 of 35 Over 65 27 59 0 0 1 3 0 5 2 0 0 9 Brief description of the care home The fees at the time of the inspection ranged from £362 to £600. Care Homes for Older People Page 5 of 35 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: one star adequate 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 unannounced inspection took place Wednesday 15th April 2010 from 09:45 to 19:00. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. During the inspection health and safety records, staff training records and the recruitment records for four staff members were viewed. The care of four people that live at the home was tracked, which included viewing care plans and medication records. Further records that were viewed are detailed in the main body of this report. Observation of work practice was undertaken and six staff members, two visitors and ten people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to Care Homes for Older People Page 6 of 35 the home and it was returned to us. Four staff, eight service user, three health professional and three relative surveys were returned to us before the inspection. Care Homes for Older People Page 7 of 35 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 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 8 of 35 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 9 of 35 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 who use this service can expect to be provided with the information about the services provided at the home to assist them to make decisions about if the home is the right place for them and to be provided with a needs assessment prior to moving into the home. The home does not provide an intermediate care service. Evidence: People were provided with information about the services that were provided at the home in the statement of purpose and service users guide, which helped them to make decisions about if they wished to move into the home. The AQAA stated service users are provided with comprehensive pre-admission documentation which explains the way in which the home is run e.g. service user guide and statement of purpose, brochure. The service user survey asked if they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them, five answered yes, one answered no, one said that they did not know and one did not answer the question. Care Homes for Older People Page 10 of 35 Evidence: The statement of purpose was viewed and included details such as the homes philosophy of care, the services and facilities that were provided to people, the management details of the home, which needed to be updated to reflect the current management arrangements, staff training, the charter of peoples rights, quality assurance, frequently asked questions and answers, the fire safety procedure and the complaints procedure. The document also stated that a copy of the inspection report of the home could be obtained from the entrance hall to the home and useful addresses, such as local hospitals and social services. The contact details of CSCI (Commission for Social care Inspection) was also included and needed to be updated to show the contact details of the current regulatory body CQC (Care Quality Commission), should people wish to contact us. The service user guide was viewed, which was also included in the statement of purpose. The service user guide included information such as details about the building and its rooms and the numbers of people that were accommodated in the home. The care of four people was tracked, which included viewing their care records, which included needs assessments that had been undertaken prior to them moving into the home. The needs assessments included information such as the persons medical history, their medication and the support that they needed in areas such as personal care. Each of the care records that were viewed included a care plan, which identified how the peoples assessed needs were to be met. The AQAA stated a comprehensive pre-admission assessment is completed by the manager, this is followed up by a further detailed assessment of their care needs and wishes on admission to the home. This assessment involves the service user and/or relative or friend along with any outside agency that is providing care at the time and a biography and life style questionnaire is included and the prospective resident and relative is encouraged to complete these to assist staff in the care plan process and to give a better over view of the resident coming in. This gives more information regarding social and emotional needs than the clinical aspects of the pre-admission assessment alone. The health professional survey asked if the services assessment arrangements ensured that accurate information was gathered and that the right service was planned for people, two answered usually and one answered sometimes. Care Homes for Older People Page 11 of 35 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. People who use this service can expect to have their needs met, to be protected by the homes medication procedures and to be treated with respect. Evidence: The care of four people that lived at the home was tracked, which included viewing their care records. The care records that were viewed included care plans, which identified the care and support that people required and preferred to meet their assessed needs, in areas such as with personal care, mobility, behaviours and social interaction. It was noted that in areas such as the support required with personal care the care plans stated needs assistance, this needed to be further explained to ensure that the care staff were aware of the specific assistance that each person needed to ensure that their needs and preferences were met appropriately. The AQAA stated residents receive effected personal and health care support based on comprehensive assessments. Care plans are regularly kept under review and are meeting all of the needs of the resident and relatives and relevant professionals