Care Home: Foxearth Lodge Nursing Home

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What the care home does well The management take time to ensure a smooth transition for people moving into the home, and as well as addressing any anxieties the prospective resident may have, they also support their relatives. To further support relatives and friends of residents with dementia, the home has started regular `informal` support meetings, which allows people to share their experiences of a loved one coming into residential care. Residents told us that the home is `always kept clean and fresh`, and they are offered a choice of home-cooked meals. Residents told us the staff are friendly and approachable and their visitors are made to feel welcome. A relative said "Foxearth really seem to care for their residents - not just deal with their medical and physical needs". The home ensures the staff they recruit are safe to work with vulnerable people, and have training systems in place to ensure staff have the skills and knowledge to provide a good standard of care. What has improved since the last inspection? The home has worked hard to address requirements and recommendations made following our last visit. They now have systems in place to ensure they never run out of resident`s medication, and that staff do not answer phones were asked undertaking personal care. The home has produced a more informative, user-friendly information guide for people living in/moving into the home so people have an idea of the daily routines, such as when meals are served. The home has introduced new care plans which are more informative, and show that residents has been consulted on how they want to be looked after, and their preferences recorded. The staff have discontinued the practise of automatically assuming residents with dementia are incontinent, by putting special covers on their chairs. Instead support is given on an individual basis and appropriate continence aids used if required. Senior management have undertaken a specialist dementia care course, which helps them identify, through observation, where they feel residents may require more positive interaction during the day to give quality to their life. In undertaking this they have seen where they needed an extra member of staff to support residents with activities during the day. The homes daily completed a five bedded extension to the dementia care unit (Woodlands), and have built a new summerhouse in the garden to enable residents to enjoy the garden, regardless of the weather. What the care home could do better: Staff need to double check how they write information into a care plans to ensure the information cannot be misinterpreted, but instead gives a clear written guidance to staff on how they are supporting the resident with their daily care. As we mentioned in our last inspection report the home should look at their use ofcolour, signage, floor coverings, and lighting to make sure it meets the needs of people with dementia. The management should review their lunchtime routines to ensure that all residents have access to a relaxed, comfortable area to enjoy their meals. They also need to make sure that dining is seen as a social activity for residents and not as a task to be undertaken by staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Foxearth Lodge Nursing Home Little Green Saxtead Woodbridge Suffolk IP13 9QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Clarke     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Foxearth Lodge Nursing Home Little Green Saxtead Woodbridge Suffolk IP13 9QY 01728685599 01728685599 admin@foxearthlodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Eileen Patricia Cantrell,Mr Brian Cantrell care home 62 Number of places (if applicable): Under 65 Over 65 52 1 38 0 dementia learning disability old age, not falling within any other category physical disability Additional conditions: 0 0 0 1 The home may accomodate one named service user who is an older person with a learning disability and dementia as named in variation application dated 4/8/06. Date of last inspection Brief description of the care home Foxearth Lodge Nursing Home provides nursing care to a maximum of 62 people in the categories of old age, and older people with dementia. The home is in a rural location, a few miles from the market town of Framlingham and is set in large grounds, which are accessible to service users. Woodlands Unit (which caters for up to 24 older people with dementia) is on ground Care Homes for Older People Page 4 of 35 Brief description of the care home floor level and comprises 2 double and 20 single bedrooms, all with en-suite toilet facilities. Foxearth Main and Barn units are on two floors, linked by a shaft lift, and comprise 2 double and 34 single bedrooms, all of which have en-suite toilet facilities. There are several lounges, dining rooms and small, quiet communal areas throughout the premises. The home charges: £728.00 per week for self-funding long stay residents. £125.00 per night for short term care. There are no additional charges except for private dental and ophthalmic fees, dry cleaning and long distance telephone calls. Care Homes for Older People Page 5 of 35 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: We (The Commission) visited Foxearth Lodge to carry out a unannounced Key Inspection, where we focused on assessing the outcomes for people living at the home, against the Key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents viewpoint, on what it is like living at the home, and gain feedback on the level of care they receive. This report has been written using accumulated evidence gathered prior to, and during the inspection. A selection of Commission for Social Care Inspection (CSCI) surveys were sent to the home prior to the inspection for them to distribute. This gave an opportunity for people using, working in, and associated with the service to give their views on how they think it is run, and their comments have been included in this report. Care Homes for Older People Page 6 of 35 The home, as a legal requirement sent us their completed Annual Quality and Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards for older people. It also provides us with any planned work they are intending to undertake during the next 12 months. Comments from which have also been included in this report. The Registered Manager was available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. We