Care Home: Evelyn May House

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well Visitors to the home are made to feel welcome and are enabled and supported to maintain friendships and relationships wherever possible. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. There is a quality assurance system in place so as to seek the views of residents and their representatives, staff and other stakeholders about the services and facilities provided at the home. Records and systems for ensuring that residents` monies are safeguarded and in place. A good range of activities is provided for those people who are `more able` and who can communicate effectively. People live in a home that is decorated, furnished and well maintained to a high standard. Residents bedrooms are spacious, comfortable and personalised. Staff receive regular formal supervision and robust recruitment procedures are in place so as to ensure people`s safety and wellbeing. Staff are provided with training in core subject areas. People are assured that any complaints or areas of concern are taken seriously by the management team of the home and acted upon. What has improved since the last inspection? The needs of prospective people admitted to the home are now formally assessed so that the management team of the home can determine if they can meet the person`s care needs. Care plans clearly record people`s individual care needs and how these are to be met by staff working at the home. In addition risk assessments are completed for the majority of assessed risk. Where medication requires cold storage, the fridge temperature is now within recommended guidelines so as to ensure that medication stored remains effective and fit for purpose. What the care home could do better: The social care needs for people who have acute dementia, poor cognitive ability and/or poor communication needs to be improved. In addition staff`s interactions with people who have dementia and/or poor communication needs to be improved so that people do not feel isolated and people have the opportunity to maintain their potential. Although there is evidence to show that staff have received dementia awareness training, the main principles of dementia awareness must be evidenced through staff`s every day practice. Currently there is little evidence to show that some staff can apply these principles so as to ensure positive outcomes for people. Care must be taken to ensure that medication is not easily accessible to people who live at the home or others to whom it is not prescribed. This will ensure people`s safety and wellbeing. Staff working at the home must receive appropriate training. This refers specifically to those conditions associated with the needs of older people. Key inspection report Care homes for older people Name: Address: Evelyn May House Florence Way Langdon Hills Basildon Essex SS16 6AJ     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: Michelle Love     Date: 3 0 1 1 2 0 0 9 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 33 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) 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 Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Evelyn May House Florence Way Langdon Hills Basildon Essex SS16 6AJ 01268418683 01268543952 evelyn.may@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc care home 59 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The number of service users for whom personal care is to be provided shall not exceed 59 Date of last inspection Brief description of the care home Evelyn May is a purpose built establishment providing care for up to 59 older people. The registration category permits the home to provide care for those people who have a formal diagnosis of dementia. The home has three floors and each floor is unitised. All bedrooms are for single occupancy and have en suite facilities. Each floor has bathrooms, toilets and lounge/dining areas. The home is situated in the Langdon Hills area of Basildon and is in reasonable distance to/from local community services and amenities. The home has a large adjacent car park. There is limited garden/patio areas surrounding the home. Evelyn May has a statement of purpose and service users guide available. Information Care Homes for Older People Page 4 of 33 1 5 1 2 2 0 0 8 59 0 Over 65 0 59 Brief description of the care home about the home and most recent inspection report are available to residents/visitors in the lobby area of the home. Copies of the homes Service Users Guide were also provided in many of the bedrooms around the home The weekly fees are £425.95 to £476.28 for those people funded by a local authority and #590.00 for a private placement. There are additional charges for chiropody, hairdressing, personal items and newspapers/magazines. Care Homes for Older People Page 5 of 33 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: This was an unannounced key inspection. The visit took place over one day by two inspectors and lasted a total of 9 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information and comments given in this document has been incorporated into this report. As part of the inspection process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their Care Homes for Older People Page 6 of 33 comments are used throughout the main text of the report. Prior to the site visit, surveys for people who live at the home, staff and healthcare professionals were requested to be sent to the home. It was disappointing that only 3 completed relatives surveys were returned to us at the time of writing this report. In addition to the above methodologies we also used a formal way to observe people who have dementia and/or poor cognitive ability. We call this SOFI (Short Observational Framework for Inspection). The registered manager and other members of the staff team assisted both inspectors on the day of the site visit. Feedback on the inspection findings were given at the end of the day to the registered manager and care operations manager. The opportunity for discussion and/or clarification was given and no questions were raised. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The social care needs for people who have acute dementia, poor cognitive ability and/or poor communication needs to be improved. In addition staffs interactions with people who have dementia and/or poor communication needs to be improved so that people do not feel isolated and people have the opportunity to maintain their potential. Although there is evidence to show that staff have received dementia awareness training, the main principles of dementia awareness must be evidenced through staffs every day practice. Currently there is little evidence to show that some staff can apply these principles so as to ensure positive outcomes for people. Care Homes for Older People Page 8 of 33 Care must be taken to ensure that medication is not easily accessible to people who live at the home or others to whom it is not prescribed. This will ensure peoples safety and wellbeing. Staff working at the home must receive appropriate training. This refers specifically to those conditions associated with the needs of older people. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 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 the service are assessed and have the information needed to choose a home that will meet their needs. Evidence: The home has a Statement of Purpose and Service Users Guide, both of which were reviewed in September 2009. Both of these documents provided prospective residents or their representatives with the necessary information to enable them to decide if the home would be able to meet their assessed needs.This information included detail about the staff employed in the home and their experience and qualifications, the range of needs which the home can meet, the range of services provided, the number and size of rooms provided, arrangements for meeting peoples personal care needs, the homes admission criteria and reference to the homes complaints process. During discussion with the registered manager we were informed that the fee range for residing in the home was from £444.08 to £690.00 per week, additional charges were made for chiropody and hairdressing. Reference to the homes fee structure was seen Care Homes for Older People Page 11 of 33 Evidence: to be included in the homes Statement of Purpose and Service Users Guide. Copies of both of these documents were seen to be available by the lift foyers on each of the units. We also observed that copies of these documents were available in the rooms of the residents that we visited. To enable us to assess the homes admission process we examined five residents plans of care, one of which was of the person most recently admitted to the home. Each of the care plans examined contained copies of admission assessments.These showed that pre admission assessments were completed prior to the persons admittance to the home. All of the assessments seen had been undertaken either by the manager, their deputy or one of the care team managers. All of the assessments were seen to be detailed and informative and provided information about peoples needs in relation to the following areas: memory, communication, mobility, washing and dressing, bathing, eating and drinking and interests and hobbies. Each assessment indicated the source from where the information had been gathered, this included COM 5 assessments of need by the local placing authority, previous care plans and where possible evidence of family members involverment in the process. On all of the care plan files examined we were unable to find any evidience to indicate whether or not people or their representatives had been informed in writing of the homes ability to meet the persons assessed needs. The AQAA details that prospective residents and their families are given the opportunity to visit the home at any time so as to allow insight into life within the home and to ease any anxieties. Care Homes for Older People Page 12 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are clearly recorded within an individual plan of care, however people cannot be assured that their needs pertaining to dementia will be fully understood and met. Evidence: As part of our inspection process we examined a random sample of five care plans, three of which were of the people who we had observed through our SOFI observation. Records examined showed that there was a formal care planning system in place to help staff identify peoples care needs and to specify how these needs should be met. Each care plan clearly identified peoples assessed needs and the level of staff support and assistance that was required. One persons care plan indicated that they problems with their vision as the result of a degenerative disorder. The care plan was seen to describe to staff how this might effect the person. It then went on to describe how staff needed to support the person to minimise the effects e.g. Staff should be sensitive to [name of person] condition and make allowances for the fact that they may not always see things that are placed Care Homes for Older People Page 13 of 33 Evidence: in front of them. Some evidence was seen in the persons care plan to reflect their personal choices e.g. their pen picture stated I am quite frail and I feel the cold, I like to be kept warm, so I like to wear layers and I also like to be colour coordinated, thank you. Our observation of this person indicated that staff seemed to be aware of their needs in respect of this issue as they were dressed warmly and were wearing clothing that was colour coordinated. Another care plan indicated as we saw from our SOFI observation that this person was likely to spend long periods of time with their head in their lap or resting on a table, and had previously sustained bruises to their head as a result. In our SOFI observation we observed