Care Home: Fleetwood Hall

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What the care home does well We saw that the care records in the home were very personalised and included reference to any risk factors associated with the care. There was also good notes on how people were supported regarding general health issues with separate notes on GP and physiotherapy input for example. We spoke with a visitor who told us that the care `excellent` and highly personalised. The resident concerned had been in previous care settings which had failed to meet their care needs and the input by care staff on the dementia unit was described as very good; `staff are very attentive and kind, [resident] is always clean and well presented and looks happy and relaxed`. We observed the care given to see the kind of staff support and we found the support offered to be both appropriate and personalised and staff were able to maintain very positive relationships which enhanced peoples feelings of well being. For example one person on the demtia unit was very agitated and upset but staff persisted in trying to reassure and assist where they could. On the Andrew mason Unit [AMU] one resident was able to discuss their care. This was in the form of aims set around improving personal care and social interactions. There are weekly activity plans covering basic routines that residents have agreed to and are easy to follow. They include aspects of personal care and work with key workers. Another resident discussed how he was now going out regularly off the unit and this had been achieved with support from his key worker. We were also able to see how support from staff had enabled the person to improve personal hygiene and appearance so that dignity was being maintained and the person was more independent. The social aspects of life in the home continue to be developed with specific staff involved in co ordinating and developing events. Some residents are involved in the garden and there is a newsletter to keep everybody up to date with events. The home has a strong culture of trying to get people `out and about` and provides transport and dedicated staff for this purpose. The staff in the home are receiving ongoing training which equips them with the skills and background knowledge to care for people. All of the care staff [100 percent] are trained to National Vocational Qualification [NVQ] standard. The management systems include good auditing and monitoring to ensure continued good standards. The process`s also ensure that the people living in the home have some say in how things are run so that the service can be developed with their needs in mind. What has improved since the last inspection? The last inspection looked at how the home manages the reporting and follow up to any concerns or allegations of abuse. We found failings in the way managers had reported through an incident to the social services so there was danger that peoples rights were not being respected. The home have, over the past year liaised well with the local safeguarding team and ensured that any issues are appropriately reported and managed. There has been ongoing work to upgrade the general environment of the home so that people can live safely and comfortably. What the care home could do better: We would recommend that an assessment of mental capacity is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. We would strongly recommend that written evaluations are recorded in all instances of care planning so that the progress of care can be established. We also discussed the advantage that such reviews can also provide the base for further ongoing input by the relative or advocate. We did observe some `institutional` practice in terms of managing the diverse needs of people. For example the locking off of a day area on the dementia unit in response to one persons behavior. Another example is the observation of a chest of draws turned to the wall in a bedroom in response to a resident placing soiled items in the draws. This displays a lack of lateral thinking about these care issues and places barriers to the relative freedom of individuals on the unit. We would recommend that any audits of the care carried out take this practice into account. We were advised that currently no people in the home are self medicating. [This was assessed on the ground floor nursing unit]. We discussed this and would recommend that managers of the units consider assessing people to encourage more independence and autonomy in this area. Staff records were viewed. One file contained only one written reference [the other being a telephone reference]. It is important that two written references are recorded to meet regulatory requirments and protect people by ensuring they are `fit` to work with vulnerable people. We have made a requirement for this. Key inspection report Care homes for older people Name: Address: Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN     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: Michael Perry     Date: 2 8 0 6 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 31 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 31 Information about the care home Name of care home: Address: Fleetwood Hall 100 Fleetwood Road Southport Merseyside PR9 9QN 01704544242 01704503956 malcolm@fleetwoodhall.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Newco Southport Limited Name of registered manager (if applicable) Mr Malcolm George Francis Rugen Type of registration: Number of places registered: care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum places - 12) Dementia - Code DE (maximum places - 15) Mental disorder, excluding learning disability or dementia Code MD (maximum places - 21) Physical disability - Code PD (maximum places - 5) The maximum number of service users who can be accommodated is: 53 Date of last inspection 15 21 0 5 Over 65 0 0 12 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Fleetwood Hall is a large detached building that occupies a position on the outskirts of Southport but within easy distance of the Town Centre and promenade. It was once an NHS hospital and has been converted to provide care over three floors. The registration is divided so that the nursing units on the ground and top floor care for older persons, older persons with dementia and also younger adults with physical disability. The middle floor is given over to the Andrew Mason Unit [AMU], which admits younger adults with longer term and enduring mental health needs. This report therefore covers both sets of National Minimum Standards. The home has been owned and managed by Newco Southport Ltd since 1996. The responsible Person is Mr R. Oreschnick. The Registered Manager is Mr Malcolm Rugan. The current fees for the service range from GBP560 - GBP1,900 weekly Care Homes for Older People Page 5 of 31 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: The inspection was unannounced and was conducted over a period of 2 days. All 3 units were visited although we mainly concentrated on the top floor dementia care unit and the Andrew mason Unit [AMU]. All day and recreation areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken to along with members of staff and the Manager. Relatives and visitors were spoken with. Prior to the inspection survey forms were sent out to residents in the home and relatives as well as staff. Some of these were returned and comments have been used in the report. We also liaised with social services officer who has visited the home recently. