Care Home: Faithfull House

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What the care home does well The home has maintained many of the excellent outcomes identified in our previous inspection in January of this year. These include the excellent opportunities afforded to people to socialise and take part in meaningful activities. It also includes the good standard of food and choices available. We were particularly impressed with the support people get with their eating and drinking when they are poorly or more frail. The environment is also still providing people with a very comfortable, clean and safe place to live. What has improved since the last inspection? The registered provider (represented by the chief executive) and registered manager have taken the shortfalls identified in our previous inspection seriously and since January have kept us updated as they have worked to meet the various requirements made by us. There have also been additional improvements made as this work has been completed. Collectively this has resulted in improvements to the services statement of purpose, which now makes it very clear what category of need the service can meet. The service will remain within its stated registration category and far more detailed and better records will be kept of the overall admission process. All care plans have been reviewed and adjustments made to the wording used when giving directions to staff on how to meet people`s needs. This has resulted in these directions being more specific. Additional care records relating to people`s pressure relief care are being consistently maintained. A huge amount of work has been carried out on making the system for medicine administration and record keeping safe. This has vastly reduced the potential risks to people and although there were a few shortfalls identified during this inspection, these will be easily rectified. There has been a general review, which remains ongoing, on the homes policy for physical restraint. This has resulted in further training for staff in relation to diversional and de-escalation skills. We spoke to a group of staff who had attended this and they were fully aware of their boundaries in relation to physical intervention. They were also able to demonstrate that they had a good knowledge of the people they care for and in particular those who may require additional diversional support at times during their care. The company`s recruitment process has gone through a major review as have existing recruitment records. All existing staffs` recruitment files have been reviewed and any gaps in recruitment criteria filled, or if this has not been possible, because of the length of time the person has worked for the service then a review of the staff member`s performance has taken place. In some cases, this is still work in progress which is nearly complete. This will result in a far more robust recruitment process for future staff and staff will not start work in the home until the full and appropriate criteria has been satisfactorily met. Finally, alterations have been made to how the registered provider checks and audits all management and care systems. This will include a new and far more robust style of monthly visit (required under regulation 26 of the Care Home Regulations 2001). This will see many systems and areas of care being more thoroughly scrutinised to ensure the home is complying with all the required regulations. For the foreseeable future a copy of this report will be forwarded to us as part of our ongoing monitoring of the service. What the care home could do better: The home still needs to look at the shortfalls identified in this inspection report relating to medicines. The work in progress needs to be completed in relation to the physical restraint policy and recruitment records. The service now needs to successfully introduce the improvements that have not already been commenced and sustain them. Key inspection report Care homes for older people Name: Address: Faithfull House Suffolk Square Cheltenham Glos GL50 2DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janice Patrick1     Date: 2 0 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Faithfull House Suffolk Square Cheltenham Glos GL50 2DT 01242514319 01242578392 suzanne.booker@lilianfaithfull.co.uk www.lilianfaithfull.co.uk Lilian Faithfull Homes Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Suzanne Dawn Booker Type of registration: Number of places registered: care home 72 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Faithfull House is a substantial attractive property, originally three Regency Houses, which have been converted to provide accommodation for 72 older people who require personal care. The home is owned and managed by Lilian Faithfull Homes and is one of three homes that the charity owns and operates in Cheltenham. It is situated in the Montpellier area of Cheltenham, within easy access of shops and local amenities. Accommodation is provided on five floors of the home. All of which are served by two shaft lifts. In addition, a variety of aids and adaptations have been provided throughout the property to assist people. All but one of the bedrooms have been equipped with en-suite facilities and assisted baths and toilets have been installed throughout the home. The communal areas on the ground floor consist of several lounges, a dining room and a conservatory. There is also a library located on the lower ground floor. People have the benefit of well-maintained enclosed gardens at the rear Care Homes for Older People Page 4 of 34 2 6 0 1 2 0 1 0 0 Over 65 72 Brief description of the care home of the property. The fees range from six hundred to six hundred and fifty pounds per week. Copies of the Statement of Purpose are available from the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we considered all the information we had gathered since the last key inspection which was carried out on 26th January 2010. This included the last Key Inspection report and the outstanding requirements. In this case we have also considered all of the specific information the chief executive has given us since January of this year. It also included a review of the recent notifications sent to us from the home. These inform us of any accidents, deaths and occurrences that effect service users. It also included any additional information we may have received from