Care Home: Friars Hall Nursing Home

What the care home does well The people we met at the home told us they received good standards of care and support. Some of the residents we spoke with said, `the staff are very good, they will assist me when I ask` or `if you ask for something, it is done`. The residents we saw were well groomed and their personal care needs were being met by the staff, who were responsive, and provided care in a kind and respectful way. People continued to be offered a choice of food options, with food prepared on the premises, which they enjoyed. Specialised diets were also catered for and the people we met said, `the food is good` or `the food is fine`. The atmosphere during the inspection was calm, and friendly, and visitors were welcomed to the home throughout the day. The home was found appropriately decorated, clean, comfortable and well maintained, with no unplesant odours evident. The home provides people with opportunities which allow some choice and control over their preferred lifestyle. This includes opportunities for them to access some local leisure activities and entertainment, and opportunities for contact with the local community. There is a commitment by the management to provide the residents with a good service demonstrated by a willingness to listen to peoples` concerns, and allow feedback to the home about the service provision. The home showed us they have basic recruitment and selection processes in place, which should ensure that only appropriately cleared staff are employed to care for the residents. The management culture ensured appropriate working relationships and so good outcomes for people living at the home. What has improved since the last inspection? Since the last inspection, the home have addressed previous concerns around information shortfalls in the residents` guide, and some recruitment and training shortfalls. The new guide now states the fees payable per week, and staff recruitment records show the relevant checks. There is now a programme to ensure that all new staff receive safeguarding training at the commencement of their employment. Last year a number of concerns were raised with us around how the home managed some moving and handling techniques, restraint issues, and pressure area care issues. This inspection evidenced that these issues had been addressed by the management by providing additional staff training, improved written records, and improved care practices and procedures. Concerns raised around a lack of adequate medical equipment, for example medical nursing beds to meet the residents` nursing needs, had also been addressed by the home by the provision of new beds and equipment. There is now a plan in place for the ongoing purchase of new equipment. What the care home could do better: This report shows the positive provision of a service that meets the needs of the people who live at the home. Two areas for improvement would be that staff must ensure that all new medicine stock brought into the home is recorded on the medicine administration records. This is to ensure that the home can undertake stock checks to evidence medicines are being administered correctly. Further, the home must further develop its activities programme to ensure that it can meet a broader range of the residents` social and leisure needs. Areas for further development include that the home should provide more detailed information in their service user guide around their admissions criteria, short-term care, and if nursing care is provided. This is to ensure that new residents are clear about the service provided. Wound care records we saw provided written details of practice but should include photos, wound measurements or a diagram of the wound, to evidence any improvements. Care plans should be reviewed to ensure they summarise key information found within the residents` records, and provide more details on their `end of life care needs`. This is to ensure that staff are aware of the care support they need to provide in those circumstances. Social care profiles should be provided to increase staff awareness of a resident`s previous social background, and so help them meet their current social needs. The home should consider appointing an activities coordinator to ensure that there is more regular social and leisure programmes provided within the home that meets the resident`s social needs. Hot water tap temperature checks should be undertaken on a more regular basis, to ensure the home can evidence that regular safety monitoring is undertaken. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Friars Hall Nursing Home Friars Road Hadleigh Suffolk IP7 6DF     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: Kevin Dally     Date: 1 8 0 3 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 34 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 34 Information about the care home Name of care home: Address: Friars Hall Nursing Home Friars Road Hadleigh Suffolk IP7 6DF 01473822159 01473822682 friarshallnursinghome@yahoo.