Care Home: Freshford Cottage Nursing Home

What the care home does well What the service does well Freshford Cottage provides nursing care for up to twenty residents. At the time of the inspection there were seventeen people living in the home. A health care professional stated that the home communicates well with the surgery regarding medical issues, and liaises well with families to gather the relevant information. Prospective residents receive a thorough assessment prior to admission to ensure that the home can meet their needs, this forms the basis of the care planning for the individual. Care plans seen were comprehensive and gave clear instructions to care staff about the delivery of care. Medication is administered to residents in a manner which ensures their safety. Care staff are encouraged to undertake further training and 66% of the staff have attained the National Vocational Qualification level 2 or above in Care. The home communicates well with the residents and residents meetings are held with ongoing discussions held about the meals they would prefer and the activities provided. The home provides a well balanced and nutritious menu which uses very little tinned or pre packed food. The chef says that he is still in the process of identifying individual likes and dislikes around the home, but aims to provide a diet which is "different from the usual food served in care homes". Questionnaires received stated that the home was "always fresh and clean", and this was evident during the tour of the home. Residents said that ` The staff are caring and kind`, " I like most of the food". What has improved since the last inspection? The owner is planning to refurbish and extend the home, however communal rooms, some individual resident`s rooms, and bathrooms have been redecorated. A new care planning system has been commenced and this has ensured that the care that people require is well documented. The home has not needed to use any agency staff in the past few months and has a stable workforce. The majority of registered nurses working in the home have been employed for several years, staying on when the home changed ownership. What the care home could do better: Whilst outcomes for residents are good and a high standard of care is delivered in a homely atmosphere, there were some shortfalls noted and requirements have been made. The Statement of Purpose and Service User Guide require updating to provide correct information for residents.Records of receipt and disposal of medication require more attention and regular stock audits are required. This recording of receipt and disposal of medication and regular audit ensures that sufficient amount of the individual`s medication is in place without over stocking which could lead to misuse of medication. Recruitment procedures require to be more robust to ensure resident`s safety, and records relating to staff training are required to be sufficiently detailed to enable the manager to be aware of when staff need training updates, particularly regarding mandatory health and safety training. Whilst it is appreciated that the home is due for refurbishment and extension the provider must ensure that the home receives regular maintenance and decoration and that staff work together to provide a comfortable home for the residents. The provider has given assurances that some issues found during the inspection would be addressed, and therefore these have not been followed by a requirement. Subsequent to the inspection the commission was informed that these were being attended to. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Freshford Cottage Nursing Home Dane Road Seaford East Sussex BN25 1DU     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: Elizabeth Dudley     Date: 0 2 0 6 2 0 0 9 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Freshford Cottage Nursing Home Dane Road Seaford East Sussex BN25 1DU 01323897845 01323872300 freshford@southcarehomes.com www.southcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Tasneem Osman, MrsZeenat Nanji care home 20 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service uses to be accommodated is 20 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Freshford Cottage is a care home providing nursing care to twenty older people. It is situated in Seaford within easy walking distance of both the seafront and the town centre and has car parking facilities for approximately 12 cars. There are rail and bus links to Brighton and Eastbourne within walking distance. The home provides accommodation for residents over two floors in six single and Care Homes for Older People Page 4 of 35 Over 65 20 0 Brief description of the care home seven double bedrooms, seven of which have ensuite facilities. Communal accommodation is provided by a lounge, dining room and conservatory, a small patio at the front of the property is also available for residents use. Three assisted bathrooms are provided.The home has recently undergone a change of ownership and the present owners, whilst presently redecorating and refurbishing the existing property, intend to build an extension, which will substantially increase the number of rooms in the home. . 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: This key unannounced inspection took place on the 2nd June 2008 over a period of eight hours and was undertaken by two inspectors. The inspection was facilitated by the appointed manager and the care home provider, Mrs Z Nanji. The appointed manager is in the process of applying for registration with the Care Quality Commission, and will be referred to as the manager throughout this report. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, and conversations with residents, staff and visitors to the home. All residents were spoken with during the inspection, and five residents were spoken with in depth and gave their views on life in the home. Information gained from staff gave an insight into the training they receive and their perspective on the quality of life provided to residents in Care Homes for Older People Page 6 of 35 the home. Documentation examined included; care plans, personnel files, staff training and supervision records, catering records and health and safety files. The AQAA ( Annual QualityAssurance Assessment), a document required by regulation which identifies improvements the home has made in the past twelve months and plans for the next twelve months, was received later than we asked for it and lacked some information required. Prior to the inspection questionnaires were sent out to relatives, residents and staff. Of these, five were returned from residents and visitors to the home, four from staff members and one from a health care professional. These gave information about the daily life in the home and helped to inform the judgments made in this report. Thanks are extended to those people who responded. Conversations with residents and relatives and surveys received showed that the home generally meets their needs and that they have a good relationship with the staff in the home. The inspectors thank the residents, staff and management for their courtesy, help and hospitality during the inspection. The last key inspection took place on the 8th August 2007 and the commission was informed on the 2nd June 2008 that the fees currently charged range between five hundred and sixty eight pounds per week to seven hundred and twenty pounds per week. Extra services such as chiropody and hairdressing are charged separately and these charges are available from the manager. What the care home does well: What has improved since the last inspection? What they could do better: Whilst outcomes for residents are good and a high standard of care is delivered in a homely atmosphere, there were some shortfalls noted and requirements have been made. The Statement of Purpose and Service User Guide require updating to provide correct information for residents. Care Homes for Older People Page 8 of 35 Records of receipt and disposal of medication require more attention and regular stock audits are required. This recording of receipt and disposal of medication and regular audit ensures that sufficient amount of the individuals medication is in place without over stocking which could lead to misuse of medication. Recruitment procedures require to be more robust to ensure residents safety, and records relating to staff training are required to be sufficiently detailed to enable the manager to be aware of when staff need training updates, particularly regarding mandatory health and safety training. Whilst it is appreciated that the home is due for refurbishment and extension the provider must ensure that the home receives regular maintenance and decoration and that staff work together to provide a comfortable home for the residents. The provider has given assurances that some issues found during the inspection would be addressed, and therefore these have not been followed by a requirement. Subsequent to the inspection the commission was informed that these were being attended to. 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.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 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. Whilst the home produces a Statement of Purpose and Service User Guide these had not been amended to reflect the current status of the home. Surveys showed that residents felt that they received sufficient information to enable them to make a decision over whether they wished to live at the home. Comprehensive preadmission assessments provide sufficient information about the resident to enable a care plan to be commenced and to inform staff. Evidence: Whilst the home has produced a Service User Guide and Statement of Purpose which include all information as required by regulation; these documents had not been regularly reviewed in some areas to provide a current profile of the home. The Statement of Purpose available in the entrance hall was not readily available to residents or visitors and contained information from four years previously which related to the previous owner of the home. Discussions were held with the manager regarding amendments required which included the address of the commission and Care Homes for Older People Page 11 of 35 Evidence: staff details. The complaints procedure included with these documents requires amending. Both the provider and manager gave assurances that this would be addressed. The National Minimum Standards direct that the Service User Guide and Statement of Purpose should be in a format suitable for the client group using them; improvements are required to these documents to ensure that they are suitable for ease of use by the residents. Visits to residents rooms showed that each resident had a copy of the Service User Guide. Each resident, irrespective of how they are funded, receives a copy of the homes Terms and Conditions of Residence and a contract which show the breakdown of fees for multiple funding, or the fee to be paid for private funding. These documents met the regulations and National Minimum Standards. Prior to admission to the home, prospective residents are assessed by the manager to ensure that the home can meet their needs. Three preadmission assessments were examined during the inspection, these were comprehensive and included all information necessary for the commencement of a care plan and staff information. It was unclear whether prospective residents are informed in writing of whether the home can meet their needs, and whether, following assessment, the home is able to admit them. Five out of the six service user surveys received by the commission, showed that the residents had received sufficient information about the home prior to admission, and had received a contract. One survey showed that the resident was unsure about this. All residents or their representatives are encouraged to visit the home prior to admission. The home admits people for respite and permanent care but not for intermediate care. 