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about Care Homes for Older People Page 6 of 31 the home and assists in focusing the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The last inspection looked at how the home manages the reporting and follow up to any concerns or allegations of abuse. We found failings in the way managers had reported through an incident to the social services so there was danger that peoples Care Homes for Older People Page 8 of 31 rights were not being respected. The home have, over the past year liaised well with the local safeguarding team and ensured that any issues are appropriately reported and managed. There has been ongoing work to upgrade the general environment of the home so that people can live safely and comfortably. 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 9 of 31 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 31 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. Assessments are carried out prior to residents being admitted and these are clear so that a completed picture of care needs can be obtained. Evidence: Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. We saw assessments on the top floor dementia care unit and the younger adult mental health unit [Andrew Mason Unit - AMU]. The assessments were consistent in detail and quality and clearly identified care needs. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that a good idea of the care needs were apparent. There were also some risk assessments completed which were appropriate. The assessments completed also showed evidence of the people using the service being involved so that care needs can be personalised and people can feel more involved in the process. Care Homes for Older People Page 11 of 31 Evidence: We discussed the implications of the Mental Capacity Act 2005 and assessments completed to ensure that peoples mental capacity is established so that daily life decisions can be made by residents or in their best interests. The home have already completed a lot of work on this regarding ongoing assessments. We would recommend that such an assessment is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. Care Homes for Older People Page 12 of 31 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. Residents health and personal care is well monitored so that residents are receiving individualised care that promotes their dignity and maintains their health. Evidence: The pre inspection information [AQAA] for the home states: We have a very good relationship with local visiting GPs and Consultants. We find them responsive to requests for attendance and for routine monitoring of clients. We have consistently good links with other health care professionals within the local community but also in the hospitals where clients may have last received treatment. We believe this enhances continuity of care and planning. We endeavor to maintain existing contacts with clients own GP (subject to their agreement), speech therapists, hearing support, and any other health or social care contact which exists at the time of admission.Chiropody and optical services and treatment available within the home. Care Homes for Older People Page 13 of 31 Evidence: This shows the homes understanding of the need for continuity in the health care of people admitted. We reviewed care files on the top floor dementia care unit and observed the care of the residents and spoke with a number of them. Care files contained care plans, which outlined the care needs of the residents concerned. Generally these were detailed and the care plan included input by an advocate who was a regular visitor to the unit as the resident lacked immediate family support. This helps ensure that peoples rights are maintained by somebody being able to speak for them and advocate on their behalf as well as showing that relatives and supporters are involved in the care. We saw that the care records were very personalised and included reference to any risk factors associated with the care. For example how staff should approach the person when anxious or aggressive. There was also good notes on how the person was supported regarding general health issues with separate notes on GP and physiotherapy input for example. We found some inconsistency in the way the care plans were reviewed or evaluated. There is a sheet listings dates of reviews but these are merely ticked and contain no detail of how the person was progressing. It was therefore difficult to follow the care with out recourse to the rest of the notes. For example one person had been referred for a wheelchair some time ago for mobility needs but there were no reviews to say whether the wheelchair had been provided and how and when it was to be used [we were advised that this is mainly for outings]. Other care needs had been the subject of written evaluations and these were much clearer to follow. Some of the assessments were also contradictory regarding the persons mobility so it was confusing exactly how immobile they were. We would strongly recommend that written evaluations are recorded in all instances of care planning so that the progress of care can be established. We also discussed the advantage that such reviews can also provide the base for further ongoing input by the relative or advocate. We spoke the advocate concerned who told us that the care on the unit was excellent and highly personalised. The resident concerned had been in previous care settings which had failed to meet their care needs and the input by care staff on the dementia unit was described as very good; staff are very attentive and kind, [resident] is always clean and well presented and looks happy and relaxed. We observed the care given to see the kind of staff support and we found the