spent time talking to 4 residents in the privacy of their bedrooms, as well as gaining general feedback whilst meeting residents during the day. We spent time sitting and observing the routines of the home, and also talking to members of the nursing staff, the coowner, and management team. We also had contact with a person associated with the home prior to the inspection. We looked at a sample of records held at the home which included care plans, staff recruitment paperwork, training records, staff rotas and medication administration records. By doing this we can see whether staff are keeping their records up to date, and reflect current practise, to ensure the safe running of the home. Everyone we met during the day was very helpful and participated in the inspection by giving us feedback, and provided information when we asked. People living at the home prefer to be described as residents, rather than service users; therefore this report reflects their wishes. What the care home does well: What has improved since the last inspection? What they could do better: Staff need to double check how they write information into a care plans to ensure the information cannot be misinterpreted, but instead gives a clear written guidance to staff on how they are supporting the resident with their daily care. As we mentioned in our last inspection report the home should look at their use of Care Homes for Older People Page 8 of 35 colour, signage, floor coverings, and lighting to make sure it meets the needs of people with dementia. The management should review their lunchtime routines to ensure that all residents have access to a relaxed, comfortable area to enjoy their meals. They also need to make sure that dining is seen as a social activity for residents and not as a task to be undertaken by staff. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. Prospective residents have their needs assessed, are given sufficient information and are invited to visit, which supports them in identifying if the home offers the environment and level of service they are looking for. Evidence: At our last inspection in November 2007, we identified that the Service User Guide should be made more user-friendly and provide the reader with more information on the daily routines of the home. The homes AQAA under how we have improved in the last 12 months, showed that they had incorporated our recommendations into their new booklet. We were given a copy of this booklet when we visited and found it to be very informative, and now gave a good level of local information. In providing this, it gives the new resident and their advocate, an idea of the level of care they can expect, what Care Homes for Older People Page 11 of 35 Evidence: their rights are, and the daily routines of the home. The booklet has been written in a larger font (making it easier to read), and includes photographs of the home and residents sitting out in the gardens. It also includes a summary of our last report, so prospective residents can see what we have written about the home. The home now refers to people living there as residents instead of patients, with gives it a less clinical feel. Staff confirmed that a copy of the Service Users Guide and Statement of Purpose is given to all new residents as part of their information pack. The Service Users Guide also gives the reader information on what to expect before and on a admission. It tells a person that prior to admission, they will be provided with all the necessary information, for them to determine whether Foxearth is where they would like to live. They are also invited to visit the home for a meal where possible. It informs the prospective resident, that staff will carry out an assessment of their needs, to ensure the home has the capability (in terms of staff and equipment) to provide the level of support the person is looking for. The prospective resident is told that the home will be involving the person, and other social and health professionals involved in their care, as part of their assessment process to ensure that all their needs are covered. All but 1 of the residents surveyed, confirmed that they had received enough information about the home before they moved in, which had helped them decide if it was the right place for them. Residents also told us that they always (3) or usually (1) receive the care and support they need. A relative spoke positively of the support given by staff when their next-of-kin was admitted from another county, telling us that Foxearth assisted this long distance transition admirably, going on to say they are very pleased that they had chosen Foxearth. The Service Users Guide states that the contract is signed with the resident (or relatives or advocate) and the home, and where appropriate with the funding body. Copies of completed contracts were held on file. The home describes the initial assessment period as being a two-way assessment, where the resident is assessed medically, and the home is assessed by the resident (or relatives or advocate) for suitability. Prior to admission, the staff will agree with the new resident a trial period, of not less than 1 month, as part of this two-way assessment. Care Homes for Older People Page 12 of 35 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 can expect their nursing and physical care needs to be monitored by experienced, trained staff, who will treat them with respect. There are systems in place to ensure residents receive their medication/treatment, as prescribed by their doctor. Evidence: The homes AQAA tells us that work is underway to introduce new care plans (a file that gives staff guidance on how the resident wants to be looked after) for service users which incorporates not only their physical and nursing needs, but also their social and emotional needs. We looked at 2 of the new care plans for people living on Woodlands unit (dementia care), and another for a resident living in the main home (which is a mix of dementia, residential and nursing care) as part of a system of tracking individual residents care. Besides reading the care plans, we also discussed the residents care needs with staff, and where possible with the resident, by sitting and going through their care plan together. In undertaking this, we are able to judge if the level of support the carers are telling us they are giving to the resident, and the Care Homes for Older People Page 13 of 35 Evidence: level of help the resident tells us they are receiving, is reflected fully in the care plan. Where it does reflect, we know that the information given is up to date, and states the actual level of support being given. Time spent with staff demonstrated that they have a good working knowledge of residents individual physical and mental health needs. We found that the new care plans covered all these areas. There was good practise in the way that some of the information had been written, as it came over to the reader that the resident had been consulted and as being in control, by informing the staff exactly how they wish to be looked after. For example, it states I am mobile and walk around the unit and can reposition myself, please check my skin when I allow you to assist me with my personal hygiene. However, we did raise concerns over how 1 of the instructions to staff I need some firm persuasion to have a shower, but once in the bathroom I enjoy it had been written. Usung words such as firm could be misinterpreted and open to abusive practise. Further discussion on the routines around the person having a shower, identified that staff are using a sensitive approach, and this section of the persons care plan needed to be re-written to reflect the actual level of positive support being given. Other comments on the care plan was positive in respect that it identified the area that the resident required support to maintain their dignity, I am having difficulty with my urinary incontinence. I may need some reminding to change my clothes if they become wet. We shared with the manager that although the home had identified the problem, and had included information to maintain the persons privacy and dignity, there needed to be another stage in between this, as to how staff could support the resident with their continence, to reduce the chance of their clothes getting wet in the first place. Discussions with the management identified that staff are still going through a transition period, from purely focusing on patients physical and nursing needs to being person centred. This is being undertaken by ensuring equal importance is given to residents emotional, social and environmental needs as well as their health needs. To support the staff in identifying where practises can become more person centred, they have started using an observational tool (Dementia Care mapping). Dementia Care mapping involves observing a person/people over a period of time. In undertaking this focused observation it enables a person (qualified to undertake it), to see how much interaction residents have within that period of time, and how it has affected their well-being. They can then look at their findings, to help them identify where the interaction has been positive, and any negative areas that need to be addressed. For example, where the observation shows that residents are being left on their own for long periods of time, or where a member of staff walks up to a resident Care Homes for Older People Page 14 of 35 Evidence: and asks if they are alright, but walks away before giving the resident time to respond/ understand what has been asked. The home said that they are then using these observations to adjust any shortfalls that they have seen, and also to feedback to staff any positive interactions observed. They felt it also supports the home in identifying any areas of further training staff may need, and incorporate it into the homes training plan. With the residents permission we went through their care plan together to see if it reflected their care needs, which they said it did. They told us that they found all the staff very pleasant and nice, and that they were quite happy living at the home. This reflected the conversations we had with 3 other residents, who said they liked the staff, and felt they were receiving the level of support they wanted. When residents move into the home from the local area, the home will support them to retain their General Practitioner (GP). However, if they need to join a new practise then the home will range this with the local GP who visits regularly, and has good knowledge of every resident. Beside the normal resources, the local NHS surgery offers, the home also contracts extra hours, which gives time for the GP to see all the residents routinely every two weeks. The GP will see all new residents on admission to discuss their medical needs, and will also meet to discuss any issues with relatives, which includes palliative care. Nursing staff have received training in the safe use of syringe drivers, to support terminally ill residents in receiving medication to help them relax and control pain. The home also has a visiting Optician service, who visit every 2 months to support residents with their optical needs, and copies of prescriptions were seen on care plans. The Service User Guide also informs residents that a dental surgeon will visit as required, or the home can arrange for residents to be seen at the surgery. It goes on to say that in-house services provided free of charge include pedicure, manicure, physiotherapy, and occupational therapy. Residents surveyed, told us they received the medical support they needed, and a relative also provided information which showed that their next-of-kins medication is being regularly reviewed by the visiting GP. During the last inspection we raised concerns that the homes system of re-ordering medication was not good enough to ensure that they never ran out. When we arrived at this inspection we were informed that the new system they had put in place following our last visit, was working well, and sufficient stocks are now ordered, to ensure residents always receive their medication as prescribed. We looked at how medication is being stored in the home, and their current practise Care Homes for Older People Page 15 of 35 Evidence: for giving out medication safely, by competent staff. We were informed that all the nurses go through the homes own medication training and assessment, as part of their induction. They felt this was important taking into account that nurses would have come from different backgrounds and experiences. Therefore, by putting staff through their own training sessions, ensures all staff follow the same safe procedures. The provider showed us a copy of the medication test questions which staff have to complete as part of their assessment. This includes the correct procedure for completing Medication and