professionals, service users and members of the public. We did not send questionnaires to the home, to seek the views of those that live there on this occasion as this was carried out as part of our previous inspection. Two inspectors then carried out this inspection on two separate days, one of which was a pharmacist inspector. Care Homes for Older People Page 6 of 34 What the care home does well: What has improved since the last inspection? The registered provider (represented by the chief executive) and registered manager have taken the shortfalls identified in our previous inspection seriously and since January have kept us updated as they have worked to meet the various requirements made by us. There have also been additional improvements made as this work has been completed. Collectively this has resulted in improvements to the services statement of purpose, which now makes it very clear what category of need the service can meet. The service will remain within its stated registration category and far more detailed and better records will be kept of the overall admission process. All care plans have been reviewed and adjustments made to the wording used when giving directions to staff on how to meet peoples needs. This has resulted in these directions being more specific. Additional care records relating to peoples pressure relief care are being consistently maintained. A huge amount of work has been carried out on making the system for medicine administration and record keeping safe. This has vastly reduced the potential risks to people and although there were a few shortfalls identified during this inspection, these will be easily rectified. There has been a general review, which remains ongoing, on the homes policy for physical restraint. This has resulted in further training for staff in relation to diversional and de-escalation skills. We spoke to a group of staff who had attended this and they were fully aware of their boundaries in relation to physical intervention. They were also able to demonstrate that they had a good knowledge of the people they care for and in particular those who may require additional diversional support at times during their care. The companys recruitment process has gone through a major review as have existing recruitment records. All existing staffs recruitment files have been reviewed and any gaps in recruitment criteria filled, or if this has not been possible, because of the length of time the person has worked for the service then a review of the staff members performance has taken place. In some cases, this is still work in progress which is nearly complete. This will result in a far more robust recruitment process for future staff and staff will not start work in the home until the full and appropriate criteria has been satisfactorily met. Finally, alterations have been made to how the registered provider checks and audits Care Homes for Older People Page 7 of 34 all management and care systems. This will include a new and far more robust style of monthly visit (required under regulation 26 of the Care Home Regulations 2001). This will see many systems and areas of care being more thoroughly scrutinised to ensure the home is complying with all the required regulations. For the foreseeable future a copy of this report will be forwarded to us as part of our ongoing monitoring of the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of the admission process is ensuring that people will only be admitted in accordance with the homes Statement of Purpose. People can be confident that their needs will be fully assessed and that the home will only go ahead with the admission if they are confident that they can meet these needs. Evidence: The service has updated its statement of purpose since the last inspection in February of this year. This now makes it clear that the service cannot currently admit people who are suffering from dementia. The Lilian Faithful group have decided however to apply to us (the Care Quality Commission, CQC) to alter the registration category of the service so that people suffering from dementia can be admitted and cared for at Faithfull House. If this application is successful the manager will still reserve the right and have the responsibility to only admit people when she is confident their needs can be met. Since our previous inspection people living in the home have had their needs reviewed and the manager is confident that the service can meet all of the current Care Homes for Older People Page 10 of 34 Evidence: needs. We inspected the admission records of three people who had been admitted since the last inspection. One person was visited by the manager in their own home and an assessment of their needs recorded. The two other people lived too far away to be visited so information about their needs was gathered from various sources such as the family when they visited the home, the persons funding authority and in one case the hospital. A record of the pre admission process could not be located for one person and it was generally obvious to us that a better way of recording all of the information gathered was needed. The home had also realised this and we were shown a new pre admission assessment record that will be used as from the next admission. In all of the above cases the manager was able to give detailed information about who she had spoken to and how she had come to the conclusion that each persons needs could be met at Faithfull House. The requirements from the previous inspection relating to a review of the statement of purpose and adhering to a robust and correct admission process have therefore been met. This home does not provide dedicated intermediate care. Care Homes for Older People Page 11 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care needs are identified and the appropriate care is provided. Where specific health care support is required, which includes their medicines, this is organised and delivered in a safe manner. The staff must however make sure that the written care plan is specifically reflecting all the current needs and the shortfalls identified by the pharmacist addressed. Evidence: We looked at the care records of four people which included peoples care plans and any additional records being completed by staff in relation to their care. The manager explained that every care plan had been reviewed since the previous inspection. Guidance