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 Lalitha Samuel care home 42 Number of places (if applicable): Under 65 Over 65 42 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Friars Hall is a privately owned care home providing both nursing and personal care to a maximum of 42 older people. The home is located on the outskirts of the small market town of Hadleigh, where amenities such as shops, pubs, church and post office are available. Buses run from the town centre to Ipswich, Colchester and Sudbury towns. The home stands in its own grounds at the end of a long gravel drive. It has a car parking area and a garden with some seating for service users. The home provides a staff residence where nurses from overseas can be accommodated while they complete adaptation courses to allow them to practice in the United Kingdom. The building is a converted and extended Victorian house, dating back to 1858, with a shaft lift giving access to both floors. There were 30 single bedrooms, 26 with en suite toilet facilities, and 6 double bedrooms (1 with en suite toilet). The premises have been under the current ownership for the last eighteen years. The fees are listed in the service user guide and range from £550 to £680 per week. The fees are based on the level of need and nursing care required. Care Homes for Older People Page 4 of 34 Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection of Friars Hall Nursing Home, which took place on the 18th March 2009. Seven outcome areas for older people were assessed during this time. Ms Sarah Ruggier, who was appointed as the new manager of the home in September 2008, provided us with information that was relevant to our assessment of the service. Ms Ruggier is currently applying for registration with the commission. During the last year we received information from some healthcare professionals who raised concerns around how the home managed some moving and handling procedures, restraint issues, and pressure area care issues. Concerns were also raised around the provision of adequate medical equipment, for example medical nursing beds, to meet the residents nursing needs. Therefore all these issues were checked at Care Homes for Older People Page 6 of 34 this inspection. We spent time talking with 5 residents who told us about the care they received and what living at the home was like. Three relatives also gave us feedback about the quality of the service provided. We spoke with some of the staff group and observed them moving and handling some of the residents. We observed the lunchtime period in the dining room, and we followed a medicine round. A selection of the residents care plans and medicine records; moving and handling records, menu records, maintenance and training records were also checked, as were a selection of other documents, including some staff files, and duty rotas. Surveys were sent to the home to distribute to the residents and relatives before the inspection took place. Four residents and 2 relatives returned our questionnaires in December 2008. A selection of their views and opinions about the home are included within this report. The provider also completed the CSCI annual quality assurance assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 This report shows the positive provision of a service that meets the needs of the people who live at the home. Two areas for improvement would be that staff must ensure that all new medicine stock brought into the home is recorded on the medicine administration records. This is to ensure that the home can undertake stock checks to evidence medicines are being administered correctly. Further, the home must further develop its activities programme to ensure that it can meet a broader range of the residents social and leisure needs. Areas for further development include that the home should provide more detailed information in their service user guide around their admissions criteria, short-term care, and if nursing care is provided. This is to ensure that new residents are clear about the service provided. Wound care records we saw provided written details of practice but should include photos, wound measurements or a diagram of the wound, to evidence any improvements. Care plans should be reviewed to ensure they summarise key information found within the residents records, and provide more details on their end of life care needs. This is to ensure that staff are aware of the care support they need to provide in those circumstances. Social care profiles should be provided to increase staff awareness of a residents previous social background, and so help them meet their current social needs. The home should consider appointing an activities coordinator to ensure that there is more regular social and leisure programmes provided within the home that meets the residents social needs. Hot water tap temperature checks should be undertaken on a more regular basis, to ensure the home can evidence that regular safety monitoring is undertaken. 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 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home could expect to receive basic information about the service, and an assessment of their particular care needs. Evidence: The home provides new residents with key information in the form of a residents guide which includes the aims of the service, the qualifications of the nursing staff, the services available, and how people can make a complaint to the home. The updated brochure now includes the weekly fees charged for the service. Potential residents would therefore receive adequate information for them to make a decision about whether the service would be suitable to meet their needs. The brochure is not clear under the sections headed admissions criteria and short-term care, if nursing care is provided. Feedback received from 3 of 4 residents said they had received sufficient information about the home before they had moved in. One did not say. Care Homes for Older People Page 11 of 34 Evidence: The information