Care Home: Finborough Court

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 Discussion with people using the service during the inspection and information received in `Have Yours Say` surveys told us, that residents are happy with the service they are receiving, comments included, "the staff meet our needs as they occur, the home does well in most things, especially hygiene and this a pleasant place where we can follow our Christian faith". Other comments included, "I am very happy here, everything is fine, I get regular visitors and the new manager is very nice, they are encouraging more activities to take place and planning more trips out" and "the home is a wonderful caring place, it has a wonderful atmosphere and always a welcome for relatives and visitors" and "I am very happy here, and satisfied with all that goes on, on the whole we get treated with respect and our privacy is maintained, by caring and friendly staff". What has improved since the last inspection? Discussion with people living in the home and staff, confirmed information we (CQC) received in the surveys, which told us that in recent months the atmosphere in the home and social activities have improved and that steps are being made to meet the needs of the residents more individually, not only the physical needs, but also their emotional, social and spiritual needs. This was confirmed in discussion with the manager, who told us of their plans to improve the provision of dementia care in the service. They are currently working with and training staff to change the ethos of the home to become more person centred, moving away from institutionalised care, and concentrating on the `welll being` of each person, focusing on their `feelings`, which is the real meaning of person centred care. Staff training is currently taking place to develop staff skills in end of life and palliative care, so that at the time of death and dying people using this service will be supported by a staff team who have the skills to ensure the comfort and dignity of the individual who is dying. What the care home could do better: Discussion with staff and people living in the home told us that staffing levels are not always sufficient to meet peoples individual needs. Comments included, "we are short staffed very often, the staff have a lot to do, it can sometimes be 11am before I can have a wash, staff tell me they will come when they can, as they have other people to do" and "I cant think of anything off hand that could be done better, but would like the buzzer to be answered quicker for toileting, but appreciate that staff are sometimes elsewhere". Staff reflected that the dependency levels of people living in the home have changed, with an increasing number of people needing more support and assistance with their personal care and to eat their meals. The manager advised they are in the process of reviewing peoples care needs and where possible are applying to the local authority for continuing care to fund additional care hours. Administration and recording of medication is generally being well managed, however where post it notes are being used on Medication Administration Records (MAR), by senior staff to communicate changes in peoples` medication, this could result in people receiving incorrect medication.Information in surveys and discussions with people living in the home provided mixed feedback about food, with comments, such as "food could be more varied and I am offered enough to eat and drink, however the variety and quality is adequate". Further consultation with residents is required to ensure people are satisfied with the food they are receiving. Key inspection report Care homes for older people Name: Address: Finborough Court Pilgrims Way Great Finborough Stowmarket Suffolk IP14 3AY     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: Deborah Kerr     Date: 2 7 0 5 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: Finborough Court Pilgrims Way Great Finborough Stowmarket Suffolk IP14 3AY 01449676336 01449672408 finborough@pilgrimhomes.org.uk www.pilgrimhomes.org.uk Pilgrim Homes Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rosemary Ann Hall Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service: Care Home CRH To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older people - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief description of the care home Finborough Court is a purpose built care home for older people, which was first opened in 1994. It is able to accommodate twenty elderly people in individual rooms in the main care home. On the 11th July 2005 a variation to the homes conditions of registration was granted, stating that The home may care for up to 22 service users, Care Homes for Older People Page 4 of 33 Over 65 0 22 22 0 Brief description of the care home of whom 4 may be Dementia (DE) (E), and 1 named person may be Dementia (DE) (E). In addition to the twenty beds in the main care home, an additional two places are registered in the attached flats, which offer sheltered accommodation. There is an agreement with the regulatory body that these two places can offer emergency respite care when needed, to ensure continuity of care for service users occupying any of the flats, should they become unwell or unable to manage, and require a period of short term / respite care. Whilst the National Care Standards Commission (NCSC) had not required particular flats to be nominated in this respect, this was on the understanding that no more than two persons living in the sheltered flats would be provided with emergency respite care at any given point in time. This arrangement was made with NCSC the previous regulatory body. The home is now registered and regulated by the Care Quality Commission (CQC). The home is part of a larger complex managed by Pilgrim Homes, which includes sheltered flats and bungalows. The Service Users Guide for Finborough Court says that We welcome applications from Protestant Evangelical Christians of any denomination who are entitled to live in the UK, regardless of their ethnic origin, nationality, marital status or gender, but they must be over 65 years of age and need residential care. We are able to take care of elderly people who need to use a wheelchair and those with failing hearing and eyesight. 