are involved in all stages of the process and are invited to and participate in regular Care Homes for Older People Page 12 of 35 Evidence: reviews with nursing staff. The care records included day notes, which identified the support that people had been provided with and the observations of their well being on a daily basis. The care records that were viewed included risk assessments, which identified the methods of minimising the assessed risks in areas such as with the use of bed rails, pressure areas, manual handling, falls and nutrition. The AQAA stated care plans include risk assessments to identify those at risk of pressure damage using tools such as waterlow risk assessment for the development of pressure sores and the action which is being taken to reduce risk e.g. use of pressure relieving aids. Risk assessments for identifying malnutrition e.g. MUST are being introduced and care plans and actions to prevent this are in place. Falls risk assessments are made and the falls co-ordinator works closely with the home to ensure that the action plan is appropriate for frequent fallers and trains the staff. Work with local falls clinic at hospital and can refer an service user who may benefit from the clinic. There were details of the outcomes of medical appointments that people had attended, such as with the doctor, optician and dentist. During the inspection we noted that a persons face was bruised, we asked them and a staff member what had happened and they explained that they had fallen. We asked to view their care records and it was noted that the details about the fall had clearly been recorded. We had also observed that the during a doctors visit on the day of the inspection, they had seen the person, the outcomes for the visit was also clearly recorded in the persons care records. This showed that the fall had been clearly documented which provided information to the care staff so that they were aware of the persons well being and that the issue had been appropriately followed up with medical professionals where required. The AQAA stated residents have an opportunity to choose their own GP and have access to all the NHS facilities in the local community, including the optician and dentist. These professionals also visit the home when necessary. People that were spoken with told us that their needs were met, that their preferences were listened to and acted on and that if they felt unwell a doctor would be called. A staff member told us that the doctor visited the home twice a week. A relative of a person was spoken with and they told us that they felt that their relatives needs were met and they commented how well their relative looked. Care Homes for Older People Page 13 of 35 Evidence: It was noted during the inspection that people looked well groomed, clean and they were wearing clean clothing, which showed that their dignity was respected. The service user survey asked if they received the care and support that they needed, two answered always, four answered usually and two said that they did not know. The survey asked if they were provided with the medical support that they needed, two answered always, five answered usually and one answered sometimes. The survey asked what the home did well and comments included they look after me well and keep me safe and look after my medical needs, medical care and support, 90 of my needs and they make sure that I am kept well dressed, clean, washed, fed on time, as well as my medication. The relative survey asked what the home did well and comments included the caring given to my (the person) by Eascotts staff has been very good, in the short time my (the person) has been in the residence I cannot fault the care (the person) is given, staff are loving and kind, (the person) is kept clean and they do give personal attention. The survey asked how the home could improve and comments included it would be good if (the persons) daily notes (think this may be care plan) were in (the persons) bedroom as they were in the previous residence so we can see what sort of day (the person) has had and we need not bother staff. Three health professional surveys said that peoples social and health care needs were usually properly monitored, reviewed and met. The survey asked if the service sought advice and acted on it to meet peoples social and health care needs and improve their wellbeing, two answered usually and one answered sometimes. The survey asked what the home did well and comments included gives 24 hour care to residents who need support. Residents physical health needs are addressed as there are registered nurses on duty. Residents basic needs are met adequately as observed during my visits and looks after patients physical nursing needs better than mental. The survey asked what the home could do better and comments included residents with mental health issues need specialist registered mental health nurses and more dementia education and ways of working although they continually strive to do better. The staff survey asked if they were given up to date information about peoples needs, three answered always and one answered usually. The survey asked if the ways that they passed on information about people between staff worked well, two answered always and two answered usually. People that lived at the home were protected by the homes medication procedures Care Homes for Older People Page 14 of 35 Evidence: and processes. The medication procedure was viewed and it clearly identified the methods of safe handling, storage and administration of medication. There were also guidelines for the administration of PRN (as required) medication. The AQAA stated the home has a policy for the receipt, storage and handling, administration and disposal of medication and the registered manager ensure this is adhered to and monthly audits of all medications by deputy manager to ensure legislation policies procedures and professional accountability are being followed. There were three units