provided by the home (the AQAA) told us, Full assessments are carried out prior to admission. Services and their family are encouraged to visit the home as many times as they wish, and a trial period is offered. Respite care is offered, if a place is available. Some of the residents client assessment forms were checked, and these showed us that basic information is gathered about their care and support needs, before they enter the home. The assessments are based on the activities of daily living and included 11 areas of assessed need, for example personal care needs or mobility needs. The assessments allow staff to assess if the home can meet the needs of each individual and ensure that appropriate information is gathered about the resident, before they move in. The assessments we checked had some information about their social needs but could be improved by providing more details of how the resident may wish to spend their day. The new manager was aware of some of these shortfalls and is currently introducing improved assessments, and new plans of care, which should provide more in depth information in theses areas. The home showed us that the staff group had received training, (please refer to the staffing outcome area) so that their knowledge, care skills and experience was adequate to support people who are elderly or have nursing care needs. Each shift has a lead registered nurse who is responsible for the overall care and direction, and care staff are trained to provide support for the residents. One example of training was that some of the staff group were able to describe what they had learned from moving and handling training. They told us the training included how to use the hoist, slings, and sliding sheets, and how to correctly transfer people from their beds or chairs. Evidence of appropriate lifts was also observed by us throughout the morning period. The home provided new staff members with induction training which covered the issues they needed to know, when they started the job. Information provided by the home told us that 17 of 20 care staff (85 ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 3 working towards this or a higher care qualification. (Please refer to staffing outcome area). This would ensure that care staff have appropriate care skills and qualifications, to understand and meet the needs of the residents. A selection of feedback received from the residents or relatives around what they think the service does well, or how the service could improve included the following views. All the staff appear to be very thorough in cleanliness and hygiene, and take a great deal of care in washing and dressing my relative. They are always very helpful and respond quickly to requests, and are very caring. Care Homes for Older People Page 12 of 34 Evidence: I think that Friars Hall is an exceptionally well run nursing home, and they should be complimented on the care they provide. All the staff are very kind to the customers. The laundry is always beautifully done, with nothing ever lost. Intermediate care did not apply at the time of this inspection, so this was not applicable. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could expect to receive appropriately planned nursing care which would be given according to their individual needs. People would be treated with dignity and respect. Evidence: The information provided by the home told us, Friars Hall has a person centred approach with the support provided based on the rights of dignity, fairness and respect. Care is provided effectively through skilled and trained staff groups. Care plans clearly record the residents personal and health care needs, and explain how they will be delivered. During the last year we received information from some healthcare professionals who raised concerns around how the home managed some moving and handling procedures, restraint and pressure area care issues. Concerns were also raised around the lack of adequate medical equipment, for example medical nursing beds, to meet the residents nursing needs. Therefore all these issues were followed up at the Care Homes for Older People Page 14 of 34 Evidence: inspection. Two care plans we checked included adequate care and risk assessment information which included regular monthly updates for the plans, assessments and daily progress records. The care plans showed us that basic individual preferences and choices regarding their daily routines had been recorded. For example one residents records said, enjoys a varied diet or requires assistance with washing, dressing, and meals. While most key nursing information was recorded in some detail, this was spread throughout the records, and not always easy to locate. The information we found around peoples social care and leisure needs, their preferences and choices was limited and could be provided in more detail, to better explain the residents background, and how they might like to spend their day. Care plans would also benefit from more details around their end of life care arrangements, to ensure the home has complete record of the choices they would wish the home follow, and their chosen end of life care arrangements. The manager told us that new comprehensive care plans were now being introduced, and these should cover the relevant information needed. The new care plan format was being provided for any new residents admitted to the home. A summary care plan assessment was found in a check list form for one resident, and this included a check of their daily living