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. Care plans identify the care required by the residents and give clear directions to staff on how the care is to be delivered to meet residents needs and expectations. Some areas of medication documentation may not wholly ensure residents safety. Evidence: During the inspection care plans belonging to 5 (29 ) of the residents were examined. The initial preadmission assessment gives information about the residents needs and is used to inform the care planning process, with additional information being included as the home continues to assess the resident. All care plans seen had been reviewed on a monthly basis and included clear instructions for the delivery of the care planned. Care plans included details of the care required in specific health issues nutrition, continence, mobility and personal care, and to a lesser extent night care planning and wound care plans. Risk assessments for use of bed rails pressure damage and use of equipment were in place. Care Homes for Older People Page 13 of 35 Evidence: Whilst the standard of care planning was generally good; it was noted that in some areas such as wound care and pressure damage prevention, there were no specific care plans in place to guide staff in the measures to be taken to prevent the damage occurring on those who were at risk of this. There was no indication in the care plans of which residents had electric or dynamic mattresses and whether the pressures of the electric mattresses were suitable for the weight of the resident or regularly monitored. Daily records stated that residents had been turned two or three hourly but there was insufficient evidence to follow this up. The home liaises with the Wound Care Specialist nurse if required, although there are no residents in the home currently requiring this service. Staff stated that there were no residents in the home at this time who required their fluid intake monitoring. Continence care plans require to be more explanatory, both regarding how often the resident requires assistance, and specific as to the continence aid required. No care plans seen had evidence of being formed in consultation with the resident or representative; although some risk assessments for bed rails had been signed by the resident. Whilst bed rail protectors were advocated in all risk assessments and care plans, there were insufficient of these in the home to be used by all the residents that required them. The provider made arrangements for these to be purchased during the day. A survey received from a General Practitioner showed that the home was proactive in communicating with the surgery regarding health care issues and liaises well with families to gather information. Surveys received from residents and relatives indicated that they were happy with the standard of care received: I am looked after very well and I am very satisfied with the staff and the management. There is no need for improvement on the many tasks that the staff and the management do. Home does everything well. Residents spoken with said they were pleased with the care that they received. Two medication rounds were observed, and these were undertaken in a manner which safeguarded the residents. Care Homes for Older People Page 14 of 35 Evidence: There were some issues around the receipt storage administration and return of medication that require attention. Staff are not always recording the amount of medication received, the name of the member of staff or the date received. This was noted to be occurring when medication had come in separate to the main medication order and in particular when medication prescription charts were handwritten. This occurred in the case of seven residents. Handwritten medication prescription charts were not been signed, dated or had the amount received recorded. When items of medication have been discontinued by the doctor, the name of the doctor, the nurse receiving the order and the date it is stopped, should be included on the prescription chart. One residents medication chart had no indication of when two medications had been stopped or who had taken this message. This particular medication chart also showed that the person administering the medication had not signed the chart for the one day two days prior to the medication having been discontinued. Another resident had not had a prescribed supplement food in stock for approximately three weeks. On receipt of the food, which was prescribed to be taken three times a day, the amount received was not recorded, and the supplement was not given on one occasion without the reason for this being recorded. Throughout the medication charts, creams, ointments and other external medications, generally applied by care staff, were not being signed by the accountable person. These must be signed as is other medication, not ticked as given. It is considered good practice to have details of the specific reasons that a resident will require an as required (p.r.n) medication. Staff must ensure that medication is regularly audited to avoid ordering items already in stock. There was a substantial amount of medication in the home. Medication for disposal was still in blister packs, it was not stored in a locked cupboard and had not been transferred to the specific containers for disposal. Neither had it been recorded in the Disposal of medication records. The registered provider who was present at the inspection was made aware of these medication shortfalls, she acknowledged and agreed that these were issues which required to be addressed. It is good practice to monitor the