Administration Record (MAR) sheets, which we looked at during the inspection and found staff had been completing them correctly. In a sample check of the amount of medication held for 1 resident, against the homes records we found the amount held to be correct. Prior to the inspection, comments made directly to ourselves, identified that when residents have spat out their medication, that nurses had been seen putting it down the sink. Discussions with the management, and paperwork seen, confirmed that the home has got proper systems in place for the safe disposal of medication, and recording to state that a resident has not taken their medication, so the situation can be monitored. The medication policies for staff to follow are available for them to read in the medication room. The AQAA told us that as part of developing the role for Senior Carers, they are in the process of training them to be involved in medication administration. Further discussion with the provider identified that the training consisted of undertaking the Skills For Care medication module. The introduction of the system will be supportive to residents who need be given their medication un-rushed as they require extra time and support to help them take it. The manager confirmed that the nurse would still be in overall control of dispensing medication, to ensure the right resident received the right medication at the right time. During our last inspection we raised concerns over staff not always maintaining residents privacy and dignity, when we saw a member of staff answering and talking on a mobile phone, whilst assisting a resident with their lunch. We also felt that the practise of automatically assuming a resident has continence problems by putting a incontinence pad on their chair, rather then focusing on using continence aids, where there was a identified problem. The AQAA in the section How we have improved in the last 12 months told us that the home has discontinued the use of chair covers indicating that we are confident in containing the incontinence of the service users. Discussions with the management also confirmed that the practise of their staff answering/talking on phones whilst providing assistance to residents had been stopped. They also told us that there is a designated trained carer present in the dining area Care Homes for Older People Page 16 of 35 Evidence: during mealtimes to meet any specific needs that may arise during this time. The member of staff is surplus to the staff already engaged with the residents. During our visit we heard staff addressing residents politely by the residents preferred name, that they included residents in conversations, and were asking the residents permission for before undertaking the task for example checking to see that they had finished their lunch before removing the plate. Verbal interaction with residents was generally good and promoted the residents wellbeing, for example when a member of staff took away a residents lunch the resident looked at the member of staff and said thank you the member of staff smiled at them saying youre welcome, which resulted in an even bigger smile from the resident. However, a shortfall was identified with a member of staff, who had not been involved with supporting the residents in the area we were observing, walked past a resident (who had been very anxious and a member of staff was sitting with them sensitively encouraging them to eat their lunch) that they should be sitting up at the table. The member of staff who was assisting the resident intercepted straightaway, informing the member of staff that they didnt want to. The management has undertaken training in the Mental Capacity Act, which helps them to identify when different situations occurred, if the resident had the mental capacity to be able to make an informed decision, and if not, to ensure that they are working in the residents best interest. They gave examples of how they had been undertaking this which are too personal to put in this report as it may end up in identifying the residents concerned. Care Homes for Older People Page 17 of 35 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. Residents are offered a choice of home-cooked meals to ensure it meets their tastes and preferences. Residents are able to choose if they want to take part in organised social activities, which includes trips around the local area, and are supported to keep in contact with their family and friends. Evidence: Residents surveyed told us they like the meals served at the home, which reflected the views of the residents we spoke with during our visit, who also said that they were being given plenty of drinks throughout the day. All residents we visited in their bedroom had a drink close at hand, if they were able to undertake this task on their own. When we visited woodlands it coincided with lunches being served. Some residents were having their lunch in their bedroom, with the remaining residents either sitting in the dining room/lounge, or in the seating area near the nurses station (where staff undertake their paperwork and answer the phone). Time spent sitting with residents near the nurses station identified it was a very busy area, and unlike the dining room/lounge, did not provide a relaxed atmosphere to eat. Care Homes for Older People Page 18 of 35 Evidence: Out of the 6 residents eating in this area, 4 remained sitting in their armchair for lunch and had a small table put in front of them, with the remaining 2 residents sitting at a table. The area was being used as a general walkway, and also house the clearing trolley where staff were clearing, and sacking dirty plates. Staff who were not providing one-to-one assistance to residents to eat their meal, were seen to hover around the residents, being overattentive. This resulted in making it a busy atmosphere, with the residents already having to contend with the sound of plates being cleared, staff walking through checking with each other who had been served their meal, and the sound of call bells going off. We watched the 2 residents sitting at the table interacting well with each other. However, as soon as 1 of the residents had finished their lunch, staff removed the plate and brought their dessert. During this time, we observed the first resident beginning to look anxious at seeing the second resident already starting on their next course. Then when the second resident finished their dessert, and the plate was