requirements, their health care needs, and any basic social needs. Key nursing areas of concern were identified in a more detailed plan. For example, one resident we tracked had moving and handling challenges, which had been clearly recorded in depth in their plan, and included good moving and handling and falls risk assessments. A visual aid traffic lights system showed staff how vulnerable the resident was when moving and handling the person was required, so ensured staff used the correct moving and handling procedures. Another resident we tracked with diabetes and moving and handling needs showed us that the home were appropriately recording and managing these care needs. A referral had been made to the appropriate healthcare professionals around their diabetes, and the home was maintaining monthly weight and diet records. There was an adequate moving and handling risk assessment in place for this resident which clearly instructed staff to use 2 carers and the hoist for all lifts. Staff were observed hoisting this person correctly during the day. Specialist assessments were also provided for both these residents which included up to date pressure area assessments, nutritional needs assessments, monthly weight charts, continence assessments, falls risk assessments, body charts, and a risk assessment around the use of bedrails. Where the use of bedrails was considered necessary for safety reasons, the home maintained a record of the residents or their Care Homes for Older People Page 15 of 34 Evidence: familys agreement for there use. One care plan included a capacity assessment flow chart which advised staff when capacity assessments may be required. All the assessments we checked were signed and dated to evidence monthly monitoring and observation. During the day we observed various staff moving and handling four residents, two with the hoist, and two with lifting belts. All lifts were undertaken using the correct techniques and numbers of staff for that lift. Good explanations were given by staff to reassure each resident about what was happening, and these residents told me they felt secure and happy with the assistance provided. It was good to see that staff offered wheelchair bound residents the choice to transfer into lounge chairs during the morning, and many residents accepted this offer. The previous concerns raised about lack of appropriate medical equipment within the home, for example medical beds, were discussed with the manager. The manager told us that after her appointment, she had worked with the owner to identify which medical equipment would be needed to meet the medical needs of the residents. The provider has since purchased 6 high low medical beds (total now 10), 12 special mattresses, 2 electric beds, 7 eggshell and 2 repose matrices. The plan is to continue to replace inadequate equipment or beds to ensure that their is a range of equipment suitable to meet peoples nursing care needs. The home had provided one resident unable to sit in a standard chair, with a specialised chair as recommended by the occupational therapy department. This allowed staff to nurse the resident safely in various positions. During the day, staff were seen working with this resident, ensuring their comfort and appropriate positioning. No improper use of residents chairs or lap belts was observed at any time during the day. One resident with high care needs including pressure area problems and swallowing difficulties was also tracked. The speech therapist and dietician had been consulted, and their advice around dietary supplements, pureed foods, and thickened fluids had been implemented. Good nutritional records were being kept, which included fluid balance and food charts. Pressure area care and weight records were in evidence and showed us that appropriate nursing monitoring was being undertaken. We were advised that the residents pressure area sore, had improved with good wound care practice. Wound care records we saw provided written details of practice but could be improved by the inclusion of photos, wound measurements or a diagram to show positive healing changes. The manager showed us a new wound care chart that she had recently introduced, that would allow staff to include the recommended nursing information. During breakfast we observed a staff member feeding a resident and they were Care Homes for Older People Page 16 of 34 Evidence: observed to do so in a patient and unhurried manner. The staff member spoke with the resident, even though they were unable to respond. The records we checked showed us the contact residents had received with various healthcare professionals, including their doctor, the speech therapist, the dietician, and an occupational therapist. Feedback received from 4 residents surveys said they always or usually received the care and support they needed, and always received the medical support required. A selection of comments about the care received included the following views. I find the staff are good and will take me to the toilet when I ask. The staff are very nice, but at times some can be difficult to understand. If you ask for something, it is done. The staff we have are very kind, and my care is good. My relative came out of hospital with both legs bandaged. The nursing care has been excellent and the injuries have now healed. We saw residents were being called by their preferred name and the residents we spoke with felt that staff were respectful and kind. Staff were observed to be hardworking throughout the inspection, were patient, polite