Care Home: Elders (The)

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What the care home does well The home`s policies and procedures promote equality and diversity and nondiscriminatory practice. People considering using this service have access to information enabling an informed choice of home. They receive a comprehensive needs assessment before admission, ensuring their individual needs, expectations and aspirations can be met. Personal care practice respects their privacy and dignity and health is promoted, ensuring access to health care services. We were informed by a person using this service, "Staff always call the doctor when I need one and respect my privacy when they help me dress and undress, or when assisting me in the bathroom and toilet". Independence is promoted and maximised using appropriate, well-maintained Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 equipment. The environment meets the needs of people using this service and all areas are clean, hygienic and comfortable. The home has a good record of staff retention, providing good outcomes for people using services. Team stability enables continuity of care and steady, incremental service improvements, as staff become more experienced, knowledgeable and skilled. Staff are trained and in sufficient numbers. Those on duty demonstrated good understanding of the individual needs and preferences of people they were supporting. The home`s atmosphere was friendly and stimulating during the visit. People using services who we consulted were positive in their feedback about their care experience at the home. One individual said, "I chose this home over others I looked at because it is not too big. This means we know all the staff and they know us and the way we like things done. Staff are flexible here and very good". Service provision includes a choice of wholesome meals. There is an open culture that encourages people using services and their advocates to express their views any concerns in a safe, understanding environment. Robust policies and procedures safeguard people using services from abuse and neglect. What has improved since the last inspection? A redecoration and refurbishment programme was instituted following the last inspection and is ongoing. This has substantially enhanced the home environment. Other improvements have addressed shortfalls in records keeping and further developed risk assessments. Monthly visits are now carried out, in accordance with statutory requirements, by members of the management committee. Their findings are recorded in a report, a copy of which is given to the registered manager. The social care programme has been further developed. Cleaning standards have been enhanced by the employment of a cleaner three days a week; also new arrangements extending the remit of the window cleaner. What the care home could do better: Pre-admission assessment information was incomplete for a person recently admitted and a care plan had not been produced for this individual. Another care plan sampled was not up to date in that it did not reflect significant change in mobility. Care plans were not holistic and the records sampled did not demonstrate an individualised approach to meeting social care needs. Whilst acknowledging some improvement in risk assessments for people using services, since the last inspection, there remain shortfalls. Moving and handling risk assessments were not evidenced to have been carried out for two people with limited mobility. Discussions with the deputy manager confirmed awareness of where improvements in these areas can be made and plans for improvement. Shortfalls in staff recruitment practice and staff induction practice were also identified. Key inspection report CARE HOMES FOR OLDER PEOPLE Elders (The) The Elders Epsom Road Ewell Surrey KT17 1JT Lead Inspector Pat Collins Key Unannounced Inspection 10:00 24th July 2009 DS0000013633.V375745.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elders (The) Address The Elders Epsom Road Ewell Surrey KT17 1JT 020 8393 9757 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) re.taylor@ntlworld.com Golden Hours Fellowship Limited Mr R Taylor Care Home 21 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE) The maximum number of service users to be accommodated is 21. Date of last inspection 25th September 2008 Brief Description of the Service: The Elders is a care home providing personal care and accommodation for up to 21 older people. Built in 1876, this Victorian, four storey, detached property has been extended and upgraded in recent years. Car parking facilities are available and a large attractive garden, with furnished terrace. The home is on a bus route and located between the village of Ewell and Epsom town. It is managed by Golden Hours Fellowship Ltd, a non-profit making registered Christian Charity and offers a practicing Christian environment. Admissions are open to non-practicing Christians, people of other religious faiths and those of none. A registered manager is responsible for the homes day-to-day management, supported by a management committee and deputy manager. Bedrooms are for single occupancy, though arrangements can be made for partners to share, and most have en-suite facilities. They are arranged on the ground, first and second floors, accessible by stair or passenger lifts. Toilets and assisted bathrooms are on all floors and communal lounges and a separate dining room is on the ground floor. Weekly fees range between £450.00 and £550.00. Contractual fee rates apply to Local Authority funded placements. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this care home is one star adequate service. This means the people who use this service experience adequate, quality outcomes. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector, beginning at 10:00 hrs and finishing at 18:30 hrs. The visit was facilitated by the homes deputy manager. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgements about how well the service is meeting the National Minimum Standards (NMS) for Older People. This includes accumulated evidence and our knowledge and experience of the home since its last key inspection. Each year providers registered with the CQC must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. The AQAA provides quantitative information about their service, requiring assessment of the same against NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content used to inform judgements about this service. The inspection process incorporated discussions with seven people using this service. We viewed the premises and garden and gathered information through discussions with the deputy manager and some staff. Documents sampled included marketing information, care records and assessments, staff files and rotas, also records specific to safety, maintenance, quality assurance and quality audits. We sampled menus, observed lunch and preparation of the evening meal and examined medication practice and storage. What the service does well: The homes policies and procedures promote equality and diversity and nondiscriminatory practice. People considering using this service have access to information enabling an informed choice of home. They receive a comprehensive needs assessment before admission, ensuring their individual needs, expectations and aspirations can be met. Personal care practice respects their privacy and dignity and health is promoted, ensuring access to health care services. We were informed by a person using this service, Staff always call the doctor when I need one and respect my privacy when they help me dress and undress, or when assisting me in the bathroom and toilet. Independence is promoted and maximised using appropriate, well-maintained Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 6 equipment. The environment meets the needs of people using this service and all areas are clean, hygienic and comfortable. The home has a good record of staff retention, providing good outcomes for people using services. Team stability enables continuity of care and steady, incremental service improvements, as staff become more experienced, knowledgeable and skilled. Staff are trained and in sufficient numbers. Those on duty demonstrated good understanding of the individual needs and preferences of people they were supporting. The homes atmosphere was friendly and stimulating during the visit. People using services who we consulted were positive in their feedback about their care experience at the home. One individual said, I chose this home over others I looked at because it is not too big. This means we know all the staff and they know us and the way we like things done. Staff are flexible here and very good. Service provision includes a choice of wholesome meals. There is an open culture that encourages people using services and their advocates to express their views any concerns in a safe, understanding environment. Robust policies and procedures safeguard people using services from abuse and neglect. 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 Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 7 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. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service have access to information enabling an informed choice of whether the home can meet their individual needs, expectations and aspirations. They can be confident that their assessed needs can be met by the home. Standard 6 was not assessed as the home does not provide intermediate care. EVIDENCE: The homes management understands the importance of having sufficient information to enable an informed choice of home. A statement of purpose has been produced specific to the services and facilities, setting out its aims and objectives and philosophy of care. This had been recently updated. A discrepancy and misleading statement in this document, which is displayed on the homes website, was discussed with management. We were informed there is a service users guide however this was not viewed. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 10 An informative brochure had also been recently updated, detailing what prospective users can expect. It provided a clear account of the homes services and facilities, of staffing arrangements, health and social care provision and how to make a complaint. Recent inspection reports are available to view at the home during office hours. The brochure provides an overview of the homes day-to-day operation and is sent to people making enquiries about vacancies. Discussions with the deputy manager included the need to ensure all marketing information is updated with the latest contact details for the Care Quality Commission. Also for consideration to be given to producing the service users guide in a variety of formats, to meet the range of communication needs of people for whom the home is intended. We sampled two care files and spoke with a person recently admitted. The admission and discharge policy and procedure viewed had been recently updated. Equality and diversity legislation underpins the admission criteria, ensuring non-discriminatory practice. The homes statement of purpose and brochure informs people who are considering moving into this home that it is a practicing Christian home, whilst welcoming people of all religious backgrounds and beliefs and those of none. This prepares people to expect the display of Christian symbols in some communal areas. The admission policy requires