straightaway cleared away, the first resident was heard to say I have a feeling someone wants to take it with the food on it, as they looked at their unfinished meal. When we went to the small dining room/lounge residents had finished their meal. There was a relaxed atmosphere as some residents were sitting chatting at the table. Other residents were sitting in their armchairs watching the television, reading a paper, or just observing what was happening in the room. We discussed our observations of the 2 different eating environments with the management, saying that we felt that the dining room allowed for a more positive dining experience for residents. where the second dining area was more task led and did not feel as relaxed. We discussed the possibilities of having a member of staff eating their meal at the table, to make it a more social occasion. The management said they will now look into the lunchtime routines, especially taking into account that they will soon be using the dining room in the new extension. They felt this would be the best time to introduce a new ethos for both the residents and staff. We also suggested that they may want to use their observational tool (Dementia Care Mapping) to give them a better insight on residents experiences during mealtimes. To assist residents who may not be able to communicate what they would like for lunch, the home tells us they now have an extensive collection of photographs of food to assist in the selection process. We heard residents discussing between themselves their views on the food which included very nice. The AQAA provided us with information on work they have been undertaking during the last 12 months to improve their service. They told us that within the dementia unit our activity sessions are now an integrated part of a morning and afternoon shifts on Care Homes for Older People Page 19 of 35 Evidence: a daily basis. We now have extra member of staff to facilitate this. They also told us that they had amended their daily routines to enable staff to spend more time with service users on the dementia unit. The management told us that they had recently started coffee mornings which are to be held every 2 months for the relatives, and friends of residents with dementia. They have also found that the get-together gives relatives a chance to express their own feelings about looking after someone with dementia, and share their feelings/experiences about their loved one moving into residential care. The management are hoping to also use this as a learning experience for staff, to see how they can further support people during this emotional time. They are also looking at the regular meetings as a way of aiding communication, by sharing with the group what they are/planning to undertake at the home. During the last meeting they did a presentation on Dementia Care Mapping, so people would have an understanding of why the home is undertaking it, and what can be achieved from the observations made. The management said they have had a good response to the meetings, with relatives ringing up to check the date of the next meeting to ensure they are not away at the time. Another area they have discussed with the relatives and friends is the use of memory boxes, asking them to supply items which have a meaning for the resident, and can instigate topics of discussions between staff and residents. The use of life histories enables staff to know about the residents life, and can be also used to positively support them. A relative evidence that this was happening when they told us in their survey that when their next of kin becomes distressed due to their being confused, staff spend time calming the resident by chatting about the family circumstances so they are able to talk to mum about us. A list of forthcoming activities, of which included trips out to the local area, were seen in the bedrooms we visited. Discussion with 1 resident identified that although they had forgotten what activities were going on, they never worried as staff would let them know whats happening and ask if they wanted to join in. Another resident we talked to confirmed that staff always gave them a choice if they wanted to go, therefore did not feel pressured to take part. The AQAA tells us that they have held several charity functions, along with their 25th anniversary celebrations, which continues to encourage members of community to become more involved with a home. Under how do you think the care home can improve a relative had written I would like to see a bit more physical activity to try and maintain (persons name) mobility. The home in their AQAA had also picked this up as an area they want to improve, saying they wanted to provide more sensory activities for a dementia service users Care Homes for Older People Page 20 of 35 Evidence: who reside in the frail, elderly unit. Discussions with the management identified the different kinds of sensory and physical activities they are looking at, which includes ball games. When we visited the noticeboard informed residents that the activity for that day will be musical bingo. Residents we spoke with, said they occupied their day reading newspapers (delivered to the home) and watching television and were aware that activities were arranged - if they wanted to join in. Residents surveyed also confirmed that there are always/usually activities arranged for them to take part in. Care Homes for Older People Page 21 of 35 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. The home has a robust complaints procedure in place, and staff are trained to safeguard the interests of people they care for. Residents and their advocates can expect any concerns they have to be listened to, and acted on in an appropriate manner. Evidence: In the homes Statement of Purpose and Service User Guide, it correctly informs the reader that if they are not satisfied with the way their complaint has been dealt with by the home, that they can seek further advice from ourselves. However, they then go on to say that the Commission for Social Care Inspection will investigate all complaints within 28 days. The way this has been written many mislead the reader into thinking we are able to investigate individual complaints, rather than our role of monitoring how services investigate and address complaints. The complaints procedure gives a contact number of social services, in the list of other contacts and advocacy services that they could seek