and caring towards the residents they helped. The residents dignity was maintained during care sessions, and they were positively included in conservations. Staff were seen knocking on the residents doors before entering, and respected their privacy. When asked, Do you feel safe?, one resident told me, yes. The information provided by the home told us, The home fully respects the residents rights in healthcare and medication. Care staff work to a very high standard and constantly monitor pain and distress. The home uses the monitored dosage system (MDS) with blister packs and medication administration record (MAR) sheets, for recording purposes. Each residents details and medicine information is maintained on the MAR records. Medicines are kept locked in the medicine trolley, which the staff take to the residents. The lunchtime medication round was observed and the MAR sheets were checked, and five residents medicines were audited. The nurse in charge was seen to sign the MAR sheets appropriately after medicines were administered and no signature gaps were noted on the MAR sheets. Five of the six medicines we audited found that the total stock balanced with the Care Homes for Older People Page 17 of 34 Evidence: records. One residents medication, the total received by the home, had not been entered onto the MAR sheet at the beginning of the month, so it was not possible to check if this medicine had been administered correctly. The information provided by the home informed us that there was medicine guidance around the control, storage, disposal, recording and administration of medicines, although this was not checked on this occasion. Care Homes for Older People Page 18 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are provided with some daily living activities, but more choice could be offered around their preferred social and leisure opportunities. Evidence: The information provided by the home told us, Residents are encouraged to have family and friends to visit them at any time. We are committed to our residents retaining links with the local community and hosts visit from local churches, brownies, community groups and entertainers. On arrival at the home, eight residents were up and dressed in the dining room and completing their breakfast. Some of the residents were grouped together at various tables and were enjoying a cup of tea and the opportunity to have a chat with other friends in the home. There was a calm and relaxed atmosphere in the dining room, and staff were assisting the residents undertake their daily routines, including assisting them with their breakfast. Background music was being played which the residents were enjoying. Residents were well groomed and some were reading the morning newspaper. One resident informed us they had woken at around 7am and had asked staff to assist them to rise. They said, The staff are good and will assist me when I Care Homes for Older People Page 19 of 34 Evidence: ask. When asked are there activities for you at the home? they said, some, like bingo. Another resident told us, yes, there are things to do in the home. The singers come, sometimes musicians, and we have exercises. During the day the majority of the residents rested in the lounge or conservatory, and we were unaware of any particular activity programme in operation, but there was a television available in one of the day rooms for residents to view. Positively, the conservatory was a quiet area which some residents had chosen to use to read or quietly converse with friends. People were offered opportunities to relocate to the dining room during lunch, or taken to the toilet on request. During the day we saw an activities events poster called Friars Hall Forthcoming events for the period January to March 2009. This included Pat the dogsessions, Touch and go entertainers, everyday miracles, and church services. Eleven of the 18 events recorded were Pat the dog sessions, so the activity choices for some of the residents would be limited. The residents had been invited to discuss activities they would like at a meeting held in October 2008. The residents put forward their suggestions for activities by way of a summer fete, card games, scrabble, singing, Christmas decorations, flower arranging, or going shopping in town. Family and friends are able to visit the home when they choose, and no restrictions are placed on visiting times. Visitors were seen calling on the residents throughout the day, and one relative told us, I am always made to feel welcome. Staff were seen to encourage and relate with the residents. One resident told us we have a laugh and joke. Their attitude was kind, friendly and supportive. Another resident told us that their family visits 2-3 times a week. Care plans checked identified some individual preferences in respect of daily routines (please refer to the last section) but more detailed information could be provided around peoples social care and leisure needs, their preferences and choices. For example, what they might like to do during the day, their previous family or employment background, leisure and personal interests. This may better assist staff in the planning and provision of additional activities for the residents. Feedback from 4 residents surveys confirmed that there are activities at the home that they could take part in. However, one relative told us, There are not a lot of activities. There is bingo on a Tuesday. Information provided by the management (AQAA) acknowledged under what we could do better, that