in the home (Lavender, Jasmine and Main), and each unit provided their own medication trolley, controlled medication cupboard and MAR (medication administration records) charts. The medication administration was undertaken by the nursing staff on each of the units, which showed that people were provided with their medication in a timely manner. Part of the lunch time medication administration round was observed in one unit of the home. It was noted that the nurse who was responsible for administering the medication checked the MAR charts and the MDS (monitored dosage system) blister packs to ensure that the appropriate medication was administered. They put the medication from the blister packs into clean pots and offered the person their medication, they recorded that the person had taken their medication in the MAR charts when they had observed them taking the medication. Where people refused their medication, for example for PRN (as required) pain relief, codes were recorded to reflect this. The nurse explained the procedures for the medication administration and they told us that they had been provided with medication training, which was confirmed in the training certificates in two nurses records that were viewed. Four staff surveys said that they were provided with training which gave them enough knowledge about health care and medication. The MAR charts for four people were viewed, one person from Lavender, one from Main and two from Jasmine. It was noted that the medication was accounted for, there were no gaps in the records and codes were used appropriately, for example when people were in hospital or had refused their medication. We spoke with the homes pharmacist who was visiting the home at the time of the inspection, they told us that in their opinion the medication at the home was managed appropriately and that they had no concerns. The health professional survey asked if peoples medication was managed correctly when it was not possible to administer their own medication, two answered usually Care Homes for Older People Page 15 of 35 Evidence: and one answered sometimes. During the inspection we observed that the interaction between staff and the people that lived at the home was friendly, caring and professional. It was noted that there was lots of friendly banter between people and staff. Staff were attentive to peoples needs and requests for assistance were attended to promptly. People that lived at the home that were spoken with told us that they were treated with respect. They were complimentary about the approach of the staff and one person said I think the world of them and pointed to a staff member. People told us that their privacy was respected and it was noted that there were privacy screens in shared rooms. We observed that staff knocked on peoples bedroom and bathroom doors before entering. However, during the inspection it was noted that all bedroom doors were open and several had a chain across their door frame. We asked a member of staff what the chains were for and they told us that it was to prevent people wandering into others rooms and to ensure that their privacy was respected. We explained that this may not be safe, a person could walk into the chain and fall over the chain, we asked if there were risk assessments for the chains and none were provided. We suggested that people may be prevented from wandering into other peoples rooms if they closed the doors. The AQAA stated the care workers are trained to give choices to service users in ways which facilitate independence and working within the limitations of their capacity/ability e.g. what clothes to wear and what to eat, what time they go to bed and get up. The home operates a policy of knocking before entering service users rooms to ensure privacy dignity and respect. The health professional survey asked if peoples dignity and privacy was respected, one answered always and two answered usually. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be provided with an activities programme that they can choose to participate in, to be provided with support to maintain their chosen contacts and to be provided with a nutritious and balanced diet. Evidence: Since the last key inspection there had been a new activities coordinator employed at the home. They told us that they worked Monday to Friday and that activities at the weekend were facilitated by the care staff. We spent some time with them in the dedicated activities room in the home, where four people were undertaking art work. They showed us photographs and records of the activities that were provided at the home. There were some good and imaginative activities that were provided, such as visits to Haverhill, art work, which was displayed around the home, a pat the dog scheme, cake making, a donkey had visited the home the weekend before the inspection, gardening, a horse and carriage ride for two people who were celebrating their anniversary, a race night and garden games, which had been made by the activities coordinator and the homes maintenance staff. They told us that they also ensured that individual activities were provided for people who did not wish to join in the group programme, which included chatting, shopping and reading. The activities coordinator had started working on scrap books with individual people, which included Care Homes for Older People Page 17 of 35 Evidence: a life story and photographs of activities that they had participated in. People that lived in the home that were spoken with told us that there were plenty of activities to keep them busy and they told us about the plans for a group of people to visit a local coastal town, which they were looking forward to. During the inspection we observed people watching television, listening to music and reading, as well as the organised art work activity. A person told us that they had received a bird table as a gift and they enjoyed watching the birds. A staff member told us that they moved another bird