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: 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: This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted ten hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in six residents and four staff Have Your Say surveys and the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with six people living in the home and two staff. The manager was present during the inspection and fully contributed to the inspection process. Care Homes for Older People Page 6 of 33 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: Discussion with staff and people living in the home told us that staffing levels are not always sufficient to meet peoples individual needs. Comments included, we are short staffed very often, the staff have a lot to do, it can sometimes be 11am before I can have a wash, staff tell me they will come when they can, as they have other people to do and I cant think of anything off hand that could be done better, but would like the buzzer to be answered quicker for toileting, but appreciate that staff are sometimes elsewhere. Staff reflected that the dependency levels of people living in the home have changed, with an increasing number of people needing more support and assistance with their personal care and to eat their meals. The manager advised they are in the process of reviewing peoples care needs and where possible are applying to the local authority for continuing care to fund additional care hours. Administration and recording of medication is generally being well managed, however where post it notes are being used on Medication Administration Records (MAR), by senior staff to communicate changes in peoples medication, this could result in people receiving incorrect medication. Care Homes for Older People Page 8 of 33 Information in surveys and discussions with people living in the home provided mixed feedback about food, with comments, such as food could be more varied and I am offered enough to eat and drink, however the variety and quality is adequate. Further consultation with residents is required to ensure people are satisfied with the food they are receiving. 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 may use this service are provided with information they need to help them choose if this service will meet their needs. Evidence: Copies of the statement of purpose and service users guide were provided at the inspection. These contain detailed information about the services provided, the facilities and also includes the complaints procedure. The service users guide gives a brief description about the founding of Pilgrim Homes, The Aged Pilgrims Friend society is a Christian charity over 200 years old providing care for the elderly and reflects the Christian values of the service. Information provided in the AQAA and verified at the inspection confirmed Finborough Court has a comprehensive applications and admissions policy and procedure to ensure that prospective users of the service are made aware of what the home has to offer. Individuals are encouraged to be involved with the assessment process and Care Homes for Older People Page 11 of 33 Evidence: information is gathered from a range of sources, with the individuals agreement. People thinking of using the service are encouraged to visit the home and spend time getting to know staff and other people living there. People spoken with confirmed they or their relative had had been provided with information and the opportunity to visit the home before deciding if was the right place for them. As part of the inspection process the records and care pathways of three people living in the home were tracked to ascertain how well the home is meeting their individual needs. All three people tracked had a detailed pre admission assessment completed, which covered all areas of the individuals health, personal and social care needs and, where required, an additional dementia assessment had been completed. Additionally, where people had been referred through social services a copy of the social workers assessment had been obtained, held on file and used to complete the individuals care support plan. From the information obtained in the pre admission assessment an holistic care plan is developed, which is person centred, and takes into consideration the individuals life history and current needs and choices. A Deprivation of Liberty checklist is carried out on admission to the home to ensure that peoples liberty is not or will not be deprived. Each of the files seen contained a copy of the individuals terms and conditions of residence at Finborough Court setting out their fees, the roles and responsibilities of the provider and their rights and obligations whilst living in the home. These are reviewed annually. The home does not provide intermediate care. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service receive health and personal care, based on their individual needs, and can be reasonably assured that at the time of their death and dying they will be supported by a staff team who have the skills to ensure the comfort and dignity of the individual who is dying. Evidence: Three peoples care pathways and care plans were tracked as part of the inspection. Care plans had photographs in place of individual residents to identify and personalise the care plan document, with the exception of one person who had recently moved into the home. The plans are well laid out, setting out the actions required by care staff to ensure that peoples health, personal and social care needs are met. These included the Daily Living Activities (ADLs) identified and assessed in the individuals assessment of needs, prior to moving into the home, including mobility, personal hygiene, skin, elimination, eating and drinking, pain, medication, breathing, sleep, communication, memory and orientation, emotional and mental health, sexuality, spiritual and social activities. Plans provide a good description of individuals needs, support required by staff and the equipment to be used. A care Care Homes for Older People Page 13 of 33 Evidence: plan summary is also in place, which provides staff with a quick overview of the individuals plan of care. Supporting risk assessments for ADLs are in place and provide a very good assessment, identifying the risks, for eating and drinking, transfers, mobility, and the action taken to minimise these risks. For example, moving and handling assessments seen, clearly reflect the equipment required to aid peoples mobility and the support needed to help them maintain their independence. The assessment identifies the type of hoist and size of the sling required to meet that individuals needs, which hooks to use and number of staff required to complete task. Other assessments include pressure area management and nutrition. To protect people from falling from their bed, assessments have been completed alongside a restraint form, which identifies the use of bed rails and bumpers, which are integral to the bed and minimize the risk of entrapment. Additionally, where an individual requires a belt to help support them in their wheelchair a lap strap has been fitted, restraint is only used in these circumstances, the individual was observed sitting in normal armchair, with no form of restraint. Care plans contain emergency evacuation plans providing good information to staff of the best and safest way to support the individual in the event of a fire. A copy of the moving and handling and fire evacuation plans are kept in each persons room for ease of access by staff. Where required, health charts are being kept and monitored, such as fluid intake output, turning and nutrition charts, these reflect people are receiving a good intake of fluid and a balanced diet. Other records kept reflect staff are monitoring peoples general health and wellbeing and any changes, are passed to senior staff. People in the home are able to access health care services. Peoples nutritional needs are closely monitored with regular weights checks being undertaken. The home has a positive relationship with the local General Practitioners (GP) and district nurses who make regular visits to the home. Dates and details and outcomes of appointments had been clearly recorded in peoples care plans. Daily records are well written and provide a good overview of how each individual has spent their day, they also document the care provided and give an indication of the individuals health and well being. Staff spoken with were able to give a verbal account of the needs and preferences of individual residents. Conversation with people living in the home confirmed that staff treat them with dignity and respect. The interactions between residents and staff were observed to be friendly and appropriate. Care Homes for Older People Page 14 of 33 Evidence: Time was spent with the senior observing them administer the lunch time medication. They had a good knowledge of medication and about ensuring people receive their medication at correct times and complications that may arise from missed medication. The home uses the Monitored Dosage System (MDS). Photographs of residents had been attached to the Medication Administration Records (MAR) charts folder to avoid mistakes with the persons identity, with the exception of two people who had recently moved into the home. The practice of administering medication is being generally well managed. The MAR charts inspected were found to be completed correctly, staff had made good use of the codes to reflect if medication had not been administered and the reason why, however where changes in medication had been on the MAR charts, post it notes had been used. For example, where an individuals Warfrin dose had changed, to 3 mg daily, not 4 mg, the 1 mg tablet had been crossed out, the post it note reflected this, but it did not make it clear, or if the post it note became detached instructions would have been confusing, which could result in the individual receiving a higher dose of Warfrin, than prescribed. This was discussed with the senior on duty and the manager, to ensure that instructions on the MAR charts are written in pen and clearly show where changes have been made, any handwritten changes must be signed by two staff. Good practice would be to obtain written confirmation of the changes by the GP. A small medication fridge is held in the staff office, the temperatures are being recorded, however