that this person spent extended periods with their head in their lap. However when a member of staff did approach them and spend some time attempting to get them to raise their head by placing it on a small table, we observed that they did place their head on a pillow, this indicated to us that the member of staff was aware of the persons care plan. All of the service users care plans which were examined on the dementia unit had dementia dependency assessments completed. These assessments were sampled and were seen to indicate that peoples needs had been assessed in terms of the following areas of need: Mobility. Transferring. Behaviour. Wandering. Communication, Personal care and hygiene. Dietary and fluid needs. Continence, Sleep. Safety. Medication and Social Support. Each of the care plan files examined included a copy of a night support plan to direct staff as to how people required support during the nigh time period. As with the other plans the directions were clear and concise. Staff spoken with during the course of the inspection indicated that they had received training around care planning. A Care Team Manager spoken with said that they had specific responsibility for certain people, but were expected to understand the needs of all of the people residing on each of the units. They went onto say that although they usually worked on specific units they did work across all three of the units within the home. This enabled them over time to get to know the needs of all of the people living in the home. Each person was seen to have a care plan in place around their cognitive ability, personal hygiene needs, sleep pattern and hobbies and interests. Where appropriate and as identified through the assessment care plans were also in place regarding falls. All five of the care plans that we examined indicated that they were being reviewed on a monthly basis. Daily records were in place and we observed staff spending time completing and updating care records. Risk assessments were in place and linked to the needs identified through the assessment process. One persons care plan indicated that at times they would become anxious and have the desire to leave the home without support. The risk Care Homes for Older People Page 14 of 33 Evidence: assessment clearly identified the actions that staff needed to follow to enable the situation to de-escalate. The strategies included offering the person the opportunity to go for a walk and get a newspaper or go for a walk into the garden or offer the person the opportunity to speak to their relative on the telephone. Staff spoken with had a good knowledge and understanding of this persons care plan and associated risk assessment. As a result of some people with dementia and/or poor cognitive ability not always being able to tell us about their experiences and what it is like to live in a care home, as part of the inspection process, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing 3 people who use services for a period of 2 hours and recording their experiences at regular intervals. This included their state of well being (mood state), how they interacted with care staff and others and what they did during this period. The observation was undertaken on the dementia unit on the top floor. The observation determined that for 2 out of the 3 people observed, in general terms their mood state was seen to be positive whereby they were noted to interact with one another, other people who live in the home and with visitors. However throughout the 2 hour period of observation, staff were observed to interact with both of these people on only two occasions, with the interactions limited to tasks e.g. handing out drinks. Actual interactions by staff were noted to be either neutral or poor. The third person observed was in the main seen to be either withdrawn or asleep and slouched forward with their head on their knees for the majority of 2 hours. On only two occasions towards the end of the observation did we note their mood state change to passive or positive. For the first 30 minutes of the observation there was no engagement and/or interaction by staff. Interaction by staff during the observation was observed to be brief but where this was provided this was seen to be good, however there were extended periods whereby there was no staff interaction and for the majority of the time they went unnoticed. Our observation showed that the level of staff engagement and interaction in the home was a little better for those people who were more able and had better verbal communication skills than those people who had more complex care needs. We observed over the full two hour period that the level of staff engagement with the person who had more complex care needs was limited to 15 minutes, shared between two members of staff. None of the remaining staff observed who spent time on the unit engaged with this person. From our observation staff appeared to have a limited knowledge and understanding of how to support people with acute dementia and/or poor cognitive ability. Staffing levels during this period were between 3-5 staff on the unit at any one time. The only other tasks that we Care Homes for Older People Page 15 of 33 Evidence: observed staff undertaking during this period, was the making and handing out of refreshments. Feedback from our SOFI observation was provided to the management team of the home during feedback at the end of the inspection. The management team of the home voiced their disappointment at the findings. The healthcare needs of individual people are well documented providing a clear audit trail of healthcare issues, interventions and outcomes. The manager confirmed that there is no a link nurse attached to the home, however there remains a good relationship with the local GP surgery and District Nurse services. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection on each of the 3 units. A random sample of Medication Administration Records (MAR) were inspected for a total of 26 people covering all 3 units. In general terms records were seen to be in good order with no discrepancies or omissions. This means that people receive the medicines prescribed for them. The temperatures of each of the storage rooms where medication is stored and the temperatures of the fridges used to store medicines are recorded each day and were observed to be within recommended guidelines. We observed the administration of medication on one unit during the lunchtime period and saw unsafe practices. This refers specifically to the trolley carrying medication left unattended while the staff member administered medication to people in the dining area and in their rooms. The trolley was left open on several occasions and when closed by the staff member it was not locked and the keys were left in the trolley door. Medication was observed to be easily accessible inside the trolley and on top of it. As a result of this and this being a repeat requirement, a Serious Concern Letter was issued to the registered provider and manager detailing the shortfalls. A prompt response was forwarded to us detailing the actions taken by the management team of the home to address the deficits. A medication profile is completed for each person detailing their prescribed medication, dose, frequency, date started and stopped, purpose and signature of the person completing the information. In addition to this a PRN profile is completed for people who are prescribed as and when required medication. MAR records for 4 people showed that on occasions they can refuse medication however no care plan or risk assessment was compiled detailing this. On inspection of the homes medication policy this details CTMs (Care Team Managers) must ensure they record the reason for refusal so that it can be discussed at the time of medication review and CTMs to ensure they contact the GP in the event that individuals refuse Care Homes for Older People Page 16 of 33 Evidence: their medicines on more than two occasions in one week for a review or possible alternatives and CTMs to ensure they record all interventions and input in the daily observation notes at all times. We looked at daily care records for each of the 4 people case tracked and could find no evidence that where refusals occurred this was recorded within their daily observation records. In addition there was no evidence to show that the persons GP had been notified for a medication review where medication had been refused on more than two occasions within one week. MAR records showed that in some instances people had refused a particular medication for more than two days in any one week. This demonstrates that people who administer medication are not adhering to the homes policy. We requested a copy of the staff training matrix. Following the site visit this was examined however it was not possible to determine if all CTMs who administer medication had up to date medication training as this was not detailed within the matrix. On inspection of a random sample of staffs files, records showed that 4 CTMs had up to date medication training and had been assessed as to their continued competence to administer medication. The manager was advised that the assessment should be completed each time an assessment is carried out. Care Homes for Older People Page 17 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people in the home are provided with social activities that meets their needs. The dining experience for some people needs to be improved so as to ensure positive outcomes. Evidence: A copy of the homes activity programme was displayed within each unit and within the main foyer of the home and this is provided in both a written and pictorial format. The home employs a full time activities co-ordinator for 37 hours per week and a part time activities co-ordinator for 13.5 hours per week. Although primarily their hours are Monday to Friday, these hours are flexible to cover weekends and evenings. The activities co-ordinators are registered with NAPA (National Association for Providers of Activities for Older People). Information relating to independent advocacy services was displayed on the ground floor for people to access. On inspection of the homes activities folder we noted that an activities assessment is completed for each person. Information recorded included individuals personal interests (both past and current), their cultural background and religious beliefs and details of any special needs. The activities co-ordinator advised that attempts are made to gather information from the persons family wherever possible. Care Homes for Older People Page 18 of 33 Evidence: As part of the inspection process one inspector spent the morning and a significant part of the afternoon on the dementia unit and another inspector observed activities on the other units. On the dementia unit the only activities that we observed taking place during the time we spent there was a game of floor skittles and a celebrity recognition card game in which six to eight people out of nineteen residing on the unit took part. These were the more mobile of the people on the unit and the most able. It was also of particular notice that the activities were only coordinated by a visitor/volunteer who visits the home on a regular basis. At no time did we actually observe any staff member becoming actively involved in the activities taking place, with only one staff member making any nominal attempt to engage with people on the unit. Out of 3 relatives surveys returned to us, 2 recorded that more 1-1 activities and engagement by staff could be provided. The activities notice board indicated that activities provided on the unit included bingo, movies, painting, quizzes, watching television, talking cards and floor skittles. For people with acute dementia we observed no real evidence to indicate that they were being involved in any form of meaningful activity or that their