table nearer to the window in one of the units as a person had told them that they liked birds. We observed a group of people in the lounge engrossed in the activities of the birds that were eating the food that had been put on the bird table by the staff member and they talked to each other, staff and us about the birds. The service user survey asked if there were activities provided at the home that they could participate in, two answered always, two answered usually and four answered sometimes. One relative survey said that the home could improve by employing a second activities coordinator and more trips into the local town. The AQAA stated our new residents that are admitted have a comprehensive recreational therapy assessment which enables the provision of quality activity not just a quantity. A detailed biography is taken when possible from each resident to establish a background of activities and past times. This also gives an indication of who is special to the resident. This allows staff to engage in varied conversations. We have links with the local community so that service users can access amenities such as library, churches, pubs, bowling, dancing and Tai Chi is practiced once a week for those who want to take part and who may benefit to improve quality of life reduce stress and improve physical condition to help avoid or combat accidents and falls or decreased self esteem morale even depression. People that were spoken with told us that their visitors were always made welcome and this was confirmed by a persons visitor who was spoken with. Peoples care records that were viewed included the contacts that people chose to maintain. The AQAA stated we have open visiting arrangements and provide free meals for visitors upon request. People told us that their views were listened to and acted on. The service user survey asked if the staff listened and acted on what they said, two answered always, two Care Homes for Older People Page 18 of 35 Evidence: answered usually, two answered sometimes and two said that they did not know. During the inspection we observed that staff were attentive to the needs of people that lived at the home and that they acted on requests for assistance promptly. There were jugs of cold drinks and glasses in the communal areas of the home and in peoples bedrooms, that they could help themselves to. We told a staff member that the drinks in one room was in the sunlight and that the drinks would be warm, they moved them immediately into a shaded, cooler area of the room. We observed staff provide people with a choice of hot drinks during lunch, in the morning and afternoon drinks round and when people asked for them. People told us that they were provided with plenty to drink. It was noted that the communal areas of the home provided bowls of fresh fruit that people could help themselves to. The homes menu was viewed and it was noted that people were provided with a balanced and nutritious diet, each meal provided two choices and there was a supplementary menu of alternatives. The cook was spoken with and they told us that they regularly spoke with people about their choices for meals and incorporated them into the menu. They told us that the staff that worked at the home kept them updated with peoples dietary needs to ensure that they were met. The cook told us that they made all deserts with a sugar substitute to ensure that people with diabetes could enjoy the same deserts as the other people that lived at the home. During the inspection lunch was a choice of beefburgers or quiche, potatoes and fresh vegetables. There were also additional choices to the menu that people could have if they did not want what was on the menu, such as jacket potato. We observed the staff working from a list of peoples choices that had been made, it was noted that one person said that they did not want what was on their choice list and they were promptly provided with an alternative. We also observed that a person had not eaten their desert a staff member asked if they wanted a yogurt instead, which was provided promptly. We asked a staff member how people made their choices for meals and we were told that they were made once a week. We discussed this during the handover to the inspection and explained that they may wish to reconsider this as people with dementia may not remember what they had chosen the week before and that peoples choices may change with weather conditions. The service user survey asked if they liked the meals at the home, two answered always, four answered usually and two answered sometimes. People that were spoken with were complimentary about the meals at the home and said that they got enough Care Homes for Older People Page 19 of 35 Evidence: to eat. Care Homes for Older People Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their complaints listened to and acted upon. They cannot be assured that the appropriate actions are undertaken to ensure that they are safeguarded. Evidence: The AQAA stated that improvements made in the last twelve months included introduced a new, comprehensive and clear complaints procedure which is published and available to all. We viewed the complaints procedure which clearly detailed how people could raise concerns about the home and the service that it provided and the actions that they could expect to be undertaken as a result of their complaint or concern. The AQAA told us that one complaint had been received in the last twelve months. We viewed the records of the complaint and it was noted that it was investigated and responded to in a timely manner. In the entrance hall to the home there was a complaint, concerns and compliments book, which was viewed. The book held several letters and cards which thanked the staff at the home for the support that people had been provided with. The AQAA stated that they did well by ensuring that all complaints or comments are thoroughly investigated in a clear, open and comprehensive manner and ensuring that they