temperature of the drug fridge and clinic room at regular intervals to ensure that medication is stored at the correct temperatures. This had not been undertaken for over two weeks. Registered nurses are asked to refer to the Nursing and Midwifery Guidelines on Care Homes for Older People Page 15 of 35 Evidence: medicine administration and the home should review their medication policies to ensure that they include relevant guidance for staff. The home is able to care for residents who are reaching the end of their lives. End of Life care plans did not contain all the information required such as residents wishes for resuscitation or preferred place of death and the provider gave assurances that this would be addressed. Communications from relatives and representatives were seen which praised the care given to residents at the end of their lives, Some registered nurses have attended palliative care training have not yet received training in the Liverpool Care Pathway or Gold Standards Framework ( nursing tools to ensure that residents receive a recognised standard of care and pain relief at the end of their lives),although this is planned for the future. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there are some activities provided, there is scope for both the frequency and the variety to be increased. Although residents choices around the activities of daily living are implicit in the homes policies and documentation, these are not always practised. The menu provides a balanced and nutritious diet although this is not always to some residents taste. Evidence: The majority of the leisure activities are provided by the care staff, although staff said that outside people such as music therapy and a motivation sessionist do come into the home on a monthly or fortnightly basis. Staff said that they do dancing every Thursday with the residents which is enjoyed and that they also do painting, occasional outings to the seafront, which is a short walk away, and some games such as bingo. Regular film afternoons are held at weekends. However one resident said that they were bored at times and another resident said that There is not much to do here. A resident said that their room overlooked the rugby field and they enjoyed watching the games taking place. No records of residents participation in activities were seen. Care Homes for Older People Page 17 of 35 Evidence: Residents can maintain contact with friends and relatives and this is facilitated by the home permitting visitors at any time. Religious services and visits are provided by a local priest, a conversation was held with this minister who said that there are regular twice monthly services but no one is pressured to attend, and often apparent non believers elect to stay in the room during the service. Residents can also have their preferred ministers of religion visit. Whilst the Annual Quality Assessment intimates that residents are enabled to make full choices around the activities of daily living and preferred times of rising and retiring are carefully recorded in the care plan, this is not always the case. Staff stated that they always start putting residents to bed between 7pm and 8 pm, and getting residents up at 8am, but qualified this by stating that if a resident wished to stay up later or rise either earlier or later, they could do so, care plans viewed did not testify to this. One resident said that they go to bed when they like but always at 8.30 pm and it was unclear whether this was the residents choice or a suggestion from staff at that specific time. Another resident said that they put themselves to bed when they wished. Whilst there is a bookcase on the first floor for residents use, it is doubtful whether residents are aware of the books there, and also the majority of the books were older paperbacks with a theme of romance or similar. There was only one large print book available. Some areas of choice around food were also questioned, insomuch that one resident said that they were not a big meat eater, and asks for no meat, but this doesnt always happen, another resident confirmed that when I ask for things to be done they are not always done. However, three of the five surveys received by the Care Quality Commission from residents answered the question: Do staff act upon what you say with usually.The two other surveys answered always to this question. Whilst the serving of lunch and assistance with meals was not witnessed at this inspection, it was noted that on arrival at the home at 09:30 some residents were still having breakfast in the dining room and lounge. It was gratifying to see that residents are able to have breakfasts at a later time, and this therefore shows that personal care is not being rushed. However, it was noted that breakfast was being prepared in the walk through area in the dining room and queries were raised regarding hygiene issues. It was recommended that a separate area away from the part which people walk through was used. It was also noted that care staff were not wearing protective aprons over their uniform which also could have an impact on hygiene. Care Homes for Older People Page 18 of 35 Evidence: Menus showed that residents receive a nutritious and balanced diet, and fruit was available on a table in the dining room. There are two choices offered at each meal, the lunch choice on this day was either shepherds pie or sausage and mash, served with accompanying vegetables, with pineapple upside down cake for dessert. The menus are in the process of being reviewed and it is recommended that a summer and winter menu are put in place. Currently the menu includes stews and dumplings which may not be suitable for the summer months. One resident said they would like more salads. The supper menu also showed options of a cooked meal or sandwiches and soup and a dessert. Very little frozen or ready prepared food is