to staff in how to meet someones needs has been made more specific and nebulous words such encourage and support have been replaced with more direct instruction. We considered the care plans we read to be very specific to the individual. We were told that any changes or updates to the care are discussed with staff on a daily basis, usually during staff handover meetings. We then went on to see an updated care plan following someones recent visit to hospital. In addition to Care Homes for Older People Page 12 of 34 Evidence: these reviews everyone has been asked if they have a particular preference when it comes to their personal care being delivered. The question was whether people preferred a male or female carer. We saw evidence of their preferences having been recorded in the care plan and also if they are not particularly bothered either way. This therefore shows that the manager has acted on one of the recommendations made in the previous inspection. One person had a new problem identified when staff were delivering the persons personal care and staff had correctly recorded their findings in the daily record. This additional problem required attention from staff to resolve and needed monitoring. This had not been incorporated in to the main care plan and therefore there was no specific guidance for staff and no ongoing report informing us of the latest situation. Its important that any additional need, albeit a short term need, be added either to the persons overall care plan or on a separate care plan. This keeps the issue current, gives clear instruction to staff on how to deal with it and provides a clear record of the action that has been taken. We have not made a requirement about this as this was discussed with the manager and Chief Executive during the inspection. This was only one example found but the need to care plan robustly and record ongoing actions is vital. We were very impressed with the care and attention given to people who may be at risk of not eating and drinking adequately. We spoke to the member of staff who has particular responsibility for providing this support, on some days of the week. This role also involves monitoring peoples progress and liaising with the chef. We also looked at the records kept by this member of staff which explain the actions that had been taken in relation to this. We understand peoples weights are also recorded and monitored but we did not look at specific records relating to this. We looked at the care being delivered to one person in respect of a pressure sore. A previous requirement was made for the additional care records, in relation to pressure care to be consistently completed. The care plan told us that the Community Nurse was visiting on a regular basis to monitor and redress the persons pressure sore. We saw turn charts, which had been consistently completed by the staff in the home demonstrating that continued pressure relief was taking place. The persons care plan also told us that a pressure relief mattress was in place. We did suggest during this inspection that the staff specify what mattress is in use at any given time so if needed they have a record of this. We therefore consider the previous requirement made in relation to this to be met based on the evidence seen at this inspection. One person had been recently admitted and a date had been made for the close Care Homes for Older People Page 13 of 34 Evidence: relatives and the person living in the home to have a meeting with the allocated key worker (a carer allocated to that person and family as a specific point of contact). We were told that this is general practice and it is a time where the person who needs the care/support can be involved in deciding how that care/support is to be given. During this inspection we did not witness any situation that would make us think that peoples privacy and dignity was compromised. We spoke to one person, who during our discussion clearly confirmed that they are treated with the utmost respect and kindness. They also went on to tell us that they have personally never witnessed any situation involving another person that they have felt uncomfortable about. During our inspection we were in situations where we could hear staff speaking to people but where they were unaware of our presence, and on each occasion staff spoke to people in a kind and respectful manner. Pharmacist Inspectors Report. The pharmacist inspector visited Faithful House on 20th March 2010 to see how medicines are looked after in the home and how concerns raised at the last inspection had been addressed. We saw that action had been taken to meet the eight requirements relating to the handling of medicines. We spoke to the home manager and two members of staff involved with looking after medicines in the home. We saw some medicines being given and checked the arrangements for keeping medicines and recording their use in the home. We also met and talked with the chief executive officer for Lilian Faithful homes. People living in Faithful House are registered with a number of local doctors. Staff told us that one doctor, who looks after a larger number of people, visits the home every week for any of their patients who need to be seen. Staff request repeat prescriptions from the doctors surgeries and check them before they are sent to the pharmacy to be dispensed. This helps to ensure that the correct medicines are ordered and available in the home. Medicines are supplied using a monthly blister pack system. Several people living in the home are able to look after some of their own medicines. The policy for this has been reviewed and risk assessments are now in place to check that people are safe. Staff look after and give out most of the medicines used in the home. Staff said that they had received training from a pharmacy in the past and that they had on-going training in the home. We were also told that further training had been booked in June. This helps to ensure that staff are able to give medicines safely. Care Homes for Older People Page 14 of 34 Evidence: We saw some medicines being given at lunchtime. Medicines were given in a respectful and safe way, with staff asking people whether they needed medicines that had been prescribed to be given when required. The pharmacy provides printed medicine administration record sheets each month for staff to complete when they have given medicines. Photographs of all