are responded to in an appropriate and timely manner involving all relevant Care Homes for Older People Page 21 of 35 Evidence: people and professionals. The home keeps a record of all concerns/complaints made and responses to these. People that lived at the home who were spoken with told us that they knew how to make a complaint and that they felt that their concerns were listened to and acted upon. Eight service user surveys said that they knew who to speak with informally if they were not happy. The survey asked if they knew how to make a formal complaint, six answered yes and two answered no. The health professional survey asked if concerns were responded to appropriately, one answered always and two answered usually. Four staff surveys said that they knew what to do if a person had concerns about the home. We had received a concern from an anonymous source and we had written to the provider to ask them to investigate the issue 29th March 2010 using their complaints procedure, at the time of the inspection we had not yet received a response. The AQAA stated the introduction of a new whistle blowing policy, which all staff are aware of and is being supported within supervision to establish knowledge and understanding. Staff that were spoken with were aware of the whistle blowing procedure. They also told us that they had been provided with safeguarding training and that they were aware of actions that they should take if they had concerns about the safety of people that lived at the home. The AQAA stated all staff are S.O.V.A (safeguarding of vulnerable adults) trained. The training certificates of three staff members that were viewed showed that they had been provided with the training. The homes training matrix was viewed which showed that all staff had not been provided with safeguarding training, which included four nurses and nine care staff. We were informed by staff that a staff member had recently been dismissed from the home. The administrator provided us with the investigation notes from the staff members personnel file. It was noted that the staff member had been dismissed from the home following reports of an abusive practice. Although the staff member had been suspended, the management had investigated the issue and then dismissed them, they had not notified the required bodies relating to safeguarding, which were Suffolk County Council Adults Services Safeguarding and CQC, as laid down in Regulation 37 The Care Homes Regulations 2001. This was to ensure that the Care Homes for Older People Page 22 of 35 Evidence: appropriate people were aware of the issue and that the appropriate safeguarding investigations were undertaken. We spoke with the provider on the telephone the day after the inspection and advised that they should have made a safeguarding alert to Suffolk County Council Adults Services and notified us regarding the incident and that they should consider making a referral to the ISA (Independent Safeguarding Authority). We received a telephone call from the homes administrator later that day to advise us that they had made a safeguarding alert and that they would ensure that a notification was forwarded to us in writing. Suffolk County Council confirmed that they had received the alert the day after the inspection and we received the notification. The AQAA said that improvements made in the last twelve months included commencement of training in implications of the Mental Capacity Act. The training matrix that was viewed showed that one staff member had been provided with Mental Capacity Act and Deprivation of Liberty training. Care Homes for Older People Page 23 of 35 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 this service can expect to be provided with a clean and comfortable home to live in. Evidence: A tour of the building was undertaken and it was noted that the home was clean and there were no unpleasant odours. There were four communal lounges and an activities room that people could choose to use, each was clean and provided sufficient arm chairs for people to sit in. The AQAA stated that they did well by ensuring that the home is safe, secure, clean and well maintained and the home is separated into three sections allowing a homely atmosphere to develop in each area to promote the well being and safety and security of the service users. Full time maintenance person to ensure the home is well maintained and faults corrected quickly. Rolling repair and redecoration programme in place. The AQAA told us about the improvements that had been made in the last twelve months which included 8 bedrooms have been redecorated which has given them a light and airy feel. 2 lounges have been redecorated and there is an ongoing refurbishment programme in action to ensure all rooms and communal areas are redecorated or refurbished in a timely manner. A health professional survey stated the large old building does not lend itself to Care Homes for Older People Page 24 of 35 Evidence: individual care as much as it could, the overriding smell of urine is unpleasant. A relative survey stated my (person) room needs refurbishing. The service user survey asked if the home was fresh and clean, four answered always, two answered usually, one answered sometimes and one said that they did not know. The survey asked what they felt that could be improved in the home and comments included home is very good but could do with a lick of paint and cleaning rooms which can be very poor. We spoke with one of the two domestic staff that we had seen during the inspection, we asked them how they managed to minimise unpleasant odours and they told us that they regularly deep cleaned carpets. They told us that they were provided with sufficient cleaning materials to ensure that they kept the home clean. Peoples bedrooms that were viewed were clean and personalised with their items of memorabilia, such as photographs and ornaments. However, it was noted that all bedroom doors were opened and some had a chain across