used with the chef saying that the majority of dishes are home made. Variable comments were received about the food: whilst surveys generally answered usually and sometimes to the question do you like the food, one resident spoken with said the food was horrible but the porridge is nice whilst another said they really like the food. Staff surveys stated the food is good and well cooked and also very tasty. It was evident that the chef takes care over the preparation of the food and tries to make it different to the normal fare, ie the shepherds pie had been cooked with wine. The chef has received training in cooking for older people and also for diabetics and is aware of the specific needs. The Annual Quality Assurance Assessment states that menus are discussed with the residents this was not borne out by comments from residents. The chef showed surprise when asked about the provision of a cooked breakfast, although the provider said that this could be provided every day if people wanted it, the chef stated that they were considering providing this once a week. The kitchen was clean, although there is currently no cleaning schedule and the majority of the documentation required by the Environmental Health Authority was in place. There was a good selection of fresh, tinned and other foods including plenty of fresh fruit and vegetables. Care Homes for Older People Page 19 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. Residents and their representatives are aware of how to make a complaint and confident that these will be addressed in an open and transparent manner. Staff have received training in the safeguarding of those in their care, therefore ensuring residents are not put at risk Evidence: Whilst some amendments are required to bring the complaints policy in line with the Care Quality Commission, all residents are provided with a copy of this in their Service User Guide in their rooms and a copy is also displayed in the entrance hall. The home has omitted to keep robust records of the concerns and complaints received, and whilst the Annual Quality Assurance Assessment states there have been no complaints, the ( then) Commission for Social Care Inspection had one ongoing for several months although this was judged not substantiated, prior to the changeover of the CSCI to Care Quality Commission. There was one adult safeguarding issue, which was not substantiated although minor recommendations were made to the home. The commission has received no further complaints about the home. Surveys received prior to the inspection showed that residents and their friends and families knew how to make a complaint and appeared comfortable that this would be Care Homes for Older People Page 20 of 35 Evidence: addressed in an open and transparent manner. The home discusses issues with residents and tries to ensure that any minor concerns that residents may have are addressed to their satisfaction before they become a complaint. The commission has previous knowledge and records of the way in which the provider addresses complaints; and these have always been addressed in a robust and transparent manner. Staff have received adult safeguarding training in in house training sessions, whilst the manager has attended safeguarding training with the local authority and primary care trust. Care Homes for Older People Page 21 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. The home is due a refurbishment and an extension planned, however during this time the standard of maintenance and tidiness in the home has been allowed to lapse, this may impact on residents enjoyment of their home. Evidence: The home is due to be refurbished and extended in the next twelve months and therefore little improvement has been made to the existing establishment. There is currently no garden available for residents, but a patio area on the front drive is furnished with seats and parasols and makes a pleasant seating area. Communal space consists of a lounge/ dining room. This was redecorated following the change of ownership in the home two years ago, some parts of this area require some attention including the removal of plants which are past their best. Residents rooms consist of both double and single rooms, double rooms are currently being used for single occupancy only. Residents are encouraged to bring in their own possessions to personalise the rooms. Whilst residents rooms are homely, and the standard of cleanliness in the home is good, it was disappointing to note that staff are neglecting to keep residents rooms tidy and are not noticing when curtains are coming off their runners or are too short Care Homes for Older People Page 22 of 35 Evidence: for the windows. Equipment to maximise residents independence, such as hoists and bath seats are in place, there is a shortage of bed rail protectors. The provider gave assurances that these would be purchased immediately. Hot water temperatures to residents outlets have been monitored and are generally within recommended parameters, although two rooms showed low temperatures the manager said that this was due to the tap not having been run for a sufficient time. Temperatures must be kept to the higher range of the permitted scale to ensure resident comfort Two of the bathrooms have been redecorated but one small bathroom, currently used by only one resident, requires attention. Fixtures such as taps are lime scaled and a piece of equipment which may have been used to support a bath seat is rusty with flaking paint. This is an infection control hazard. The sink in the clinic room requires to be renewed as do the sinks in some of the rooms, the current sinks are in a man made material and have succumbed to staining and lime scale. The manager is the infection control champion which means that she has undertaken a course on infection control and now liaises between the Health Protection Agency and the home. Water jugs in the home have become glazed from the dishwasher, the roughened surface will not respond to thorough cleaning and therefore these should be replaced. The pedal bin in the staff toilet was broken and could impact on infection. Also as previously mentioned, staff must wear protective clothing when dealing with food. Residents laundry is undertaken in the home, with soiled items being washed in red disposable bags. In view of the planned improvements to the home, it is understood that major refurbishment will not be carried out, but minor improvements in the residents rooms and the home in general would ensure that the home remains a pleasant place to live. The provider gave assurances that this would be addressed and subsequent to the inspection informed the commission that work had commenced to address the issues mentioned. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in suitable numbers and care staff are encouraged to participate in training to increase their knowledge of the care required by the residents in the home. Recruitment systems currently in place do not safeguard the residents in the home. Evidence: The duty rota and discussion with staff, showed that there are sufficient staff on duty over a twenty four hour period to meet the needs of the residents currently living in the home. As the night duty is currently covered by only one care assistant and one registered nurse, this must be kept under review and adjusted should the number or dependency levels of the residents increase. The duty rota does not show the family name of all staff. Full names must be kept on all documents such as rotas. Staff spoken with said there was always sufficient staff on duty and that they did not feel under pressure. This was also reiterated in surveys sent to staff by the commission prior to this inspection. The home encourages staff to study for the National Vocational Qualification in Care. Currently 66 of the staff have attained this at either levels 2 or 3 and a further two members of staff are enrolling on this course. Care Homes for Older People Page 24 of 35 Evidence: On talking to the manager and a registered nurse, and examining the training records available in the home, it was evident that registered nurses are not being proactive in ensuring that their professional duty to update and enhance their knowledge is being met. Training records were not sufficiently up to date to enable the inspector to gauge whether the mandatory training had been updated within the required timescales; but on discussion with three members of staff, they informed the inspector that they had recently had moving and handling and fire training. They were unsure about how recently safeguarding training had taken place and it was unclear whether the first aid training one member of staff had attended was still in date or whether they had updated their training for Appointed First Aid person. The chef has not had any fire training since he joined the home; this must be addressed. The manager must ensure that all staff, including night staff and ancillary staff, have received mandatory training at the intervals directed by regulation. Whilst it was intimated that all staff have had Deprivation of Liberty Safeguarding Training, delivered by the provider. It later transpired that this was, in fact, a briefing on Deprivation of Liberty Safeguarding delivered at the staff the meeting rather than formal training. Staff are not yet receiving a recognised induction course such as Skills for Care. Surveys received stated that the homes own induction course only partially addressed the information required. A recently employed member of staff stated that she had just finished her induction which was over a period of three days; but she had prior experience of care work. Four staff personnel files were examined, of these, two members of staff had been employed with only one written reference and neither of these were from previous employees or were professional references. One recently employed member of staffs Criminal Record Bureau Check was not in the file and could not be found, although the manager stated it had been received. Whilst a requirement was made at the previous inspection regarding personnel files has not been complied with, the provider has ensured us that she will personally oversee the recruitment documentation, and given that in the three sister homes in the area, personnel files have always complied with regulation, the decision has been Care Homes for Older People Page 25 of 35 Evidence: made not to pursue this further at this time. However a requirement has been made at this inspection. No records have been kept of the expiry dates and renewal of registered nurses PIN (Personal Identification Numbers); the manager must ensure that this is kept up to date in order to ensure the safety of residents. Care Homes for Older People Page 26 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. Management systems in place do not fully safeguard residents and staff. Staff do not receive regular formal supervision which could result in care not meeting residents expectations. Evidence: The manager is a registered nurse and has been in post as manager for two years. She is currently applying for registration with the Care Quality Commission. Although she had almost finished the Registered Managers Award, this was unable to be completed due to matters beyond her control, she now intends to pursue this further. The manager has undertaken training in Deprivation of Liberty Safeguarding and the Mental Capacity Act. No residents currently in the home require assessment under these acts. This training will be cascaded to staff. Surveys received and residents and staff spoken with spoke of the homely ambiance Care Homes for Older People Page 27 of 35 Evidence: in the home and all residents spoken with