the people living in the home are kept with these sheets as an additional identity check. Staff involved with giving medicines have initialled a sample record sheet so that it is possible to check records and identify who has given medicines. The medicine policy has been updated since the last inspection. The medicines administration records we looked at had been completed clearly and fully. We checked several blister packs of medicines and saw that they had been given as recorded. It was more difficult to check medicines supplied in standard packs because although some packs were dated this was often the date they had been received and not the date they had been started. Action should be taken to allow these medicines to be audited to check that they have been given correctly. We saw two records where the number of signatures on the record did not exactly match the tablets missing from the pack. We also saw that one weekly tablet was still in the pack and the administration record confirmed that it had not been given, but the reason for this was not recorded. One pack of tablets was labelled to be given twice daily but the administration record was printed as once daily and the record showed it was given once daily. This was checked with the pharmacy during the inspection, who confirmed that the medicine should be given twice daily. This emphasises the importance of checking medicines and the printed administration records on receipt to ensure that medicines are given correctly. Handwritten additions to the administration record sheets had been signed, dated and checked by a second person to reduce the risk of mistakes being made. We saw that space on the record sheets to record any medicine allergies had been completed to reduce the risk of people being given unsuitable medicines. Some medicines are prescribed to be given when required we saw that protocols have been put in place to give guidance to staff about what these medicines are for and when they should be given. This helps to ensure these medicines are given appropriately and consistently. Several medicines are prescribed with a variable dose, we saw that staff were not recording the amount that they gave. This means that there is no record of how much Care Homes for Older People Page 15 of 34 Evidence: medicine the person has needed. Action should be taken to ensure the amount given is always recorded. We saw that a record for the use of Warfarin, which has a variable dose and needs special monitoring, showed the dose that had been given. It is good practice to keep the printed information confirming the current dose of Warfarin with the medicines administration record sheet so that staff can check that they are giving the correct dose. The yellow booklet Oral anticoagulant therapy. Important information for patients should also be available to ensure the safe use of this medicine. Separate sheets, kept in peoples rooms, are used to record the use of creams and ointments. These records must include the dosage instructions so that it is clear that the medicine has been used as prescribed. We saw one persons record for a cream being applied every morning but the dose instructions on the label were to use it two or three times a day. The manager told us that this person chose to use the cream once a day. If the preparation is prescribed regularly a reason must be recorded if it is not used. Any change in dose instruction should be discussed with the prescriber to make sure that it is appropriate for the preparation, and the prescription can be changed accordingly. Records are kept of the medicines received into the home and of the disposal of unwanted medicines. This means that there is an audit trail to show that medicines have been used safely. Secure storage is available for medicines. A thermometer is available to monitor the room temperature and check that it is suitable for storing medicines. A lock has been attached to the medicine fridge and daily records show that fridge temperatures are suitable for storing medicines. Two medicine trolleys are used to transport medicines safely around the home. Lockable medicine cupboards in peoples rooms are used to store morning and night time medicines, which are usually given here. This has resulted in staff transferring medicines from one labelled container to another to ensure that there is a supply in both the persons room and the medicine trolley. This is not good practice because it increases the risk of mistakes being made. Staff also told us that people sometimes need to take medicines out of the home if they go away from the home on holiday. To avoid the need to take the blister packs with them staff have transferred medicines to a weekly dosette box. However this also increases the risk of mistakes being made and people taking the wrong medicines. Staff need to discuss with their pharmacist how medicines can be supplied so that they are always given from the original, Care Homes for Older People Page 16 of 34 Evidence: labelled pack supplied by the pharmacy, both in the home and on holidays. A new controlled drugs cupboard has been installed to ensure that storage of controlled drugs, which need additional security, meets legal requirements. A new register, for recording use of controlled drugs, has been started since the last inspection. The manager told us that she had done some training for staff to make sure that they knew how to keep the records correctly. The register had been completed appropriately, with regular checks, and showed these medicines had been looked after safely. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There remains excellent systems in place for people to make choices and to be genuinely supported in meaningful social activities. Evidence: This outcome was not inspected in detail during this inspection as it was rated as providing excellent outcomes for people during the previous inspection in February 2010 and as far as we are aware there should be no reason for this to have altered. We did however speak to some people who told us that they go out on a regular basis. One person said she had particularly enjoyed the outing that had taken place on the day of our inspection. We spoke to another person who clearly makes independent daily choices. This person had been out to the local shops and confirmed that they are supported to maintain the activities that are particularly meaningful to them. This person also showed us the efforts made by another person who lives in the home and again it was clear that this person is engaged in activities that help retain skills that have been acquired over several years. We were conscious of several people coming in to the home to visit and of people going out with their visitors. We saw some people sitting in the garden enjoying the Care Homes for Older People Page 18 of 34 Evidence: good weather. Later in the day a group of people were observed listening to music in the lounge. One person commented that they are often able to sit and listen to music that brought back good memorys. We met the receptionists pet who comes in on a weekly basis to visit the people in the home. She explained that several people have become quite fond of him and look forward to his visit. We spoke to the chef who informed us of how people make their food choices and how he works closely with the staff member who monitors those who are a little more frail. He also told us that peoples individual likes and dislikes are known to the kitchen staff. The impression we were given was that the kitchen can be flexible on a daily basis in relation to what people would like to eat or can manage to eat. This was confirmed by one person we spoke to who also felt the food was generally very good. We spoke to a member of staff who has particular responsibility for making sure that the dining area is welcoming and clean when people arrive to eat. This person was also observed by us to be very sociable and engaging with people when they arrived for breakfast. We saw people reading daily newspapers whilst eating breakfast and this told us that the dining room was a relaxed place to eat. Each time we walked around the home there appeared to be a very sociable and welcoming atmosphere being maintained by the staff. When we listened to staff talking they were naturally providing people with opportunities to make choices or were helping them to express their preferences. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaint or concern will be taken seriously, proportionately investigated and appropriate action taken to address it. A review in several areas of adult protection has resulted in changes that will help protect people from potential abuse and harm. Evidence: The home has a complaints policy with procedures which are in a prominent place within the home for people to read. People are also given information on how to make a complaint or raise a concern on their admission. We discussed two complaints that the home has received. The first complaint was made by a family who disagreed with decisions being made about their relatives future care. The home were not making these decisions in isolation and specialist mental health practitioners, along with the persons funding authority were involved. This was described by the manager as being a difficult situation for all concerned and there were some things that the home may do differently if faced with this situation again. The second had also been managed by including the persons funding authority. Some elements of this complaint had been upheld by the home, others have necessitated certain arrangements and support to be put in place for the complainant so as to enable the home to move forward with the care of the complainants relative. Care Homes for Older People Page 20 of 34 Evidence: All staff are trained in safeguarding adult procedures and the home has a policy with procedures outlining what potential abuse is and how any allegation or actual incident of abuse will be managed. There are several other policies and procedures in place which aim to protect the vulnerable people living in the home. We revisited the two areas of concern from the previous inspection in February which were the processes around the potential use of restraint and the companys recruitment practices. Requirements were made in the previous inspection relating to both these areas. The chief executive has been in regular contact with the Inspector on both these areas and extensive work has been carried out to ensure the companys processes are able to protect people from abuse and harm. Further details relating to recruitment can be found in the staffing outcome of this report. Currently the home is not caring for anyone who presents with overt challenging behaviour. Since the last inspection staff have received additional training in various methods of diversion and de-escalation skills. We spoke to four members of staff who had attended this training and who were able to show us that they could link what they had learnt to their current practice. They understood the value of keeping the care very person centred, knowing the individual well, the use/value of meaningful activities and needing to be aware of peoples individual reactions to various situations. We spoke about triggers and alterations in behaviour which may require managing. Work is still in progress on some elements of the Physical Restraint Policy which tells us that physical intervention will only be used as a last resort. When asked, staff gave us their interpretation of a last resort which only ever related to situations where someones or other peoples health and safety would be compromised without intervention. When the company have completed taking advice on this the staff will receive appropriate guidance. Therefore we conclude that one out of the two requirements made in relation to this has been fully met and the second is work in progress. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 home that is safe, clean and well maintained. Peoples diverse needs are recognised and the environment adapted to meet these. Specialist equipment is provided to those people who need it. Evidence: We did not inspect this outcome fully as it was rated as providing excellent outcomes for people during the previous inspection in February of this year. We noted various things as we moved around the home that confirmed that this outcome has probably not altered. During this inspection we saw the environment being cleaned and it smelt fresh and looked uncluttered. Areas that we visited appeared well maintained and there have been no changes in the maintenance arrangements since February. We noticed that there were soap dispensers and disposable towels available in toilets. One bathroom we visited was clean with appropriate arrangements in place for the disposal of rubbish/waste. Staff were observed putting on disposable gloves and aprons when they were preparing for certain care tasks. Staff that were preparing food or who were involved in delivering food were wearing clean protective clothing. We saw adapted equipment available for the bathing of people and we observed staff using mobile hoists for the safe maneuvering of people who are unable to mobilise. We observed people using the sloped entrances to the home both to come in with walking aids and Care Homes for Older People Page 22 of 34 Evidence: to access the garden in their wheelchairs. The chief executive confirmed completion of extensive redecoration and repair to the front facade of the building. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is staffed by enough people who are skilled in meeting the needs of those who live there. New robust arrangements for the recruitment of staff will help to protect people from potential abuse and harm. Evidence: The manager confirmed that the home is staffed according to the needs of the people living there. She explained that adjustments are made to the staffing when required. One example included the need for one carer to be present in the communal areas at teatime and later in to the evening when other staff are busy. The manager is now looking at making similar adjustments so that a member of staff is present in the dining room area when some people come down early for breakfast. As we discussed in the Complaints and Protection outcome of this report there were serious shortfalls in the companys recruitment processes that needed to be addressed. When investigated by the current chief executive it would appear that these have been of long standing. It would also appear that the companys previous auditing had not successfully picked these shortfalls up. We have been informed that the company have gone back through all its recruitment files since 2002 and that some of this work is still being carried out. Where there were gaps in recruitment criteria being collected at the time, such as suitable references Care Homes for Older People Page 24 of 34 Evidence: and the exploration of gaps in employment, these have all been addressed for those employed within the last year. For staff who have been employed for longer periods of time the gaps are being filled where possible and if this is not possible the staff members suitability and performance is being reviewed through supervision records. The company have told us that staff have always been employed following receipt of a check against the Protection of Vulnerable Adults (POVA) list or as it is now known, an adult first check through the Independent Safeguarding Authority, ISA. We inspected the recruitment records of two people. One staff member had been employed just before this inspection and following receipt of an ISA clearance which was seen by us. Two satisfactory references were seen in place and there were no unexplained gaps in employment. There was a contract of employment in place stating the staff members hours of work and role. This person has only attended the welcome workshop which is part of the induction training and the company are awaiting receipt of the Criminal Record Bureau (CRB) clearance before they start work. We were informed that a verbal risk assessment process has always taken place when the company have considered employing someone before receipt of their CRB or if their CRB shows past convictions, but it was admitted that these have not been recorded. They have confirmed that this will be done in the future. The chief executive has made a decision not to employ people before receipt of a new CRB. We discussed the scenario of, if the home may need to recruit someone before a new CRB was received, for example if they urgently required additional staff, again a full written risk assessment would be completed, following the guidance on the CRB website. We were informed that this member of staff is going to be allocated to an experienced member of staff who will act as a mentor during their six month probation period. The second member of staff had been employed for over a year. We saw the previous gaps in the recruitment criteria, which included employment before receipt of references and unexplained gaps in employment. As part of the review undertaken a curriculum vitae had been requested which explained the gaps of employment and the staff members performance had been reviewed and there were no concerns. We were informed that clearance against the POVA list had been sought before this persons employment but proof of this had not been kept so we were unable to substantiate this, however a CRB was seen during this inspection. Evidence of ISA checks will now be retained on file. We spoke to the human resource (HR) manager who has worked for the company for some time. She was very clear about the new arrangements in place and what she Care Homes for Older People Page 25 of 34 Evidence: now needed to see completed. She also told us that the introduction of a recruitment checklist was proving very helpful. We were told that once the recruitment criteria has been met by the HR department it will be for the registered manager of the home to check before they agree for the new recruit to start work in the home. We were also informed that new HR computer software is due to be installed and that this will make the recording of the process far easier. During this inspection we saw evidence that the company have taken this shortfall seriously and have taken action to improve their recruitment processes generally but have also taken action to ensure that they are satisfied that the people already working in the home are safe to be doing so. We therefore consider that the requirements made in the previous report, relating to recruitment have been met in one way or another. This now means that the home can be generally confident that the people working there are people who would not harm the people living in the home. It also means that they now have a system in place that will meet the basic requirements required by the Care Home Regulations 2001 in the recruitment of new staff. We are aware of a full induction training being given to staff but this was not inspected in detail during this inspection. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are now improved and better understood arrangements, both on a corporate and home level, that will help to ensure that the business and home is managed in a way that benefits the people living there and will help the service comply with the required regulations. Evidence: The chief executive has worked closely with the home manager to rectify all shortfalls identified in the previous inspection in February of this year. Both have addressed the issues in a very positive manner which has and will continue to benefit those living in the home. Just after this inspection took place the company have been able to confirm the imminent start date for a new manager for one of the companys sister homes. Although, since our previous inspection in February the manager of Faithfull House has been concentrating on the management of Faithfull House, the sister home has still required management support but this news will hopefully resolve this added Care Homes for Older People Page 27 of 34 Evidence: pressure. A more useful and comprehensive quality assurance and auditing system has been devised to ensure the home remains compliant with necessary regulations. The chief executive has submitted an improvement plan to us and to the board of trustees, along with a report on the improvements already made. He has identified areas where he needs to be far more involved in the checking of systems and processes. These will be incorporated in to a newly devised regulation 26 visit carried out monthly as part of the Care Home Regulations 2001. This has in part already begun but as the improvements have yet to be sustained, we have requested that a copy of the monthly regulation 26 report be sent to us until further notice as part of our ongoing monitoring of the service. The findings of the new regulation 26 visit will be discussed with the home manager as part of her ongoing supervision and any shortfalls/plans addressed within fixed timescales. The home continues to seek the views of those who live in there and the views of those who visit, as it has always done so. We have been told that members of the board of trustees regularly visit the home in order to hear peoples views on the services being provided. We inspected the arrangements for the safe keeping of some peoples personal money. All amounts being securely held corresponded with the records in place and receipts are kept for audit purposes. People have access to this money when they require it. Records of health and safety checks were not inspected during this inspection as this was carried out in detail during the previous inspection and were found to be satisfactory. During this inspection however it was identified that personal emergency evacuation plans (PEEPS) were still needed for each person living in the building. This had been a recommendation in the previous inspection report. We feel there had been a genuine misunderstanding by the managers as to what was actually needed in relation to these. Advice was taken from the fire safety officer during our inspection by the chief executive and these will be carried out as soon as possible. The manager explained that the fire officer visited about a year ago and we discussed the identified jobs for completion on the homes fire risk assessment. The majority have already been addressed and others are work in progress because of some building work that may Care Homes for Older People Page 28 of 34 Evidence: take place in the basement of the home. One persons evacuation needs had been considered by staff because they are predominantly cared for in bed and specialised evacuation equipment had been purchased and staff have been trained in its use. We receive notifications from the home as required under regulation 37 of the Care Home Regulations 2001. Care Homes for Older People Page 29 of 34 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 18 13 The registered person must 12/03/2010 make sure that where physical intervention is used its use has been agreed in the best interests of the individual to safeguard them from harm. This is to protect people from possible abuse. Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Administration records for 01/07/2010 creams and ointments must include clear dosage instructions. If these preparations are not used as prescribed, a reason must be recorded. For medicines prescribed with a variable dose the amount given must be recorded. this is to ensure that medicines are given as prescribed and it is clear how much medicine has been given. 2 9 13 Ensure that arrangements are in place to allow medicines to always be given from the labelled pack supplied by the pharmacy and to make sure that these packs to be audited. This is to avoid the risk of mistakes being made as medicines are transferred 01/07/2010 Care Homes for Older People Page 31 of 34 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 and to check that they have been given correctly. 3 18 13 The registered person must make sure that where physical intervention is used its use has been agreed in the best interest of the individual to safe guard them from harm. This is so that people are protected from possible abuse and/or poor practice. 4 38 23 The registered persons must 30/06/2010 comply with any requirements and recommendations made by the fire safety officer, under the current Fire Safety Regulations. In this case this is to ensure safe and smooth evacuation of people in the event of a fire 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 30/06/2010 1 3 Care should be taken to always record all of the information gathered during the pre admission process and the pre admission assessment of needs, carried out by the home, should always be signed and dated. Written confirmation of the current Warfarin dose should be kept with the medicines administration record sheet, so 2 9 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations that staff can check they are giving the correct dose. A copy of the booklet Oral anticoagulant therapy. Important information for patients should be readily available because this contains important information about the safe use of this medicine. 3 9 The registered manager should discuss with the pharmacy how they can ensure that suitably labelled medicines are provided for people who go on holiday from the home. This is make sure that people can take their medicine safely when on holiday. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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