the thermometer on the front of the fridge was reading high at 8 degrees, although the thermometer gauge reflected this was within safe zone, the manager was advised they need to get thermometer checked, to ensure contents in the fridge are being stored at the correct temperature. Information provided in the AQAA and verified at the inspection confirmed, staff training is given in person centered care and relevant care issues on an on going basis. Induction and on going training covers the need to respect residents and their wishes, including end of life care arrangements. The manager is currently working with seniors and staff to be more proactive in end of life care, training is currently being arranged through St Elizabeths Hospice in Ipswich to develop their skills in end of life and palliative care. The manager is currently implementing the use of the Liverpool care pathway, when people in the home move towards the end of life, they confirmed they have good links with the district nurse team and GP, providing necessary beds and mattresses to help in the prevention of pressure areas and to ensure that pain and symptoms are controlled when an individual requires palliative care. They also confirmed that Care Homes for Older People Page 15 of 33 Evidence: relatives are encouraged to stay in the guest room to be nearby during the last few days of a loved ones life. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with activities that meet their expectations and which meets their spiritual, social and recreational interests. Evidence: Information provided in the AQAA and verified during the inspection confirmed that people using the service, relatives and or advocates are able to participate in both the spiritual and social activities, provided within the home, especially if it is difficult for them to maintain spiritual and social contact outside of the home. Routines within the home include morning prayers at 11am and two worship services on Sunday afternoons and Monday mornings. People can attend or choose to listen to the service via speakers throughout the home, including their rooms. People spoken with also confirmed they are supported to access services at local churches that they attended prior to moving into the home. One person told us they are able to maintain their usual routine of rising early in the morning, to complete their daily reading and prayers for an hour, before they have their breakfast. Care plans viewed contained individuals life histories, providing a good profile of the person. These provided information of the individuals past, focusing on significant and Care Homes for Older People Page 17 of 33 Evidence: important events in their life, what matters to them and why. This information provides vital links to the persons past, which has formed their identity, and forms the basis of communication and provides staff with an understanding of the individual. The life history of one individual contained photographs of people important to them and in their life, and reflected their greatest achievements, favorite holidays and items of clothing. Another life history reflected the individual used to like arranging flowers, this was confirmed in discussion with them, they told us, I they used to arrange the flowers in the church every week. The manager has purchased some brightly coloured silk flowers, the individual showed these to the inspector and confirmed they enjoy touching, feeling and arranging these. During our visit we spoke with six people living in the home. People spoken with confirmed they are able to spend their time as they wish and do take part in some of the activities or choose to spend time in their room or communal lounge, talking or playing games. They also told us, they are happy living in the home, comments included, I am very happy here, everything is fine, I get regular visitors and the new manager is very nice, they are encouraging more activities to take place and planning more trips out. We have plans to visit the river Deben in June, Felixstowe for a fish and chip lunch and an outing to a garden centre, arranged for afternoon tea. One person told us, they have been able to rekindle an old friendship, when their friend moved into the home, so they have good company and in the nice weather they like to sit outside to talk. Another person told us, I am supported to retain my independence and spend my day as I choose, I have had a bath and massage today, I do as much as I can do, I strip my own bed, and change pillow slips, I do not want to be idle, staff help me with the rest. I also like to keep my mind active, I have been reading council leaflets about the different parties, deciding who to vote for. I exercise my right to do this using the postal voting system. Comments received in staff Have Your Say surveys told us, that in recent months the atmosphere in the home and social activities have improved and that steps are being made to meet the needs of the residents more individually, not only the physical needs, but also their emotional, social and spiritual needs. Staff told us they are trying to spend more quality time with residents and that more activities have been structured, such as crafts on Mondays, where people are supported to make cards using parchment and colour printing and co-ordinated art sessions on a Thursday afternoon. Additionally, the art table has been set up in the lounge, which has a range of pens, paper and craft materials, which people can access at any time. The manager also told us, they are in the process of reinstating music therapy, a