further advice from. It would be informative for residents who are social services funded, and unhappy how their complaint has been handled by the home, to be made aware that they can also complain directly to social services. Residents surveyed told us that staff always listen and act on what they said, and if they were unhappy about any aspect of their care, they all knew who to talk too, and how to make a formal complaint. This reflected our findings when talking to residents, Care Homes for Older People Page 22 of 35 Evidence: who felt comfortable to raise any issues to staff directly. The home keeps a detailed record of all complaints received, and what action had they have taken to address them. Since we last inspected the home they have received 14 complaints, 1 of which had come via our office, and was forwarded on to the home to deal with. Looking at the complaints it was identified that some were more formal complaints were others were a record of incidents, or concerns brought to the managements attention. The management told us they prefer to make a note of all concerns raised, or an incident that could lead to a complaint being made, so they can evidence their commitment to improving the service. Out of the complaints/concerns they had received, 7 had been upheld. We looked at a sample of the letters sent back to the complainants, which included where shortfalls had been identified how the home was going to address them. The relative completing our survey also confirmed that they knew how to make a complaint, and felt that when they have raised any issues with the home, that the management had responded appropriately to address them. The AQAA informs us that the home safeguards their service users by ensuring that CRB/POVA checks are undertaken; as part of their safe recruitment practise to confirm that staff employed by the home have been cleared to work with vulnerable people. A member of the staff has undertaken the train the trainer course run by the vulnerable adult safeguarding team, which enables them to provide training for staff at the homes. The home safeguarding training also incorporates the use of videos, which identifies poor practise in looking after older people, especially people with dementia, which are used as discussion points. In undertaking this, it allows staff to reflect on their own practise, to see if without realising it, that some of the practises identified in the video, they may have unintentionally been doing. For example going to move a resident in a wheelchair without consulting with them first, or talking over the residents to another member of staff. The home has also shown this video during their relative coffee mornings, to further make people aware that if ever they saw staff acting in such a way, that they should report it. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a well maintained, clean, fresh, safe and comfortable environment to live in. The Home offers people with dementia space to walk around, however they cannot be assured that the current decor, lighting and floor coverage will meet all their sensory, mental health and mobility needs. Evidence: Following a complaint made directly to us, we asked the home to check that all staff call systems were working, as concerns were raised that this was not the case. The complaint was upheld by the home, and work was undertaken to ensure all rooms had a working call bell system. During this inspection we tested the system in a vacant bedroom, in the main part of the home and found it to be in working order. When we visited Woodlands unit, assurances were also given by nursing staff that all the bedrooms have a working system. Whilst visiting bedrooms we identified that some rooms had no call bell cords attached to the call system. We were informed by staff that where they had not been fitted, it was because they had risk assessed that the resident as being unable to use it. However, where staff have identified that the resident may try and get out of bed, and there is a risk of them falling, the home uses sensor mats by the bed which would alert staff that the resident has got up, so they can visit the resident and give assistance if required. Care Homes for Older People Page 24 of 35 Evidence: Since we last visited, work has started on the new extension, which we were informed was near completion. The area linking it to the home was still boarded off, so we did not look at it during this visit. However, we were informed that our colleagues from the Regional Registration Team will be arranging to visit the home, as part of processing the homes application to increase their registered places to 67 residents. Doing our last inspection we mentioned a relatives comments about the corridors in Woodlands appearing darker than the rest of the home, and that the black-and-white tiled flooring in the reception and on one corridor is a cold and unwelcoming appearance. As we stated in that report we also shared our concerns that the black and white squares could cause anxiety and mobility problems for people with dementia. This is because the resident could view the black squares as being a hole in the ground, and worry about stepping on it. At this visit we found that the tiles were still evident. Staff confirmed that they had observed a resident approach the black tiles, and lift their foot up in the air and was hesitant about walking across it. We also found that the corridors, especially taking into account it was only 1.30 in the afternoon, were darker than the other corridors in the home even with all the lights on. We are informed that the lighting in the new extension will be brighter, however this did not address the problems with the rest of Woodlands. The situation needs to be looked at, especially if residents have a form of dementia which is affected by insufficient lighting. Since our last visit talented staff at the home have been painting murals on the corridor walls, to give residents a point of interest whilst walking around. The home in their AQAA acknowledged that the colour system, and signage in the home could be improved upon particularly in the dementia unit. Discussions with the staff identified that theyre looking to use stronger key colours for the doors, which will help residents in finding areas such as the toilet and bathroom. Comments made in a relatives survey, reflected comments in the homes complaint book, concerning problems due to the late autumn this