social care needs were being met. As mentioned previously we observed several people spending long extended periods of time, left to their own devises. Conversely on the other units where peoples needs were less complex and people had good verbal communication and cognitive ability, there was positive evidence of staff interacting with people in the home. We observed staff sitting chatting with people, whilst other staff were observed giving support to people e.g. hand massages, manicures, playing card games and some people completing arts and craft projects in readiness for the forthcoming bazaar. The activities co-ordinator advised that a Christmas party is planned for each unit. It was our observation that the home does quite well in providing meaningful daytime activities for more able residents. However for people with acute dementia they need to make further development and look to explore how they can promote an environment for these people that includes them rather than excludes them. There is a rolling 4 week menu in place at the home which was seen to offer people a varied choice of meals each day. We observed the lunchtime meal within two out of the three units (Bluebell and Rose). The menu depicting choices of meals available throughout the day was written up on the notice board in the dining room of each unit. However it was difficult to determine how or if people with acute dementia would be able to understand it. We discussed this with the manager at feedback and were advised that there are picture cards within each unit to assist staff to communicate with people in the home about the menu choices available. It was unclear on the day of the site visit as to why these were not used. The manager gave us assurances that Care Homes for Older People Page 19 of 33 Evidence: these were readily available and that staff should have used these. We spoke to 4 service users on Rose unit and only one person was able to tell us the lunchtime choice available. We observed that people requiring assistance with their meals were seen to be supported on a one to one basis in a positive manner. The lunchtime meal was served from a heated trolley sent up from the main kitchen. At no time did we observe any member of staff reminding people as to the meal choices available. The dining experience for people on both units was rather hectic and task orientated with little verbal interaction between staff and residents. The environments were at times very noisy and did not promote an environment where one would necessarily find the eating experience a positive one. The home needs to explore ways in which the mealtime experience for people with dementia can be made into a more enjoyable and positive experience. We observed staff following the meal, updating nutritional records to show what food people had consumed. It was difficult to determine how much people had or had not enjoyed the meal, but from our observation we concluded that it was not as positive an experience as it could or should have been. People spoken with on Rose and Camellia units were generally positive about the meals provided and comments included the meals are fine, I enjoy the meals provided and I have no complaints. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home and their representatives are confident that their complaints will be listened to, taken seriously and acted upon. Evidence: A copy of the homes complaint procedure was displayed on a notice board located within each unit and in the foyer. The procedure identified to who any compliments or complaints should be referred to and the timescale within which any complaints received would be responded to following investigation. On inspection of the complaints log, records showed that in the last 12 months there have been 10 complaints. These were seen to relate to missing items of clothing and other personal effects for some people, allegations that personal care was not provided in some instances, dignity and confidentiality issues and lack of communication between the home and relatives of people living at the home. A record was noted to be kept of each complaint detailing the investigation and actions taken. The AQAA confirmed that each of the complaints were dealt with within 28 days and all complaints logged were upheld. Staff spoken with demonstrated a good understanding of the homes complaints procedure and from discussions with 5 people who live at the home, 4 people were able to confirm that they felt confident that any complaints and/or concerns raised would be dealt with and they knew who to raise issues with. Care Homes for Older People Page 21 of 33 Evidence: We also looked at records of compliments and these recorded Thank you all for looking after [our relative] so well during their stay with you over the last few weeks. We appreciate everything you did for her and it was great for us to see them so happy., During our visits we have only seen kindness, patience and helpfulness shown to all the residents. Thank you all again for your care and Just a small card but a big thank you to all the staff that care for my relative so well. I have visited a few times and always found all of you very caring, it must be a very difficult task caring for so many poor folks. We were advised that since the last key inspection there have been no safeguarding referrals. Staff spoken with demonstrated a satisfactory understanding of safeguarding procedures within the home. On inspection of the staff training matrix records showed that the majority of staff working at the home have up to date SOVA (Safeguarding of Vulnerable Adults) training and further training is planned in December 2009. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained environment that meets their needs. Evidence: A partial tour of the premises was undertaken by us throughout the day of the site visit. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a high standard and is both homely and comfortable. Furnishings and fittings were domestic in nature and were of a good quality and were in keeping with the environment. Each unit has sufficient communal space and this refers specifically to a large lounge/dining area. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. Off each of the dining areas there is a small kitchenette which enables staff to make drinks and snacks. On the day of the site visit the home was well lit, clean and odour free, with no evidence of any unpleasant smells or odours. Appropriate signage was observed within the home to help aid peoples orientation within the home environment. Efforts had been made within all areas of the home to make them as homely as possible, with corridors and other areas displaying pictures, ornaments and other sensory images. The AQAA details that in the last 12 months all lounge areas, corridors and the main foyer have been redecorated and recarpeted. In addition bedrooms are being redecorated as they become vacant or require attention. Care Homes for Older People Page 23 of 33 Evidence: A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised to suit individuals taste and personal preferences. The AQAA confirms that prospective people can bring in their favourite items and are encouraged to personalise their rooms. People spoken with confirmed they were happy with the home environment and their personal space. The home was in a good state of general repair and no health and safety issues were highlighted at this site visit. The home employs a maintenance person and appropriate robust maintenance checks are carried out and there is a scheduled maintenance programme in place which ensures the environment is kept safe for peoples health and wellbeing. A random sample of fire records were examined and these were seen to be in order. Care Homes for Older People Page 24 of 33 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 live at the home can expect to be supported by staff who are robustly recruited, but who do not always have skills and abilities to support people who have complex and/or dementia care needs. Evidence: On the day of inspection 56 people were living at Evelyn May House (15 people on Camilia, 22 people on Rose and 19 people on Bluebell). The manager confirmed that staffing levels on Camilia unit are 1 Care Team Manager and 1 care assistant 07.00 a.m. to 21.45 p.m. and between 21.45 p.m. and 07.15 a.m. 1 care assistant, on Rose unit 1 Care Team Manager and 3 care assistant 07.00 a.m. to 22.00 p.m. and between 09.45 p.m. and 07.15 a.m. 2 care assistants and on Bluebell unit 1 Care Team Manager and 3 care assistant 07.00 a.m. to 22.00 p.m. and between 09.45 p.m. and 07.15 a.m. 1 Care Team Manager and 1 care assistant. The manager confirmed that the staffing levels are determined by the dependency levels of people who live at the home and these are calculated each month and recorded. We were advised that the current staffing levels during the day are based on 7.5 residents per member of staff and at night these are based on 5-4 residents per member of staff. In September 2009 a review of staffing was undertaken by the organisation and an increase in staffing levels was allocated for activities, maintenance and anciliary staff. Both the manager and deputy managers hours are supernumerary to the above figures, Care Homes for Older People Page 25 of 33 Evidence: however as and when necessary they can be deployed to work alongside staff. The home does not use agency staff however any staff shortages due to staff sickness and/or annual leave are covered from within the existing staff team and bank staff. On inspection of 4 weeks staff rosters these evidence staffing levels as detailed above are being maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. As stated previously the deployment of staff on each unit was observed to be satisfactory however interactions by staff with people who live at the home were observed to be variable, especially with people who have acute dementia needs. The staff recruitment files for 4 people newly employed at the home since the last key inspection were examined. Records showed good recruitment procedures are in place so as to ensure peoples safety and wellbeing. All records as required by regulation and the National Minimum Standards were in place. A record of induction that complies with Skills for Care Common Induction Standards were in place for three out of four files examined. A copy of the staff training matrix was provided to us and examined following the site visit. This showed that much emphasis continues to be placed on providing staff with appropriate core training. Records showed that since the last key inspection to the home some staff have received training relating to basic first aid, moving and handling, dementia awareness, health and safety, food hygiene, fire awareness and infection control. Records also showed future planned training for staff however there was no evidence to show specialist training for those conditions specifically associated with the needs of older people. As part of case tracking we looked at the training records for the 4 members of staff newly employed at Evelyn May House since the last inspection. In addition to core subject areas records showed that staff had received training relating to challenging behaviour training, activities based care and feelings based emotions-a dementia care workshop. The AQAA details that it is planned to provide staff over the next 12 months with training pertaining to the Mental Capacity Act and Deprivation of Liberty safeguards. The AQAA confirmed that 25 members of staff currently hold a NVQ qualification and 14 people are currently working towards or near completion of either NVQ Level 2 or 3. Care Homes for Older People Page 26 of 33 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. While management arrangements in the home are generally sound, shortfalls identified could potentially affect outcomes for some