retired dance teacher is coming into the home to host musical appreciation sessions. The staff have cordoned off an area in the lounge to create a reminiscence corner, which has a range Care Homes for Older People Page 18 of 33 Evidence: of old implements, items of interest from the past and has a table and chairs laid out for afternoon tea, unfortunately no one was seen using this area. Groups of people were observed playing a range of handmade wooden games in the lounge during the afternoon, which included puzzles and skittles. One person who lives in the flats and one from the bungalows at Finborough Court were invited to Maundy Monday celebrations at Bury St Edmunds Cathedral, due to their services to the church over many years, where they met the Queen. One of the people that attended the celebrations gave a presentation to all residents in the home, about the day and the different types of Maundy monies. People told us, they enjoyed looking at the photographs and the presentation, which they had found very interesting. Time was spent with the manger discussing the future implementation of dementia care in the service. They are currently working with senior staff to change ethos of home to become more family orientated, and encourage the well being of people with a dementia, getting away from institutionalised care. The manager is involved in a joint working project with the director and managers across ten Pilgrim Homes to look at developing strategies for dementia care, which focus on developing information about each individual incorporating a range of positive triggers. These triggers will have a set of responses, which staff will know will work for that person to promote positive well being. The inspector joined a group of residents whilst they were having their lunch. The lunch time menu provided a choice of beef hotpot or omelet, followed by jam tart and custard or fruit jelly. Feedback about the food was mixed, some people said the food was very nice, comments included, the food is very good, we do have choices and can have tea and coffee when we want and the food is good, we are offered a choice of food, two choices every day, and I can have alternatives on request. Others considered that there could be more variety, as meals can be a bit samey, additionally people complained the meat in the hot pot was tough and hard to chew and swallow, however residents did acknowledge it is difficult to meet every ones tastes. Care Homes for Older People Page 19 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 use this service have access to a robust and effective complaints procedure and are protected from abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were examined. People using the service and staff confirmed they were aware of the complaints procedures and were clear they would talk to the manager if they had any concerns and were confident that there concerns would be dealt with. Residents told us, the manager, is very approachable and I feel able to discuss any concerns openly with them and the office staff are very helpful, always available, I would be happy to approach the manager, if I was unhappy about something. The homes record of complaints identified that there has been one complaint made about the service in 2008, prior to this the last recorded complaint was in 2005. The most recent complaint was made from a person living in the home about arrangements in the dining room. This was fully investigated by the manager and a residents meeting held to discuss issues and peoples views, with an agreed outcome that people are able to sit where they choose. The complaints log confirmed a letter had been written to the individual raising the concerns with agreed response. Care Homes for Older People Page 20 of 33 Evidence: Staff spoken with were clear about the actions to take if people make complaint. One member of staff confirmed they had attended training in Customer Care, which has helped them deal with such situations, to ensure they listen, understand and reassure the person raising the concerns they are taking the issues seriously. Not all staff have received Safeguarding of Vulnerable Adults (SOVA) training, the manager is in the process of arranging training where there is a shortfall, including SOVA. Senior staff have attended a Pilgrim Homes conference, recently where they discussed and received training with regards supporting people to manage their behaviour, where this may be challenging to others. They are to present and cascade this to all staff. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) prior to commencing employment. Staff spoken with were clear about their role and their duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse, including reporting to incident to the local authority safeguarding team via Social Services, Customer First service. Care Homes for Older People Page 21 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. Finborough Court continues to provide people who live there with a safe, well maintained and homely environment. Evidence: Finborough Court is a purpose built care home, which provides single accommodation for up to twenty older people. It is set in the village of Great Finborough, approximately three miles from Stowmarket. People living in the home have access to local facilities of a shop, post office, pub, and two schools. Information provided in AQAA and verified at the inspection confirmed the home is maintained to a high standard of decoration. Colours and furnishings are pleasing to the eye and create a calm, homely atmosphere. All