a pre-admission assessment before admission, which is also the practice for emergency admissions. The pre-admission assessment process involves gathering information from a range of sources. It also includes obtaining copies of community care needs assessments for people placed and funded by Local Authorities. Some shortfalls in recording pre-admission assessment outcomes were identified and discussed. Additionally, there is a need to generate a preliminary care plan from pre-admission assessment information. These plans can then be further developed after admission following further assessment of needs and risks. The home is efficient at obtaining specialist input and any further training for the team before admission takes place, as necessary. This enables people admitted to this home to be confident staff possess the necessary skills to meet their needs and of the suitability of the environment and equipment. A physiotherapist carried out an assessment at the home prior to the recent admission of an individual, providing staff with guidance specific to moving and handling practice and advice on equipment. A portable ramp delivered on the day of the inspection visit, was ordered based on this advice. Discussions with a person recently admitted confirmed the admission process had been a positive experience. She commented, I was in hospital for a year before coming in here. A relative chose the home, I like my room and the staff made me very welcome. They are all very good to me and very kind. The home does not offer an intermediate care service. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care received by people using this service is based on assessment of individual needs and is mostly set out in care plans. Shortfalls were identified in the area of care planning, risk assessment and management of medication. Principles of respect, dignity and privacy are put into practice. EVIDENCE: Nineteen people were using the homes services at the time of the inspection visit. The inspection process included sampling care records of two people and discussions with a number of people using services and staff, also carrying out practice observations. Key workers are allocated groups of people using services and have specific key working responsibilities. The deputy manager is responsible for care planning, involving key workers and people using services in this process. Reviews of care plans do not always involve relatives; however copies of care plans were stated to be accessible to them, for their input and comment. It was suggested that people using services with capacity to do so, be requested to sign their care plans. Also for their agreement to relatives reading their care plans to be sought and documented. Observations confirmed Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 12 overall improvement in care notes, providing an audit trail of care delivery and of significant events. Monthly summaries of care are produced by key workers. The deputy manager confirmed recognition of where care plans and risk assessments could be further developed and stated this was planned. The need for care plans to be more holistic was discussed, as those sampled focused on physical care needs. Care plans must be updated, to reflect current needs. A care plan sampled did not reflect or address a significant change in mobility for this individual. Though the scope of risk assessments had been extended, discussions with the deputy manager confirmed awareness that risk assessments and risk management plans needed further work. These need to demonstrate assessment of environmental risks, for example, access to toiletries in bedrooms of vulnerable adults, access to stairs and steps, access and use of the garden which is not enclosed, use of bedrails and access to ensuite bathrooms. Whilst the moving and handling risk assessment tool had been further developed, evidence was not found of moving and handling assessments carried out on the two files examined. Both individuals had limited mobility. Other areas where improvement could be made include the need for a more individualised approach to monitoring nutritional needs. Currently some individuals are unable to use the homes weighing scales and nutritional assessments were not evidenced. Use of a validated nutritional assessment tool was suggested also a more detailed falls risk assessment tool. Care plans did not address behavioural management, the need to do was discussed, to support consistency of practice. Observations confirmed that health and personal care provision at the home is based on individual needs. Health is promoted and access to health care services facilitated. Staff said they receive good support from medical and nursing professionals. A person using services said, Staff always call the doctor when I need one and respect my privacy when they help me dress and undress, when I have a bath or use the toilet. Suitable aids and equipment are provided, including a sling hoist. A ramp had been obtained to enable a wheelchair user to access the lounge. Specialist equipment can be loaned if necessary, for example, adjustable height beds with bedrails and for pressure sore prevention. Observations confirmed staff are responsive to non-verbal forms of communication of people using services, of which 50 have varying degrees of dementia, according to the AQAA. Best practice social engagement was observed between staff and individuals with dementia or memory loss, for other reasons, in the lounge. Staff communicated appropriately with individuals, patiently allowing them sufficient time to process and respond to what they said to them. Staff also used appropriate touch to reinforce information when communicating with these individuals. It was evident, based on all available information, that the wishes of the people who use this service are respected by staff and their wellbeing is promoted. A person using services told us, I chose this home over others I looked at because it is not too big. This means we know all the staff and they know us and the way we like things done. Staff are flexible and very good. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 13 We assessed the management of medication, including storage and recording practice and viewed three medication administration charts. A monitored dosage medication system is used and administration practice had improved since receipt of a medication trolley, supplied by the homes pharmacist. Medication storage, including storage for controlled drug was to a satisfactory standard. Though no controlled drugs were currently prescribed, one drug was stored and recorded as a controlled drug. The outcome of this practice led to secondary dispensing practice by night staff. It was agreed this would be reviewed. Medication administration on day duty is the responsibility of senior care staff. They have received medication training; however this training did not include practice assessment, to ensure competence. It was suggested medication refresher training be included in the staff training programme and for this to incorporate a practice assessment element. A system for general practitioners (GPs) to carry out routine medication reviews was not in place. Observations identified the need to arrange for medication reviews for some people using services whose needs were reported to have changed. Prescribers directions were not always followed, for individuals, for this reason. The need to improve medication record - keeping was discussed, specifically, for relevant codes and information to be entered on these records, explaining reasons for non-administration of prescribed medication. Care plans should also be generated for prescribed treatment for skin disorders and provision of supplementary drinks and care notes demonstrate prescribers instructions are followed. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the 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 social activities programme has been extended and people using the homes services have opportunity for choice in their daily lives. A balanced and varied diet is offered. EVIDENCE: The homes atmosphere was calm, friendly and respectful of the people using this service. Routines and staff are flexible, enabling choice and promoting independence in their daily lives. These choices include times of getting up and going to bed, whether to have a bath or shower, choice of clothing and how people spend their time. Positive relationships were evident between staff and individuals using services. We were informed that staff had mostly received dementia awareness training, aiding their understanding of the communication needs of people with dementia. Environmental orientation cues included signage of toilets and information on a board in the lounge about menu choices, the date and weather. Consideration could be given to provision of further orientation cues around the premises. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 15 The social activity programme had been further developed since the last inspection. A self-employed activities therapist provides activity sessions three afternoons a week. One of these sessions took place on the day of the visit, providing a group activity in the lounge. Musicians and entertainers also visit on a regular basis. Visits by a PAT dog called Coaster and his owner is a new development, stated to be much enjoyed by everyone using this service. Records of social activities were recorded in a book. The need for an individualised approach to identifying and meeting individual care needs, through the care planning process, was discussed. Care records need to demonstrate how social needs are being met for each individual. Recent activities included film shows and watching tennis matches during the Wimbledon tournament on a new, large wide-screen television, in the lounge. Birthdays, anniversaries and other special occasions are celebrated, with provision of a buffet, cards and presents. A mobile library service stocks the home with a good range of large print books. A person sat in her bedroom was noted to have a couple of these books on the table beside her chair. At an additional charge, a hairdresser provides a regular service and personal newspapers may be ordered. A gentleman was reading his newspaper in the lounge during the visit. A pay phone is available on the ground floor and telephones can be installed in bedrooms, for private use. There is regular input from a church group and a monthly communion service also takes place at the home. Families and friends of people using services are made welcome and can visit at any time. A quiet room is available for visitors use, if preferred. A visitor took her mother out for the afternoon at the time of the inspection. Staff said they sometimes support people using services to go out for a walk or in a wheelchair in the local area. Toiletries and other personal items are mostly brought in by relatives. Discussions with two people without relatives confirmed staff offer to shop for personal items, on their behalf. The chef and catering assistant were both on duty at the time of the visit. The chef prepares breakfast and lunch, during the week and the catering assistant prepares these meals, working on her own, at weekends. The home does not have dish washing equipment and the catering assistant washes up after breakfast and lunch during the week and is assisted by care staff in this task, at weekends. Care staff are responsible