people living in the home. Evidence: The manager has the necessary qualifications and experience to run the home. The manager has been employed with Runwood Homes PLC for some considerable time and has been formally registered with us since 2006. The manager has attained the Registered Managers Award, has a BSc in Dementia Studies, has completed a course in Leadership Matters in Person Centred Care and is currently undertaking a management development course. During the site visit the manager demonstrated a good understanding and awareness of the organisations key planning strategies and business plan and understands the principles of person centred care and the importance and value of delivering good care to the people who live at Evelyn May House. The manager confirmed she holds a regular weekly surgery at the home. While we recognise good areas of practice, improvements and sustainability in some Care Homes for Older People Page 27 of 33 Evidence: areas, there are still some areas identified in this report that require further development as these potentially effect the quality care outcomes for people living at Evelyn May House. This refers specifically to staff interactions with people who live at the home, ensuring that staff are able to support people who have acute dementia, poor cognitive ability and poor communication and some aspects of medication practices and procedures. The AQAA was completed and returned to us when we asked for it. The AQAA contained clear information about the quality of the services provided, the changes they have made and where they still need to make improvements. The data section of the AQAA was fully completed and presents an accurate picture of the home. A random sample of staff supervision records were looked at. Records showed that people are receiving regular formal supervision and an annual appraisal in line with the guidelines as detailed within the National Minimum Standards for older people. In general terms records were seen to be of a good standard however in some instances there was little evidence of follow up actions having been monitored and/or addressed. For example the staff file for one person recorded them as having provided poor care and support to a resident. Although appropriate actions had been taken by the managment team of the home to deal with this issue, there was little evidence to show how their future performance and practice was being monitored. The AQAA details that supervision and appraisal training is to be provided to senior staff. The manager confirmed that a quality assurance questionnaire to seek the views of people who live in the home, their representatives, staff and other stakeholders was completed in October 2009. The results of these were not available at the time of the inspection however we were advised that these would be completed on 08/12/09. Relatives surveys returned to us recorded positive comments about the quality of service provided. Comments included On the whole, Evelyn May is a very good care home, staff are very easy to approach and they are really helpful and They provide well for peoples day to day needs. In addition to the quality assurance questionnaire, the organisation monitor the quality of the service through regular monthly visits by a member of the organisation. Records showed these were completed each month, were detailed and informative and included evidence of an action plan and outcomes. There was also evidence of regular staff and resident meetings conducted at the home once monthly. The manager advised relatives meetings have not proved very successful, however she is looking at other ways and means of engaging with peoples representatives on a regular basis. A random sample of residents monies and records were looked at and these were Care Homes for Older People Page 28 of 33 Evidence: seen to be well maintaned and managed. Corporate health and safety policies and procedures were readily available. On inspection of the staff training matrix this showed that all staff have received health and safety training. No health and safety issues were highlighted and on inspection of a random sample of health and safety certificates, these were found to be satisfactory and in date. A monthly analysis of accidents, falls and pressure sores are documented and reviewed by the manager. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Ensure that the medication trolley is not left unattended and medication easily accessible to residents and others. Previous timescale of 2/2/09 not met. This will ensure unnecessary risks to residents health and wellbeing is prevented. 07/12/2009 2 12 16 Ensure that all people living in the care home are provided with a varied programme of stimulating and interesting activities. Previous timescale of 28/2/09 not met. So as to ensure that all people have their social care needs met. 07/12/2009 Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Ensure that staff working in 25/01/2010 the home, promote and make proper provision for the health and welfare of people in the home. This refers specifically to staffs interactions with people who have poor cognitive ability and/or poor communication. So as to ensure that people can attain their full potential irrespective of their care needs. 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 9 Ensure that where people regularly refuse medication, there is a plan of care and risk assessment in place detailing how this is to be proactively managed. Staff should remind people in the home as to the meal choices available each day. This will ensure that people know what is readily available and/or to be provided. 2 15 Care Homes for Older People Page 31 of 33 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 3 15 Ensure that staff promote the use of pictorial aids, so that people with poor cognitive ability know what food choices are available and/or to be provided. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!