support offered to be both appropriate and personalised and staff were able to maintain very Care Homes for Older People Page 14 of 31 Evidence: positive relationships which enhanced peoples feelings of well being. For example one person was very agitated and upset during this time but staff persisted in trying to reassure and assist where they could. Eventually one member of staff was able to communicate reasurance and help the person to become distracted. Andrew Mason Unit [AMU] The care planning on the AMU has been standardised and is now more consistent. The care files seen were organised and easier to follow. Each care need was addressed in some detail on those seen and these were evaluated appropriately. There were also risk assessments which contained care interventions and actions are included as part of the care planning process. We liaised with a visitor to the home from social services [prior to the inspection] who also found the care records fairly comprehensive. We saw that the care files seen contained evidence that people living on the unit had been involved in drawing up care plans and each bedroom contained a copy of the care plan so that people could reference it if they wished. One resident was able to discuss their care plan. This was in the form of aims set around improving personal care and social interactions. There are weekly activity plans covering basic routines that residents have agreed to and are easy to follow. They include aspects of personal care and work with key workers. Another resident discussed how he was now going out regularly off the unit and this had been achieved with support from his key worker. We were also able to see how support from staff had enabled the person to improve personal hygiene and appearance so that dignity was being maintained and the person was more independent.This has been progressed over a long period of time due to the persons disability. There is now choice available for people who are resident on the unit regarding GP input. There is also consultant psychiatrist input so that medical reviews are carried out consistently. Residents spoke of the regular reviews undertaken by the psychiatrists and felt reassured about this support. Medications We looked at the care plans of several residents that had been prescribed medicines on a when required [PRN] basis. We found some good information to support their use clearly highlighted in supporting care plans in the medication records. Having detailed Care Homes for Older People Page 15 of 31 Evidence: written care plans is important to help ensure residents receive their medicines correctly. We saw evidence of regular monthly medicines checks being carried out by the senior managers. These checks can ensure good monitoring and pick up any mistakes or improvements needed. We were advised that currently no people in the home are self medicating. [This was assessed on the ground floor nursing unit]. Staff spoken with had clearly not considered this as a way of assisting people to become more independent. We discussed this and would recommend that managers of the units consider assessing people to encourage more independence and autonomy in this area. The home has policies and procedures to support this. This was discussed on previous inspections. When we spoke with people they told us that they get their medication on time and feel well supported. Care Homes for Older People Page 16 of 31 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. The attention to the social needs of the residents in the home helps ensure that they have a good quality of life. Evidence: The AQAA completed by the manager offers some evidence of ongoing developments of the social life in the home: We have developed a number of small group holidays. We hold an in house exercise groups with visiting physiotherapist. We have five staff offering activities and helping people to maintain strong links with their historic home communities. There was an understanding on the nursing units of the importance of facilitating good communication with residents and allowing them the time to develop their lifestyles. One resident spoken with had a very personalised bedroom that contained enough space for personal items and books and other activity / pastimes that complimented the residents lifestyle. All bedrooms seen displayed a high level of personalisation. Residents spoken with advised of the various activities that are undertaken in the home. There are staff members coordinating some of these events and the home also Care Homes for Older People Page 17 of 31 Evidence: employ a driver who also contributes a lot in terms of working with some residents and getting them out and about. We liaised with a visitor from social services prior to the inspection who told us: I met and spoke with several residents in the nursing wing and all appeared well cared for, one gentleman took a great interest in working in the garden and tending some house plants. On the top floor I spoke briefly to several people and had a discussion around the World Cup. By chance I had a chat with the internal social activities co-ordinator and she mentioned some of the forthcoming events. Quizzes are the big thing of the moment with a competition between the 3 units and she has bought a cup to be presented to the eventual winner. She has also arranged a quiz between Fleetwood Hall and residents of a nearby sheltered housing scheme. Many of the lounges are decorated with flags and other bits for the World Cup and they are going to have some themed meals where the courses come from different countries that are competing. They also planning a Mid Summers Day BBQ for all the residents. Additionally there are regular trips out, often to Blackpool. This week a number of residents had gone to a barge on the canal near Burscough for a trip and a lunch. All AMU residents are offered the chance to go on holiday but not all wish to take this up. Care notes include a note of any activities that residents partake in including the dementia unit on the top floor. There are difficulties in accessing green space [shared with ground floor] due to the unit being on the top floor and therefore more geographically removed so that people with dementia are reliant on care staff support for accessing the garden. Any development of care here should focus on regular activity off the unit as well as on. Staff did report that some residents went out on a weekly basis on the minibus but felt that this could be made more regular for some residents who do not get off the unit at all. The manager has recently increased the staffing on the demetia care unit so it