furnishings are well maintained and replaced as necessary. The home remains clean and odour free. People living in the home are encouraged to personalise their rooms, and to add finishing touches of their own to make their living space more homely. These were nicely decorated with peoples personal effects to reflect their individual personalities, hobbies and interests. The manager is currently looking to install memory boxes outside peoples rooms to help them identify their own rooms, and trigger memories. Care Homes for Older People Page 22 of 33 Evidence: Communal areas are spacious and well furnished with domestic style furniture, lighting, carpets and curtains. These are well used and people living in the home are encouraged to arrange these areas in a way that meets their needs on a day to day basis. Other communal areas consisted of a small lounge, used as a private meeting area for residents and their guests, a smaller lounge on the lower ground floor with tea and coffee making facilities, a multipurpose room, used by the hairdresser who visits weekly, people also have their own personal hairdressers visit. The room is also used by a chiropodist, massage therapist, dentist and optician by appointment. The service has had some money donated, which has been put to good use purchasing plants and creating raised plant pots and beds, so that residents who want to, have been able to be involved in planting vegetables and salad plants. The manager advised they are also looking to using some of the money to purchase a widescreen television for the main lounge, so that residents will have a better view of DVDs. As stated in the AQAA the home is being well maintained, Pilgrim Homes, property services manager visits regularly to assess the environment and any alterations required. A plaster crack down the wall leading to fire exit, needs attention, which the manager advised is in progress and a new oil tank has recently been fitted. To ensure the safety of people living in the home, all radiators are guarded with purpose built radiator covers, which minimises the risk of people falling against them and sustaining burns. All hot water outlets to baths, hand wash basin and showers have been fitted with thermostatic valves, which regulate the temperature of the water, to ensure these do not exceed the safe recommended temperatures. The premises complies with the fire service requirements. Finborough Court is on two floors, ground and lower ground, accessible by passenger lift and stairs. The home has sufficient bathrooms and toilets available to meet the needs of the people living there. There is a total of five bathrooms and eight toilets, across both floors. The home are considering the possibility of developing one of the bathrooms with a step in shower into a wet room and to reposition one of the toilets in one of the en-suite bedrooms to allow for hoist access. The home is generally equipped with aids and equipment to promote mobility and maximise peoples independence, including grab rails and other aids, which are available in corridors, bathrooms, and toilets and where required, and in residents own rooms. One of the bathrooms, has a bath chair installed. The chair had been temporarily removed. The manager explained they are waiting for new safety straps and the proper cleaning agent to be delivered, before putting into use. A staff training session on how to use the equipment has been planned. The home has a range of Care Homes for Older People Page 23 of 33 Evidence: hoists, risk assessments seen in peoples care plans confirmed, each person is assessed to ensure the correct size sling is being used. All equipment is being regularly serviced as per the manufacturers recommendations and confirmed from the records inspected. Call systems are provided in all individual and communal rooms. People living in the home and information provided in the Have Your Say surveys confirmed the home is kept very clean and is well looked after. The laundry facilities are clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Systems were in place to minimise risk of infection via the use of red bags for any soiled laundry soiled. Appropriate protective equipment, such as aprons and gloves are availble. Hand washing facilities of liquid soap and paper towels are provided in all en suite and toilet facilities, where staff may be required to provide assistance with personal care. 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 using this service are supported by a staff team that are trained, skilled and competent to do their jobs, however people living and working in the home tell us there are insufficient numbers of staff to meet people individual needs. Evidence: We CQC, received information in six service users and four staff Have your Say surveys, which told us that the staffing ratio is cause for concern, as peoples physical, social and emotional needs are not always being met. Comments included, we need more staff, because of the increased needs of the people living in the home, who need two carers, it is very hard, so staff are struggling and we really need more carers on shift, we have two to three carers and a senior to support twenty residents, I do not think we really meet all the residents needs, especially emotional, which is sad. Discussion with people living in the home confirmed this, they commented, we are short staffed very often, the staff have a lot to do, it can sometimes be 11am before I can have a wash, staff tell me they will come when they can, as they have other people to do, but I like to get up at 6am. They