more socially and mentally stimulating activities could be provided. This is an area for the home to further develop. The home provided a rolling menu guide for residents with a choice of two hot meal Care Homes for Older People Page 20 of 34 Evidence: options each day. Examples of some of the weekly main menu choices available included lamb hotpot or cheesy leeks, roast pork or smoked mackerel, meat pie or pasta in tomatoes & basil sauce, bacon and mustard sauce or tuna bake stake, and steak and kidney pie or bubble and squeak. The main meal of the day was served in a well maintained light and airy dining area, with staff ensuring all residents had a drink available with their meal. More poorly residents were fully assisted by staff, were unhurried, and their meals had been pureed into separate constituent parts. The meal on the day we visited was a choice of cheese and bacon flan or tuna pasta bake, served with broccoli, carrots, and mashed potatoes and gravy. Dessert was fruit pie. The tables were set with table cloths, condiments and cutlery. The food looked and smelt appetising. Several residents we spoke with said that the meal was adequate for their needs. Feedback from 4 of 4 residents when asked, do you like the meals at the home?, said usually or always. Comments about the meals included the following selection of views. It would be great to have a written choice of menu offered, as I am hard of hearing, and the helpers are mostly foreign. On the whole, I get good meals. The food is fine. Overall the home is good but I think the food is not as good as previously Care Homes for Older People Page 21 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints and concerns would be taken seriously and acted on by the home. Evidence: The information provided by the home said, People are encouraged to express any concerns that they may have to the authorities. The management deal with any complaints quickly and fairly, and is always available to deal with any issues. The home has a complaints procedure available for the residents and a copy was provided in the service user guide. The complaint book was checked and 5 complaints had been received, four of which related to a period prior to the new managers arrival. All 5 complaints related to care issues and concerns about individual residents, and the new manager had investigated and responded to these. Another concern about an individuals care was received by the Commission a day after the inspection, so was referred to the home for investigation. The investigation undertaken by the manager was very thorough, and provided clear evidence that the concern had been appropriately managed by the home and the nursing staff. One issue around security at the front door was upheld by the home, and they have since changed the arrangements for meeting relatives and visitors on arrival. Feedback received from 4 of 4 residents questionnaires said that they always know Care Homes for Older People Page 22 of 34 Evidence: who to speak to, if they are not happy, and do know how to make a complaint. Some of the people we spoke with said the manager was approachable, or that they felt safe at the home. Another resident told us the matron is very nice and comes to see me. The home has policies and procedures in place for the safeguarding of vulnerable adults including whistle-blowing procedures. The home has access to the Suffolk interagency policy on the protection of vulnerable adults, June 2004. The manager was aware for her responsibilities in reporting any allegations of abuse to Social Services via customer first, for referral to the safeguarding team. One safeguarding referral has been received by the home in November 2008, and the issues raised have been appropriately addressed by the home. Recruitment procedures checked (please refer to staff section) showed us that new employees would be checked and cleared before they work with any vulnerable adults. Staff training records checked and feedback from staff members informed us that they had been provided with safeguarding training by the home. Care Homes for Older People Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, living at the home benefit from clean and well-presented surroundings, suitable for their needs. Evidence: The home stands in its own grounds with mature trees, well developed gardens and seating for the residents. It has a car parking area at the end of a gravel drive. The home provides a staff residence where nurses from overseas can be accommodated while they complete adaptation courses to allow them to practice in the United Kingdom. On arrival at the home, a grounds man was noted cleaning the outdoor areas, and this looked well maintained. The building is a converted and extended Victorian house, dating back to 1858, with a shaft lift giving access to both floors. There were mainly single bedrooms, most of which have with en suite toilet facilities, and 6 double bedrooms (1 with en suite toilet). The premises have been under the current ownership for the last eighteen years. During the inspection it was evident that the provider continues to improve and renew the fabric of the premises. They told us, All the shared rooms have dividing curtains Care Homes for Older People Page 24 of 34 Evidence: replacing the screens. Much of the old furniture and carpets were changed. Most of the rooms have been redecorated. Much of the old aids and equipment have been replaced. There is now an aquarium in the lounge. A tour of the building including the main lounge, conservatory, and