spoke of the kindness of the staff and manager. Whilst the care given in the home and the actual care plans are good, some of the other documentation and records do not always comply with regulation or the National Minimum Standards. The Annual Quality Assurance Assessment (AQAA) was received after the due date, but was comprehensive. Some statements in the document did not reflect what was currently happening in the home. The home has a quality monitoring programme in place, this was not examined during the inspection but the provider informed us that questionnaires are sent out to residents, their representatives and other stake holders. The questionnaires are based on the different services offered by the home, sent out at intervals throughout the year and results from these informs the service that the home provides. The manager stated that residents meetings are held three monthly and staff meetings are held at intervals throughout the year.Minutes were seen of these. No money for residents is held within the home and the home does not act as appointee for any resident. Policies and procedures were last reviewed in 2007 and require reviewing to ensure that the staff in the home are aware of, and are following, best practice. Not all certificates relating to the servicing of utilities was in the home. The annual gas certificate was not found, neither was the Portable Appliance Testing certificate.The provider gave assurances that these have been obtained. Records did not identify whether all staff have had mandatory training at the required intervals and records showed that at least one member of staff did not have fire training. The fire risk assessment has been reviewed and checked by the Fire Authority. Regulation 26 visits have been undertaken on a monthly basis by one of the two registered providers and copies of these were seen in the home. These did not identify the shortfalls found at this inspection. Whilst the AQAA states that regular formal supervision of staff takes place, discussions with staff and records available did not testify to this. Care Homes for Older People Page 28 of 35 Evidence: Areas which caused concern regarding health and safety of residents were identified. Two windows did not have patent restrictors,subsequent to the inspection the provider confirmed that these had been rectified, therefore no requirement has been made. Scissors and bleach tablets were found in a bathroom and a pair of scissors were found left in the dining room. A portable fan and a portable heater were found in a residents room, no risk assessments were in place for these. Care Homes for Older People Page 29 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 30 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 1 4 14 That the registered person 30/06/2009 confirms in writing to the prospective service user that following assessment, the home is suitable for meeting the service users needs. To ensure that service users have confidence that the home can meet their needs 2 7 15 That care plans are formed 26/08/2009 and reviewed in consultation with the service user or their representative, and shall include all preventative measures required to ensure that residents receive the care relevant to their assessed needs. To ensure that service users are aware of the care that they are to receive. 3 9 13 The registered person 01/07/2009 ensures that there is a policy and staff adhere to it for the receipt, recording, storage, Page 31 of 35 Care Homes for Older People 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 handling, administration and disposal of medication. To ensure service users safety 4 12 16 That the leisure activities reflect service users preferences and past and current interests and sufficient activities are provided to ensure that service users are physically and mentally stimulated. To ensure that service users have a good quality of life. 5 14 12 That residents choices around activities of daily living are recorded and that staff ensure that these are maintained. To ensure that service users have a good quality of life. 6 16 22 That a record of complaints and minor concerns and the actions taken to address these be kept in the home. In order that the manager and relevant stake holders have adequate records of complaints and concerns made about the home in compliance with Schedule 4 of the regulations. 07/07/2009 01/07/2009 30/07/2009 Care Homes for Older People Page 32 of 35 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 7 26 13 That all matters relating to the control and spread of infection as discussed in the main body of the report are addressed. To prevent the spread of infection and to improve the environment for service users 30/06/2009 8 29 19 Documentation as required 30/06/2009 by regulation and schedule 2 of the regulations must be in place prior to any member of staff commencing work at the home. To ensure the safety of the service users 9 36 18 That staff receive regular formal supervision at timescales directed by the National Minimum Standards. To ensure that service users care meets their expectations. 30/06/2009 10 38 13 That issues around health and safety and relevant training as identified in the main body of the report are addressed. To ensure the safety of service users and staff. 30/06/2009 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 That people receiving medication on an as required basis should have the specific reason they are receiving this included in the medicine charts. That the clinic room and drug fridge temperatures are recorded on a regular basis to ensure that medication is stored at its optimal temperature. That newly employed staff commence a recognised induction course. 2 30 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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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