for preparing a light meal in the evening. They were stated to also prepare sandwiches and leave these and cake or biscuits, for night staff to serve with drinks. We spoke with the chef who had produced a varied four-weekly rotating menu, based on feedback and preferences of people using services. Breakfast is usually served in rooms and includes a choice of freshly made porridge or range of cereals, choice of white or brown toast or bread with butter, juice and pot of tea or coffee. On Sundays there is the option to have a boiled egg. The two course lunch menu includes an alternative dish. On the day of the visit the choices were fish in cheese sauce or chicken, accompanied by potatoes and fresh vegetables and icecream and tinned pears, for desert. The choice of menu was clearly displayed on a board in the lounge at lunch time and later changed to display the evening meal choices. We were informed by the deputy manager that it was Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 16 practice for care staff to consult people about their choice of meal at lunch time and communicate this to the chef. A discussion later with one individual confirmed she had not been offered a choice of meal at lunch time and this was reported to the deputy manager. We were informed that the chef bakes cakes and makes home made puddings. The division of responsibilities for ordering food between the chef and the manager was stated to sometimes create problems in following the menu. Provisions requested by the chef were not always ordered or ordered in sufficient quantities. Care staff prepare a light evening meal and its content is recorded in a diary. Discussions with care assistants confirmed they offer people using services a choice of food based on availability of provisions. Typically evening menus comprise of ready processed foods, for example quiche, sausage rolls, chicken nuggets, spaghetti or beans on toast, soup, sandwiches and cakes. The chef was concerned that care staff frequently forgot to probe food temperatures at night and this matter drawn to the attention of the deputy manager, during the inspection. Discussions with staff confirmed their view that their catering duties were manageable as part of their work-load. People using services were overall complimentary about the quality of meals. One person told us, I like the food, usually it is nice and I always have enough. The kitchen was clean and tidy and suitably equipped. The Environmental Health Officer had recently inspected food safety and no requirements made. The chef had not had formal feedback on the outcome of that inspection or sight of the report. The presentation of dining tables in the dining room was of a good standard also the presentation of the meal we observed. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People using the 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 using this service are able to express their concerns and have access to a complaint procedure; they are protected and their welfare promoted by the homes policies and procedures. EVIDENCE: The home has an open culture that encourages people using services and their relatives and advocates to express any concerns in a safe and understanding environment. This judgement is made on the basis of feedback from individuals we spoke with during the visit. Comments included, I tell them if Im not happy with things, I soon let them know and they change things to please me. Staff ask if there is anything troubling me and try their best to put things right. The complaint procedure is included in the brochure sent to people who use this service, before their admission. A copy of the procedure is also displayed in the entrance hall. The complaint procedure has defined response timescales and includes contact information for the Care Quality Commission (CQC). The need to update this with the CQC new office details is recognised by management. Observations identified the need for a minor change in the complaint procedure, to avert expectations for CQC to investigate complaints, which is not within the regulators remit. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 18 Since the last inspection a suggestions box is no longer provided for people using services or visitors to use as part of the concerns, complaints and compliments procedure. The importance of ensuring records are maintained to demonstrate concerns that are not formal complaints are acted on, was discussed. The homes safeguarding adults policy had been recently updated and a copy of the local multi-agency safeguarding procedure was available. The need to obtain the latest copy of this procedure was identified. Staff training records evidenced staff had received training to enable them to identify indicators of abuse or neglect and to know what action to take. The homes policies preclude staff involvement in the financial affairs of people using services. At the time of the visit no money was kept by management on their behalf. Though not encouraged, occasionally personal money or valuables may be held by management. Procedures ensure secure storage and all transactions for money are recorded and witnessed. Discussions with the deputy manager included the importance of familiarising herself with the Mental Capacity Act. A copy of the same was found in the office, though she had not been made aware of the same. The need to be aware of the homes assessment responsibilities relating to this legislation was discussed. It is suggested management source relevant training. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is comfortable, clean and hygienic. A planned programme of redecoration and replenishment of worn furnishings is ongoing. EVIDENCE: The statement of purpose states the home provides a safe, manageable and comfortable environment. Bedrooms range in size and are all for single occupancy. 