stated, the staff are nice but I sometimes do not feel cared for and so many people need help and support to meet their personal care needs. Staff spoken with confirmed, it can sometimes be 11am in the morning, before we can ensure all people have had the support they need. Fifteen people require assistance to get up, wash dress and have breakfast in the morning, Care Homes for Older People Page 25 of 33 Evidence: which means we often cannot provide proper care and support, if we rush, only five people living in the home are totally independent. The duty rosta reflects the home is staffed twenty fours a day seven days a week. The normal staffing ratio is a senior plus three care staff, with hours that range between 7am and 3pm, with two people finishing at 1pm. The afternoon shift is staffed by a senior and two staff, between 3pm to 9pm, with one member of staff commencing at 1pm, to join the morning shift. Nights are covered by two waking staff. There was evidence from the staff rota, discussion with residents and staff that staffing levels are well maintained, however staff are feeling under pressure at busy times of the day. Staffing levels were discussed with the manager, who acknowledged there are currently some staff gaps, between people leaving and recruitment of new staff. One male carer with dementia experience and one night staff are both starting employment soon. The manager recognises that the dependency levels of people living in the home have changed, with a number of people needing more care than previously, seven to nine people now require support to eat their meals. During the weekdays there are other support staff available, such as the manager, cook and housing assistant to help at meal times, however at weekends it is different, and staff are feeling pressured. However, they commented they are currently working with staff trying to get them out of a pattern of following routines, so that they can better support peoples needs, when they require it. Additionally, they are in the process of reviewing peoples needs and where possible are applying to the local authority for continuing care to fund additional care hours. The AQAA states the home has a robust recruitment processes in place, to select the right candidate and to protect the people living in the home. Examination of three staff files confirmed all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment, with the exception of a character reference for one member of staff, which had been an oversight, where this had not been returned. The manager agreed to chase this reference. Staff surveys and discussions confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Most recent training has included first aid, moving and handling, health and safety and fire safety. More specific training to meet the needs of the people using the service has included dementia awareness. The manager acknowledged there are a few gaps in training, in particular medication and safeguarding adults, and is arranging this as a Care Homes for Older People Page 26 of 33 Evidence: priority to ensure all staff have received up to date training. Food hygiene was booked, but had to be canceled due to sickness, person centered care, fire safety, continence and pressure area care training sessions are planned for May and June 2009. The manager advised they are planning to introduce a staff port folio, to encourage staff to take responsibility for their own training and development. This will allow staff to pick and mix training. Information seen on the staff notice board reflects training available through St Nicholas Hospice in Bury St Edmunds, to develop skills in end of life and palliative care. Other courses staff have requested to attend include advanced care planning, talking to patients and changing practice, working with loss and bereavement and ethical issues at end of life. Information provided in the AQAA states the home employs a total of twenty three care staff. Ten of whom have achieved a National Vocational Qualification (NVQ) level 2 or above, with three staff who have requested to start NVQ training soon. Two senior staff have completed the assessors award and are in-house assessors for NVQ. Additionally, two ancillary staff have a relevant NVQ. These figures reflect the home has 50 percent of staff who hold a recognised qualification, which meets the National Minimum Standard (NMS). The AQAA states all new employees complete their induction training within the first six weeks of their employment. Pilgrim Homes have produced their own induction booklets for care staff and ancillary, which meet the Skills for Care, Common Induction Standards (CIS). Staff spoken with confirmed they had received a very good induction, which included an orientation tour of the home, introduction to Pilgrim Homes, health and safety issues, personal care, moving and handling and care home procedures. They confirmed that had also been issued with a staff handbook containing, the organisations policies and procedures and code practice. Care Homes for Older People Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. Evidence: Rosie Hall has been appointed manager of Finborough Court, they have been in post for two months, but was known to the service as nurse manager, previously when home was dual registered, for nursing and care about nine years ago. Her responsibility is to manage all of Finborough Court, which includes the care home sixteen flats and twelve bungalows on site, supported by two housing assistants. The flats and bungalows are not registered with us, CQC therefore information