the doorway, this is further discussed in the health and personal care section of this report. There were also small gates, the type that were used to prevent children from falling down stairs, at the bottom of the stairs and across one of the ground floor corridors. The AQAA stated that they did well by personalising residents rooms to make it more homely for them and the home encourages service users to bring in small personal items of furniture and photographs and to decorate their rooms individually taking into account health and safety issues. The majority of the windows in the home provided attractive views of the countryside that surrounded the home. There were large attractive grounds, which people told us that they could walk around or sit in if they chose to. The activities coordinator showed us barrels that people had planted flowers in. They also showed us a range of garden games that they and the maintenance person had made that people could use. The AQAA stated that they provided a large enclosed safe outdoor space secure for service users to enjoy to promote health and well being. The homes laundry was in a building outside of the home, it was noted that it was clean and tidy and provided two washing machines and two drying machines. The laundry staff member was spoken with and they told us that they worked Monday to Friday each week and alternate Saturdays. They told us that there was sufficient machines to ensure that peoples laundry was kept clean. They were aware of the infection control procedures and they showed us the stock of protective disposable aprons and gloves in the laundry for their use to minimise cross contamination. Care Homes for Older People Page 25 of 35 Evidence: The laundry and bathrooms that were viewed provided hand washing facilities, which included hand wash liquid and disposable paper towels to minimise cross contamination. During the inspection staff were observed to use good infection control procedures, which included washing their hands and wearing protective gloves and aprons when undertaking tasks such as supporting people with personal care and handling food. The AQAA stated the risk of infection and cross infection is minimised by staff training and awareness of the importance of prevention and isolation of those needing it as advised by the Health Protection Department even if this means changing to a single room it will be provided. Care Homes for Older People Page 26 of 35 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. People who use the service can expect to be protected by the homes recruitment procedures. They cannot be assured that all staff are appropriately trained to meet peoples needs. Evidence: The AQAA stated the home has the duty rota which clearly shows which staff are on duty at a specific time. The home has a policy of assuring staffing levels by the use of existing staff or calling agency staff. A staff member that was spoken with told us that the home was staffed twenty four hours each day and that one nurse and three carers worked in the three units during the morning shift, one nurse and two carers worked in the units Main and Jasmine and one nurse and three carers in Lavender during the afternoon shift. During the night one nurse and five carers supported the people that lived at the home. This was confirmed by the staffing levels that were seen on the day of the inspection and in the staffing rota that was viewed. During the inspection it was noted that the interaction between staff and the people that lived at the home was friendly, caring and professional. Staff were attentive to the needs of the people that lived at the home and requests for assistance were attended to promptly. Care Homes for Older People Page 27 of 35 Evidence: Staff that were spoken with told us that there were enough staff to ensure that peoples needs were met. The staff survey asked if there were sufficient staff to meet the needs of the people that lived at the home, two answered always and two answered usually. People that lived at the home that were spoken with told us that the staff were attentive to their needs, that call bells were answered promptly and they were complimentary about the approach of the staff that worked at the home. The service user survey asked if the staff were available when they needed them, three answered always and five answered usually. A staff member had recently been dismissed, this is further discussed in the complaints and protection section of this report, which included blocking call bells during the night with an object. A staff member that was spoken with told us that the call bell system had since been changed to ensure that the call bells could not be blocked in individual peoples rooms. The recruitment records of four staff members were viewed and it was noted that appropriate checks had been made to ensure that people were safeguarded. The checks included CRB (Criminal Records Bureau) checks, identification, two written references and their work history which was included in their application form or CV. The AQAA stated checks including CRB and POVA checks before employment commences. Four staff surveys said that checks such as their CRB and references were undertaken before they started working at the home. The AQAA told us that there were thirty three care workers at the home, which included eight qualified nurses and twenty five care staff. Thirteen care staff had achieved a minimum of NVQ (National Vocational Qualification) level 2. This means that the home had met the target of 50 of care staff to have a achieved a minimum of NVQ level 2 as identified in the National Minimum Standards relating to older people. The AQAA stated all staff working within the home complete mandatory training applicable to their role (Skills for Care) including POVA (protection of vulnerable adults), manual handling, person centred care, fire, infection control measures (working with Suffolk County Council providing training in Skills