should be easier to facilitate more off unit activity. We did observe some institutional practice in terms of managing the diverse needs of people. For example one person trashes the second day area on the dementia unit so this has been locked off by staff. Another example is the observation of a chest of draws turned to the wall in a bedroom in response to a resident placing soiled items in the draws. This displays a lack of lateral thinking about these care issues and places barriers to the relative freedom of individuals on the unit. We would recommend that any audits of the care carried out take this practice into account. On the AMU some of the residents are limited in their ability to make some specific life choices but interviews were consistent in that residents are listened to and choices made on a Care Homes for Older People Page 18 of 31 Evidence: daily basis are respected. Staffing levels are good on the unit, which allows for one to one input for some of the more needy residents with respect to physical care and the importance of using this time for positive social interaction was a feature of the staff interviews conducted. We spoke with residents who seemed relaxed and settled on the unit. many were enjoying the sunshine outside. One new member of staff said; there is a sense of freedom here because of the layout of the unit and also the attitude of the staff. A resident said: staff are good and i can talk to them. Generally all residents praised the meals. There is good choice and residents said that they look forward to the choice of a cooked breakfast each morning. We saw a meal [dinner time] on the dementia care unit and this was a relaxed and sociable occasion. There were plenty of staff on hand to assist when needed. Care Homes for Older People Page 19 of 31 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. There are processes in place for dealing with concerns and ensuring that people are protected. Evidence: There is a complaints procedure in the home and the manager has a system for recording in house concerns and complaints. Since the last inspection there have been no complaints. The complaints procedure is displayed in the home in more immediate terms with an easy to understand leaflet and is evidence of a positive attitude to the views of the residents and visitors. We spoke to residents about how they would complain or raise a concern and they were confident that they could approach the staff who they felt would listen. The pre inspection information completed by the manager lists areas of good practice. The last inspection report a year ago evidenced a failure by the managers to report a incident to the safeguarding team at social services which may have compromised an investigation. Since last year the home have been careful to liaise with social services over any concerns and during January 2010 reported and assisted with an investigation into a concern expressed by a resident which was followed through appropriately. The manager has been proactive in terms of getting staff to understand the implications of the Mental Capacity Act and how this affects peoples rights in the Care Homes for Older People Page 20 of 31 Evidence: home. Staff have had training and the home have managed a difficult situation in terms of acting in a residents best interest by referring through for an assessment under the Deprivation Of Liberty Safeguards. Again this was assessed by the local authority on the residents behalf and the home displayed a good understanding and support of the persons rights. The manager is currently in the process acquiring the new social service procedure [Sefton] and will update all staff. This shows that people living at Fleetwood hall are listened to and there rights upheld and they are protected. Care Homes for Older People Page 21 of 31 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. The home continues to be developed with the needs of the residents in mind so that the home provides comfortable and safe accommodation. Evidence: The pre inspection information for the service tells us: Externally, Fleetwood Hall is, and will remain, a large and imposing building which some will see as institutional. We have tried to soften the visual appearance through exciting flowerbed arrangements, minimal signage, new windows, a new front porch, new parking areas and road etc. This shows an understanding of the affect of the environment on peoples well being and evidences some positive steps to remove any barriers and maintain good standards. We have continued to implement our ongoing maintenance and improvement program with extensive new parking and driveway areas, enlarged gardens, fresh and attractive fencing around banks and slopes,internal redecoration, flooring and carpeting, and ongoing works throughout the home. The ground floor nursing unit and the Andrew mason Unit were both clean and well Care Homes for Older People Page 22 of 31 Evidence: maintained in general. Both provide personalised accommodation for residents and the bedrooms seen clearly displayed this. There is access to green space on the ground floor unit and this is well maintained and some of the residents are involved in assisting in the garden. The AMU has been upgraded over the past few years and this is continuing with new flooring in various areas, a new bathroom and decor to bedrooms and the female day area. There have also been new furnishings for other day areas. Residents were generally pleased with the standard of the accommodation and commented on this. The top floor dementia care unit has also been upgraded with new bath and shower facilities as well as having the existing day area decorated and refurnished and a new lounge area created. Again bedrooms in this area were highly personalised and comfortable. This shows that the staff on the unit are concerned to promote individual aspects of peoples personality and make bedrooms as homely as possible. At the last inspection we spoke about the need to develop the area in terms of more orientation aids such as signage etc which would enable people to find their way around more easily and this has been actioned with signs now on residents doors and also toilets and bathrooms. This shows that the unit continues to develop. We have made comments under daily life... regarding some observations around institutional practice such as shutting off day areas and placing of furniture in bedrooms and the manager and team leader on the unit need to be aware of and closely monitor any practice that may stop residents accessing facilities. Care Homes for Older People Page 23 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing in the home ensures some consistency of care so that peoples needs can be met. Evidence: Nursing We visited and spoke with staff on both the ground floor nursing and top floor dementia care unit. There were appropriate staff for residents needs. Staffing ratios are consistent and staff interviewed stated that staff turn over was minimal.The top floor dementia unit has had some experienced staff employed and a clinical lead.This has helped ensure more consistency. Care staff spoken to have had updates or training in dementia care and the qualified nurses spoken with had also been on regular updates and stated that the home were good at providing training and that they felt supported by the management. On the Andrew mason Unit [AMU]staffing is also consistent and there is generally a 1:3 ratio maintained. The figure also includes the unit manager. Residents reported that staff are always available and that they felt supported by the care team. There are trained staff who are appropriately qualified and experienced with regard to nursing this client group. Again the rate of turnover of staff is currently fairly low and Care Homes for Older People Page 24 of 31 Evidence: there are therefore consistent personal on the unit. We did discuss an issue around communication and effective handover as some staff shift patterns do not always facilitate effective handover of information and the manager said he is currently working with staff to support this. Staff records were viewed [3 in total] and all were comprehensive in that staff information available and the required Criminal Records [CRB] and vulnerable adult checks [ISA] were recorded along with references. Files also contained some training certificates and supervision records. One file contained only one written reference [the other being a telephone reference]. It is important that two written references are recorded to meet regulatory requirments and protect people by ensuring they are fit to work with vulnerable people. Training was discussed with the staff. Staff were pleased with the training offered from induction through to access to NVQ which has been stepped up over the last few years and now all care staff have achieved an National Vocational qualification [NVQ] which provides a good staff base for the care of residents. Staff are well thought of by residents and visitors alike and there were many positive comments recorded through out the inspection and the support observed was appropriate and genuine. Care Homes for Older People Page 25 of 31 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 home is managed with the inclusion of the views of the people using the service which helps ensure that the service is developed with respect to their best interests. Evidence: Malcolm Rugan is the Registered Manager for the. He has worked in the home for a number of years and prior to appointment as manager was employed in a deputy management role. He has an NVQ course in management and has an RMN [Registered Mental Nurse qualification]. Feedback from staff, residents and visitors generally is that he is consistent in approach and is easy to communicate and talk to. He completed a pre inspection self assessment of the service which was clear and considered and gave very good evidence of an understanding of the strengths and weaknesses of the home and how the service can be further developed: We adopt an open door approach with residents and their families. They tell us this ensures that areas of concern may be raised and progress monitored in an informal way. Two Service Users and two family members sit on the Clinical Governance Board Care Homes for Older People Page 26 of 31 Evidence: that meets regularly. This Board is a formal setting within which to hear views and experiences and to assess how well the home is reacting to these. We make wide use of advocacy services, team leader meetings and our key workers ensure that that views of each client are represented heard and acted upon. The manager was able to discuss developments in terms of quality issues in the home. There is a yearly external audit that accesses both staff, resident and relative views of the home and provides feedback to the managers. There are various audits conducted regularly including health and safety audits, which are reported through the health and safety management team. There is also the clinical governance team [described above]consisting of management, staff and relative and resident representatives. We spoke to one of the resident representatives who valued this inclusion. This shows commitment to including residents in the general running of the home. The requirements and recommendations previously made have been met and the home has generally showed progress over the last year in further improving standards in the home. Care Homes for Older People Page 27 of 31 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 28 of 31 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 29 19 All new staff must have two written references on file. This meets regulatory requirments and helps ensure that people recruited are fit to work with vulnerable people. 05/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 We would recommend that an assessment of mental capacity is carried out pre admission so that it can be clearly established the persons capacity to make a choice about coming to the home. We would strongly recommend that written evaluations are recorded in all instances of care planning so that the progress of care can be established. We also discussed the advantage that such reviews can also provide the base for further ongoing input by the relative or advocate. 2 7 3 9 We would recommend that managers of the units consider assessing people to encourage more independence and Page 29 of 31 Care Homes for Older People 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 autonomy in the area of self medication. 4 12 We would recommend that all of the residents on the dementia care unit are given equal opportunity to access fresh air and outings. Managers need to be aware of any institutional practice that may inhibit freedom of choice in the home. Audits should be aimed at monitoring such practice as that described in the report and aiming to think more progressively in terms of care solutions. We would recommend that all staff are updated with the latest policy document from social services regarding safeguarding. The issues around improving communication between shifts should be addressed by the manager. 5 14 6 18 7 27 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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