dining areas, showed us they have been decorated and maintained to good standards were fresh, clean and without any unpleasant odours. Most of the rooms are spacious and new furniture was in evidence in all these rooms. The hallways were accessible for wheelchair access. Chairs organised in the lounges provided adequate space around them to allow staff access with hoist lifting equipment. A number of the residents rooms were checked, and again were found to be well maintained, clean and tidy with good basic furniture, and beds. All the bedrooms we visited had call bell points, and were seen in operation though out the day. Some residents preferred their own company, and were able to remain in their own room, if they wished. The records we checked showed us that fire extinguishers and emergency lighting are checked monthly and weekly testing of the fire alarms continues. Hot water tap temperature records showed us that these are being checked and are within safety limits, although these were last checked in January 2009. The home was found clean and fresh in the areas seen. People living at the home confirmed this. Observation, and discussion with people living and working at the home, showed that staff continued to take adequate steps to maintain hygiene and avoid the spread of infection. This included appropriate use of plastic gloves and aprons and hand hygiene, which was seen in use during the day. When asked is the home fresh and clean? 4 of 4 residents surveys said always. One person said, When I first visited the home, the cleanliness was one of the first things that impressed me, and in the few months I have been here, it is obvious that there is a programme of cleaning that keeps the home spotless. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home would experience sufficient staffing levels. Although staff are trained to meet the residents safety needs, staff would benefit from more healthcare training. Evidence: The staff rota checked showed us that morning shifts were usually covered by 1 registered nurse (RN) and 6 or 7 care staff, and late shifts, 1 registered nurse and 5 care staff. Night shifts cover was 1 registered nurse and 3 care staff. The manager was usually extra to these numbers, although was working on the late shift on the day of the inspection. There were cleaners, a laundry assistant, chef and kitchen staff were employed daily as well as maintenance personnel. Staff said that there were sufficient numbers on duty to enable them to meet the support and care needs of the residents, and that the new matron was really improving things. Staff tody us there was a good working relationship between them and they now had more regular staff meetings, so were aware of what management expected of them. Feedback from 4 of 4 the residents said staff are usually or always available when we need them. One person said, Sometimes they are very busy. In any community you Care Homes for Older People Page 26 of 34 Evidence: have to go along with the situation, and may need to wait. During the inspection and busy periods staff were in attendance and only small delays in assistance was noticed. Call bells were answered promptly and care attended to in an efficient manner. Three staff files were checked and these confirmed the home operates adequate recruitment procedures, to ensure that new staff are checked and cleared to work with vulnerable adults. The staff members records checked included criminal bureau records (CRB) checks and protection of vulnerable adults (POVA) checks. Further, staff had completed an application form and provided a record of previous employment. References had been obtained for new employees and proof of their identity by way of a passport or birth certificate. One nurses records checked showed us that the home had obtained a check of their professional identity number (PIN) from the nursing and midwifery council(NMC). Staff training records checked showed us that the home provides basic training around the needs of the residents, and relevant to their job roles. One new employee had received induction training based on the skills for care common induction standards (CIS) which covers 6 key areas over a 12 week period. The records checked showed us that they had attended training for safeguarding, fire, infection control, moving and handling training, health and safety training and communication training. The manager told us that new care staff will now attend the Kerrison Centre, where they will receive this training. General training for existing staff was discussed. Training completed within the last 6 months included core sessions around safeguarding training and moving and handling, for 13 staff members, with one session for 4 staff left to complete these. Fire lecture updates will be completed for all staff by the end of May and infection control training is being completed for 10 care staff. The home is planning to undertake epilepsy, diabetes, dementia training, and mental capacity act training in the near future. The home was fully aware of some of the training shortfalls and had plans to make training a priority within the next few months. Staff records we checked while showing that core training had been completed, did confirm that updates and training specific to their job roles had been completed. Information provided by the home told us that 17 of 20 care staff or 85 had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 3 working towards an NVQ 2 or higher care qualification. This showed us that over two thirds