for Care Course 5 days for all carers usually within 6 weeks of commencement working at the Home), food handling and hygiene and trained RGNs are registered with the NMC and are developed in specialist roles to ensure high quality up to date care (dementia care, wound care, mentorship, management). Care Homes for Older People Page 28 of 35 Evidence: The four staff records that were viewed including training certificates, which included an appropriate induction course, manual handling and safeguarding. A training matrix was viewed, which showed that there were several shortfalls in the training provision of the staff that worked at the home, for example all staff had not been provided with safeguarding training, which is further discussed in the complaints and protection section of this report, four nurses and nine carers had not been provided with manual handling training and four nurses and eleven carers had not been provided with dementia training and two staff had been provided with wound care training. Staff that were spoken with told us that they had been provided with the training that they needed to do their jobs. Four staff surveys said that they were provided with training which kept them up to date with new ways of working, that provided them with enough knowledge about health care and medication, that helped them to meet peoples needs and that was relevant to their role. Care Homes for Older People Page 29 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect that their financial interests are safeguarded. They cannot be assured that their health, safety and welfare is fully promoted and protected. Evidence: There was a new manager that worked at the home since February 2010, they were on leave at the time of the inspection. The AQAA stated the manager has more than 20 continuous years of experience in managing nursing, residential, dementia & learning disability homes. The manager holds a DMS and is trained to CIEH trainer level to enable her to be accountable and to carry out her role professionally and responsibly armed with the necessary knowledge. The manager professionally updates to keep abreast with current government guidelines and initiatives. The manager continuously professionally develops on external training days. Care Homes for Older People Page 30 of 35 Evidence: Staff that were spoken with were complimentary about the management style of the manager. A staff member told us that the homes providers regularly visited the home, which was approximately three or four times a week. They told us that the providers monitored the running of the home at the times of their attendance. There were some issues identified during the inspection, which showed that there were shortfalls in the management of the home, for example not reporting safeguarding issues, which is further discussed in the complaints and protection section of this report, we were informed at the inspection that one person who lived at the home had a pressure area for which we had not been notified of and the shortfalls in the training provision for staff that worked at the home, which is further discussed in the staffing section of this report. The records of four peoples spending money was viewed and it was noted that they were appropriately safeguarded. Clear records of transactions, receipts and the balance of money that was kept in the home for safekeeping were maintained. We checked the actual balance of money with the records and it was noted that they were correct. People were provided with the opportunity to express their views about the service that they were provided with in their care reviews, daily discussions with the staff and satisfaction questionnaires. A health and safety folder was viewed, which included service certificates that showed that equipment and appliances were routinely serviced, such as the homes lift and hoists, electrical appliances, fire equipment, the boiler and gas. During the inspection it was noted that bedroom doors were open and some held a chain across the door frame, we discussed this with a staff member who told us that they were in place to ensure peoples privacy from others who may wander into their rooms. We explained that closed doors would ensure peoples privacy and that they needed to risk assess the use of the chains to ensure that the risk of accidents was minimised. Care Homes for Older People Page 31 of 35 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 32 of 35 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 18 18 Staff must be provided with safeguarding training. To ensure that they are aware of how to safeguard people that live at the home 27/05/2010 2 18 12 Where there have been abusive practices safeguarding alerts must be made to the Suffolk County Council Adults Services Safeguarding To ensure that people that live at the home are appropriately safeguarded. 30/04/2010 3 18 37 The Commission must be notified of any event which adversely affects the well being or safety of people that live at the home. To ensure that people are safeguarded and that the registered person acts appropriately and in accordance with Regulation. 30/04/2010 Care Homes for Older People Page 33 of 35 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 4 30 18 Staff must be provided with the training that they need to do their jobs. To ensure that peoples needs are appropriately met. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that where care plans state needs assistance, that they include the specific assistance that each person needs and prefers. It is recommended that alternative methods of ensuring peoples privacy be used, rather that the chain across peoples doors. It is recommended that the methods for people to order their preferences of meals be reconsidered to ensure that people are provided with the opportunity to make their choices on a more regular basis. 2 10 3 15 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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