in this report reflects the service provision in the care home only. Rosie is in the process of applying to us, CQC to become the registered manager of the service. Rosie has a range of qualifications to support her position as manager of the service, they are a registered nurse, a district nursing sister, with experience in palliative care and a diploma in leg ulcer management. They are also a prescribing nurse and has Care Homes for Older People Page 28 of 33 Evidence: experience of training and mentoring staff and nurses as a clinical practice mentor. Information received in Have Your Say surveys and discussion with residents and staff provided positive feedback about the manager, comments included, I love my job, as with all care homes it is hard, but we have excellent support from our manager, even though they have not been here long, she has been excellent and the new manager is always willing to help. Other comments included, since Rosie has been the manager, she has got things going, more activities and Rosie is very nice, they are encouraging more activities to take place, more trips out and activities and in the two months Rosie has been here, things have much improved, more activities are happening, and the service is a lot more person centred than before. To ensure the home is run in peoples the best interests, an annual quality monitoring system is in place, which seeks the views of residents, relatives and staff. Pilgrim Homes also has three different committees. The Home Support Group and Home Visitors meet regularly and visit the home to ensure the spiritual side of the home is managed and maintained and where required are able to act as advocates to discuss issues and concerns in private with people living in the home. The Auxillary committee is responsible for fund raising for the home and organises regular activities to raise money. The most recent relatives and residents surveys completed and returned, provided good feedback about the service people are receiving. Comments included, the home is a wonderful caring place, it has a wonderful atmosphere, perhaps more social activities could be provided and it is a credit to the staff that the home is clean and fresh and always a welcome for relatives and visitors, together with the hospitality when the need arises and I am very happy here, and satisfied with all that goes on, on the whole we get treated with respect and our privacy is maintained, by caring and friendly staff. People using the service are provided with the opportunity at regular residents meetings to have their say about how the service is being run and managed. The minutes of the most recent meeting held confirmed issues such as food, activities and the quality assurance surveys had been discussed. To ensure all people were provided with the opportunity to have their say, staff joined the meeting and broke into small groups with residents to discuss issues, the carers then provided the feedback to the manager who initiated discussions, to resolve issues that had been raised. Staff files confirmed that regular supervision takes place. The documentation reflects that these sessions include discussion about achievements since last the last meeting, any problems, strengths and weaknesses are discussed, the individuals approach to job and areas of development and training needs. Care Homes for Older People Page 29 of 33 Evidence: The home takes steps to safeguard the health, safety and welfare of people living and working in the home. Risk assessments are carried out for all safe working practices with significant findings recorded and the action taken to minimise risks occurring. The most recent Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The home does not have any appliances requiring a supply of gas, therefore there are no gas safety certificates. Certificates confirmed the passenger and stair lift have been serviced in line with the Lifting Operations and Lifting Equipment Regulations (LOLER). The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly. Examination of the accident report book reflected that incidents involving people living in the bungalows and flats were being recorded, in the same book as for those occurring in the residential part of the home. The manager was advised to separate these out as this provides an inaccurate picture of falls and accidents occurring in the registered part of the service. Whilst action has been taken to minimise the number of falls occurring in the service, the accident statistics for 2008, reflect there had been sixty one slips trips and falls. Between January and May 2009, there has been fourteen incidents. The manager was advised to contact the falls co ordinator again, for further advice on assisted technology and aids available to further minimise the number of falls. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 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 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 Where amendments need to be made to Medication Administration Records (MAR) these should be made on the chart its self and not post it notes and clearly marked, in pen, and signed and witnessed by 2 staff. Consultation with residents is recommended to ensure that all people living in the home are satisfied with the food they are receiving. A review of the dependency levels of people living in the home would be beneficial to establish the level of staffing required to ensure their are sufficient staff available at all times throughout the day. 2 15 3 27 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!