year, with flies around the home. To address the situation the management has consulted a Pest Control Company,who have strategies to reduce the problem, ready for spring time (as it was too late to put into action this year). The strategies will include spraying walls around the home, which deters the flies from landing. This will be in addition to the use of fly screens, fly traps, and for bed fast residents specialist cream bought from the pharmacists which helps deter flies from landing on exposed skin. Residents surveyed told us that the home is always kept clean and fresh, which reflected our findings as we walked around the home. We found residents bedrooms to Care Homes for Older People Page 25 of 35 Evidence: be decorated to a good standard, and personalised. Residents told us that they were comfortable, and the room met their needs. On Woodlands there is 2 dining areas, 1 in the lounge and another by the nurses desk. As mentioned in the Daily Life and Social Activities section of this report, the dining area in the lounge provides a pleasant environment to eat, however the second environment, due to being situated in an open, busy area was not. Staff felt that the situation should be addressed once they put their new dining room, located in the new extension, is put into use. Care Homes for Older People Page 26 of 35 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. Residents living at the home can expect to be cared for by trained, skilled staff in sufficient numbers to support their assessed needs. Evidence: Residents surveyed, when asked if there are staff available when they needed them, 3 replied usually, and 1 always. The Service User Guide informs the reader that the home is at all times staffed at or above the minimum level required by law, to ensure that the residents can be cared for to the highest standard. The Commission for Social Care do not set the staffing levels in homes, as the home has to demonstrate to us, taking into account residents individual changing physical and mental health needs, that they have sufficient staff on duty at all times to ensure their needs are met. The way the information has been written in the booklet refers more to when the home was registered (prior to 2002)with the Health Authority, who did set minimum staffing levels. Therefore, it may be more informative to the reader, for the home to state the minimum number of Nurses, Carers and ancillary staff they will find on each of the shifts and the homes responsibility in constantly reviewing the situation. At the time of writing this report, we had not received any staff surveys back, therefore had no written feedback from the people undertaking the hands-on care, if they felt there was sufficient numbers of staff on duty to meet all the residents Care Homes for Older People Page 27 of 35 Evidence: assessed needs. However, feedback from residents we spoke with during the visit, and from the relative surveyed, it was felt that the current staffing levels are able to meet residents needs. During the inspection we found the call bells were being answered quite quickly, with a slight delay during the busy lunchtime period. When we sat with residents in the lounges, there was always a member of staff to be seen. The relative completing the survey felt as far as they were aware, staff always appeared to have the right skills and experience to look after people properly. They also felt that staff are able to meet the different cultural diversity needs of the people they looked after. The AQAA tells us that as a result of undertaking their own observation (Dementia Care Mapping) that they have put an extra member of staff on the dementia unit to enable staff to spend more time with the residents. In undertaking this it evidences that the home is constantly monitoring staffing numbers and their workload, to ensure that they are able to meet the residents needs. We looked at the rota for the main home, and were informed that 2 carers come on at 7 a.m., followed by another 4 carers at 8 a.m., which are in addition to the nursing staff. Whilst looking at the paperwork, we fed back that it was a little confusing having peoples name under the care section, who were not carers. This is because at a quick glance it could lead people to think there are more carers on duty than there actually are. The management said it was a clerical error and would correct it. Prior to the inspection, concerns were raised directly with us, that when staff are on training sessions they are taken off the floor and not replaced, leaving the staff left on the shift trying to cover the extra workload. The management confirmed that there had been a problem on 1 of the training days. They said that although staff are aware that they should not attend training sessions during shift , unless their hours have been covered, this had not happened on 1 occasion. We looked at a rota which showed that 2 members of staff have recently undertaken a half-day training session. The hours put down on the rota showed that the afternoon staff had been brought in early, to cover the people going on the training session. This ensured that the staffing levels were maintained. From information supplied in the AQAA, and observation of staffs practise, showed that the training being undertaken was supporting staff to have a greater understanding of both the emotional and social needs of residents, especially the most vulnerable. Residents also confirmed that they felt safe and comfortable with staff, and had no concerns over their competency to be able to provide the level of care they require. The management keep training records for each member of staff to show what Care Homes for Older People Page 28 of 35 Evidence: training they have undertaken. There is also a spreadsheet which gives an overview of all training being undertaken, and helps the home identify future training needs. The individual training records held copies of certificates, to confirm what training they had undertaken. The AQAA also informed us that they have become members of the Palliative Care Team, Alzheimers Society and registered with Skills for Care. Information Supplied in the AQAA identified that they have a high number of staff (57 out of their 64 permanent staff) who hold a National Vocational Qualification (NVQ) Level 2 or above, and a further 4 staff who are working to-wards the qualification. Information supplied also showed that the gender of Care staff (56 Female and 8 Male), Reflects the gender of their client group (51 Female and 8 Male residents). This ensures that if a resident requests personal care to be provided by someone of the same gender, the home should be able to accommodate this. We looked at the recruitment paperwork for 2 new members of staff, and found evidence that the home had undertaken checks on the persons Identity, to confirm that they are allowed to work with vulnerable people, before they started work. Copies of training records showed new staff were being put on an induction training programme, when they started, and receive regular training updates to give them the skills and knowledge to undertake their role. Nurses keep their professional knowledge updated by attending in-house and external training days. The external training days are linked with the nurses delegated responsibilities at the home (such as diabetes and wound care). Having attended the training day, the nurse will then come back and cascade the information to their colleagues, to ensure their knowledge is being kept updated as well. Care Homes for Older People Page 29 of 35 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. Residents can expect the management and staff at the home to be approachable, and open to hearing new ideas and suggestions, as part of their commitment to developing the service. Residents can expect the home to be managed by experienced staff, who are committed to providing a good level of care within a safe environment. Evidence: Since our last inspection, Mrs Sindhu Ajis application to become Registered Manager has been approved by The Commission, and a new registration certificate issued to reflect this. However, we did notice a clerical error on the certificate, as Mrs Aji name appears both as the Responsible Individual, and Registered Manager, instead of just the Registered Manager. Since the inspection we have contacted our colleagues in the Regional Registration team, who will arrange a new certificate to be issued. The Statement of Purpose contains an easy to read organisation chart, which clearly shows the management structure, and which areas of the running of the home they Care Homes for Older People Page 30 of 35 Evidence: are responsible for. The Registered Manager is supported in their duty by the Nurse Manager, and the Nurse in charge of Woodlands. From discussions during this, and the last inspection, we have identified that they work well as a team, complementing each other skills and knowledge. We also spent time talking to the proprietor (Co-Owner) Mrs Cantrell, and looked at the content of the current medication training they were undertaking with staff. Discussions with both Mrs Aji and the Nurse Manager, evidenced their enthusiasm and motivation to develop their knowledge of caring for people with dementia, to ensure not only their physical needs are met, but also their social and emotional needs. As part of this, they have both completed further training in dementia (certificates of which were held on file), to support them in undertaking this. Also since our last inspection, the home has started support meetings for relatives and friends of residents with dementia. This enables relatives to share their experiences informerly over a coffee, and for the home to share information on what theyre doing to support their next-of-kin. Other ways of gaining the views of people using, and coming in contact with the home are through the homes own quality assurance surveys. The home also has a volunteer who visits individual residents to gain feedback on how they feel the home is run. The AQAA informs us that they are considering sending out their questionnaires more regularly perhaps twice a year, and looking to see if they could change, or add any new questions to the surveys. An example they gave us of the questions they may include is if there was one thing you could change what would it be. The use of dementia mapping also enables the home to gain feedback from people, who due to their mental frailty would be unable to complete, or fully understand the questions asked in the surveys. This is especially important taking into account the out of the 62 registered places, up to 52 of these places are for people with dementia. The home uses the feedback gained from their quality assurance surveys, complaints register, resident reviews, staff supervision and our own inspection reports, to identify where they are doing well, and what areas they need to work on to improve or enhance their service. We did not look at the supervision records during this inspection, but the AQAA confirms that this is regularly being undertaken. The home uses the information gained to give feedback on individual staffs performance, and to identify any further Care Homes for Older People Page 31 of 35 Evidence: training they would like to/need to undertake. The organisational structure of the home with Managers, Nurses, Senior Health Care Assistants, ensures there is a good support network for new carers by always having a senior member of staff on shift, to offer advice and support. Information supplied by the home, confirmed that they have policies and procedures in place for staff to follow, to safeguard the interests of the people living and working at Foxearth. The AQAA showed that they have all been reviewed in the last 12 months. This includes the policy for keeping a written record of all residents monies and valuables held in safe keeping. Training records showed that staff are receiving training in assisting people with their mobility safely, and in reducing the chance of any infections spreading. Staff also receive training on what action to take if a fire broke out, and records confirmed that fire equipment and alarm systems are being regularly serviced, to keep them in safe working order. Care Homes for Older People Page 32 of 35 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 33 of 35 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 7 The home should have systems in place to check that the wording used in care plans is appropriate, and not open to misinterpretation. The home should review the decor, lighting and floor coverage in the dementia care unit, to see how they can make it more suitable for residents with dementia and sensory needs. 2 20 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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. 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