60 have en-suite toilet facilities and some are fitted with baths. All bedrooms have washbasins. People using this service are encouraged to personalise their rooms. A person using services commented, I love my room, its lovely and very clean. Communal toilets, assisted bathrooms and shower facilities are on all floors. Communal rooms were nicely furnished, comfortable and domestic in character. Since the last inspection a redecoration programme has been implemented and remains ongoing and worn furniture had been replaced. The programme compliments the traditional style of existing furnishings and the Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 20 buildings architectural features. The recently redecorated entrance hall affords a good first impression of the home, with new furniture, grandfather clock and chandeliers. The weekly provision of fresh flowers in the hallway and other communal areas is a new development, providing a welcoming feature. The dining room had been tastefully redecorated and natural light in this area had been enhanced by the choice of voile curtains. The communal lounge is large and comfortably furnished and is imminently due for redecoration. The sun lounge off the main lounge overlooks the garden, affording a comfortable, light, quiet sitting area. A risk assessment of the steps outside the sun lounge door opening onto the furnished terrace needs to be carried out, to assess whether a handrail is necessary. We were informed staff assist people up and down this step. The large garden is well maintained, however not enclosed. A gate was broken leading to the car park from the garden. The registered manager has since reported this is being replaced. Laundry rooms were clean and locked when unattended, ensuring safe storage of hazardous cleaning substances. A washing machine had been replaced with a model that has a sluice cycle. Clinical waste is appropriately handled and disposed of and hand - washing facilities enable good infection control practice. A number of staff had completed or were nearing completion of infection control training. A high standard of cleaning and odour management was evident throughout the premises. Care staff have a generic role, with cleaning responsibilities as part of their duties. Cleaning standards have been enhanced by the employment of a cleaner three days a week and agreement for the window cleaner to clean the sun lounge windows and its roof. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, skilled and in sufficient numbers to support people using the service and the smooth running of the home. Some shortfalls in staff recruitment practice exist and staff induction not evidenced. EVIDENCE: The staffing structure is based around delivering outcomes for people using this service and is not led by staff requirements. Staff ratios are determined by the assessed needs of people using services and take account of staffs generic role which includes cleaning and catering responsibilities. A senior care assistant is on duty throughout the waking day, together with the manager, deputy manager or both, during the week; also four or five care assistants on early shifts and two or three care assistants on late shifts. At night two waking care assistants are on duty. The staff team also includes a chef, assistant chef, a cleaner who works three days a week and person responsible for maintenance and gardening. Some members of the management committee also have designated roles and responsibility at the home. People who use this service benefit from a stable staff group. Currently there are no staff vacancies. Staff retention is good, the low turnover enabling continuity of care and of services and an individualised approach to meeting needs. We examined two staff files employed since the last inspection, to Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 22 assess recruitment practice and shortfalls in this area were fully discussed with the deputy manager. Specifically, the need to ensure a full employment history is obtained for all prospective employees and references are sought, where relevant, from last employers. A record explaining gaps in employment needs to be maintained. As stated at the time of the last inspection, recruitment records need to demonstrate proof of identity of all prospective employees. Observations confirmed new staff take up post after receipt of disclosures from the Criminal Records Bureau (CRB). The need to adhere to the CRB code of practice for recording, storage and disposal of CRB disclosures, was discussed. Induction records were not available for these two employees. The deputy manager stated they would have received an informal induction and records not maintained of the same. Evidence was seen of a new induction format in preparation for future new employees, based on the common induction standards. The Annual Quality Assurance Assessment (AQAA) confirms that twelve of the sixteen permanent care workers have attained National Vocational Qualifications (NVQ) in care at level 2 or equivalent. This exceeds the National Minimum Standard, demonstrating the Charitys high commitment to staff training and development. A committee member who visits the home once a week is an NVQ Assessor and provides support and guidance to the team. Records sampled demonstrated an ongoing programme of staff training. The homes atmosphere was warm and welcoming and people using services have confidence in the staff. Their comments included, Staff are all lovely, they give me lovely baths and sit with me. I am very happy I chose this home, staff are good. A care assistant who has worked at the home for five years said, I love coming to work. An agency worker told us, I am always happy to be sent to this home, it a good place to work and the care is very good. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home is overall effectively managed, some shortfalls were identified in care planning, risk assessment, recruitment and staff induction. Quality assurance systems need to be more robust, ensuring continuous selfmonitoring and improvement. EVIDENCE: The registered manager has managed the home for more than twenty eight years and past inspection reports confirm he has attained the Registered Managers Award qualification. He was not on duty on the day of the inspection visit. The inspection was facilitated by the deputy manager who has relevant extensive experience and National Vocational Qualifications in health and social Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 24 care (NVQ) Levels 2 and 3. The management structure includes senior care assistants who have clearly defined roles and responsibilities. The senior care assistant on duty was stated to have NVQ Level 3 and in excess of twenty years relevant experience. Two senior care assistants are planning to work towards achieving NVQ Level 4 in the coming year. The management team is supported by an administrator who spends one day a week at the home, and is responsible for invoices. She is the homes NVQ Assessor and provides valued input and advice to the management team and staff. The administrator has recently been updating policies and procedures; she has also discussed with the deputy manager where improvements to risk assessments can be made. Based on all available information, the inspection outcomes suggest the management team has a clear understanding of the key principles and focus of the service, based on the Charities values and priorities. There is evidence of continuous improvement of services and facilities; also a focus on equality and diversity issues, promoting rights, especially in the areas of dignity, respect and fairness. Observations however indicate the need for more management time to be spent in the areas of care planning and risk assessments. Also for management monitoring systems to be more robust. The homes Annual Quality Assurance Assessment (AQAA) contained relevant information. This needs to be in future validated by more evidence, demonstrating how the home meets the National Minimum Standards for Older People (NMS). Discussions with the deputy manager included where improvements can be made when completing the AQAA. It was handwritten on this occasion but will in future be complete using information technology, which is a new development. The home works to a clear health and safety policy. There is a consistent record of meeting environmental health and health and safety legislation. Self monitoring systems for health and safety were observed however need to be more robust. Significant recent investment has gone into fire safety at the home and the fabric and decor of the building. The need to consult the fire officer about developing fire evacuation plans for individuals using this service was discussed. Risk management measures include radiator guards, restricted windows, door alarms fitted to the fire exit leading to a fire escape and other external doors and valves fitted to control hot water at a safe temperature. Hot water temperatures are also regularly monitored. On the day of the visit, however, the hot water temperature to an en-suite suite bath in a room occupied by a person with dementia was found to be hazardous. The deputy manager planned immediate action to ensure the safety of this individual. Observations identified door alarms were not all functioning on the day of the inspection. The need to carry out a risk assessment for the fire door leading to the front car park off a busy main road was identified. Other matters for attention included the need to move the emergency call bell in the second floor shower room so this is accessible from the toilet and in a bedroom, so this is accessible to the bed. The faulty footrest on the stair lift, though reported to Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 25 have been recently repaired, was a potential hazard and in need of further attention. Quality assurance systems include systematic, regular review of services. Trustees of the Charity ensure members of the management committee carry out monthly statutory inspection of the home, on behalf of the responsible individual. Reports of these visits were sampled during the inspection. The homes quality assurance system includes obtaining direct feedback from people using services, through discussion and surveys. Currently the survey questionnaire used is being redesigned with the intention of also surveying other stakeholders. The quality survey analysis sampled for 2008 demonstrated high levels of satisfaction with service provision. Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 13, 15 Requirement For all people using services to each have an up to date plan of care generated from comprehensive needs and risk assessments. For recruitment practice to include obtaining a full employment history from prospective employees, together with a satisfactory written explanation of any gaps in employment. The registered person must also ensure references are sought from last employers, where relevant and new staff receive structured induction training. Timescale for action 24/08/09 2 OP29 OP30 18,19 24/08/09 Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elders (The) DS0000013633.V375745.R01.S.doc Version 5.2 Page 29 Care Quality Commission CQC South East Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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