of the care staff had a care qualification so would be competent to support nursing staff to meet the residents care needs. Care Homes for Older People Page 27 of 34 Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could expect an appropriately managed service including feedback from the resdients around the quality of the service provision. Evidence: The home had an appropriate management structure, with the new manager suitably qualified and experienced, to lead the team of nursing and care staff. The owner and registered provider, Mrs Samuel also visits the home regularly, so is in contact with the residents and relatives. There was evidence that the manager is communicating well with the staff and residents, and was taking the lead to raise care standards at the home. This was evident from some of the staff meeting minutes we saw, where the manager outlined where improvements were needed. Further, the residents meeting minutes showed us that feedback was received directly, and any issues raised, were being addressed by the home. The people we spoke with including the residents, relatives and staff confirmed that Care Homes for Older People Page 29 of 34 Evidence: they were very positive about the appointment of the new manager. They told us, there have been changes, since the new matron started. We have had staff meetings, and have had a lot of things to do. We are getting there. Some relatives told us We find the new manager very approachable, and a resident said, I think the matron is very nice. She has visited me on a few occasions to see how things are. The home has quality assurance systems in place to receive feedback from the residents. This included an annual quality assurance questionnaire which was undertaken in May 2008, when around 20 questionnaires had been returned to the management. Three questionnaires were checked and overall people were very happy with the environment, food, staff attitude, care and management. However, the survey questions were quite basic, and could be expanded to explore more of the residents views on the care received. The home had appropriately informed the Commission of any notifications required under regulation 37, by informing us of any incidents at the home. As already discussed, the home has a complaints/compliments procedure that allows any concerns to be raised with the management team. As described in the last report, the home held small amounts of peoples personal money deposited with them for safekeeping and to cover incidental expenses. Records, receipts and balances are kept to evidence this. Records were not checked on this occasion. Records checked and discussions with the staff group showed us that staff were receiving support and supervision by management. Two staff members records checked showed us that one member had received supervision, but a second staff member had no supervision records available. Their records did show us that they had received a verbal warning over a particular issue. The manager informed us that the staff members supervision records had been handed over to nursing staff to undertake, so the records of supervision were unavailable for inspection. A tour of the premises and check of the records did not identify any health and safety concerns at the home. As already discussed, there was evidence of regular fire safety checks and hot water tap temperature checks. The staff records we checked showed that these staff members had attended appropriate training in manual handling and fire safety, and that more training would be completed shortly. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered provider must ensure that all new medicine stock totals are recorded on each residents MAR sheets. This is to ensure the home can undertaken stock checks to evidence medicines are being administered correctly. 17/06/2009 2 12 16 The home must develop its activities programme. This is to ensure that it can meet a broader range of the residents social and leisure needs. 17/07/2009 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 1 The home should provide more detailed information in their service user guide around their admissions criteria, shortPage 32 of 34 Care Homes for Older People term care, and if nursing care is provided. This is to ensure that new residents are clear about the service provided. 2 3 Care assessments should include information about residents social needs so that the home are aware of how the resident may wish to spend their day. Care plans should be reviewed to ensure they summarise key information found within the residents records, and their end of life care needs. This is to ensure that staff are aware of the care support they need to provide in those circumstances. Wound care records should include photos, wound measurements or a diagram of the wound, to provide additional evidence of any improvements. Social care profiles should be provided. This is to increase staff awareness of a persons previous social background, and help them meet their current needs. The home should consider the appointment of an activities coordinator. This is to ensure that there is more regular social and leisure opportunities within the home that meets the residents social needs. Hot water tap temperature checks should be undertaken on a more regular basis, to ensure the home can evidence regular safety monitoring. 3 7 4 7 5 12 6 12 7 25 Care Homes for Older People Page 33 of 34 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. 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