Care Home: Girvan

What the care home does well The Deputy Manager has demonstrated that they can work with the CQC. Following the initial site visit where four main concerns were raised, three were in relation to health and safety matters a referral was made by the inspector to the health and safety executive. On the subsequent site visit the Deputy Manager had ensured that these issues had been addressed, window restrictors had been ordered a carpet company had been called to fix the carpet, and a builder had been instructed to make the garden area safe for residents to access. The fourth area of concern was around the infection control procedures in the home. The Deputy Manager had removed a bed in the downstairs room replacing it with a new one, staff were cleaning and shampooing the carpets on the day of the inspection and infection control training had been booked for the 17th July. What has improved since the last inspection? The home has had no new admissions since the last inspection however they now have a procedure in place to follow with regard to confirming in writing a person`s suitability for the home. The home has a new policy in place for nutrition in the home, they have also created new menus and there were copies of referral letters to the Speech and Language therapy service seen on the day of the inspection. Safeguarding vulnerable adults training had been booked for the staff, and the Deputy Manager has sourced an independent trainer and had created a years training program for staff to ensure that they have the skills and knowledge to support and care for the residents placed in the home. All polices and procedures had been reviewed since the last inspection. What the care home could do better: Risk assessment must be completely updated and reflect comprehensive risks for the residents placed in the home. The Registered Provider must address the risk with regard to residents falling and having accidents in the dining room, these accidents have been centred on the dining chairs. On the day of the inspection this was raised with the Deputy Manager who immediately started to source more appropriate seating. The Registered Provider must ensure that the residents remain safe and that risk assessments are in place. The service must ensure it records and maintains a list of the complaints in the home, and the action and outcomes taken. The Registered Provider must ensure they have sufficient staff to meet the needs of the residents placed in the home, especially at the weekends. The Registered Provider must ensure that staff receive supervision in line with the national minimum standards and that standards with regard to health and safety in the home are maintained. Key inspection report Care homes for older people Name: Address: Girvan 3 Upper Sea Road Bexhill on Sea East Sussex TN40 1RL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 0 6 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Girvan 3 Upper Sea Road Bexhill on Sea East Sussex TN40 1RL 01424218838 01424218838 edwina@girvancare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Emardee Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 13. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category age - (OP) Dementia - (DE(E)). Date of last inspection Brief description of the care home The home is registered to accommodate up to thirteen older people who have a dementia type illness. The registered provider originally purchased the home as an individual and has now registered the home under the new provider of Emardee Ltd. Accommodation is provided on three floors, stair lifts are available to assist residents to access first and second floor accommodation. All the bedrooms are single apart from one shared room, seven of the bedrooms have en-suite facilities. Communal areas consist of a pleasant lounge and dining room on the ground floor, and a small quiet lounge on the first floor. Girvan is a detached property situated a short distance from the town centre, railway station and sea front in Bexhill on Sea. The home provides care and support to residents who are both privately funded and Care Homes for Older People Page 4 of 26 Over 65 0 13 Brief description of the care home those who are funded by Social Services. The homes fees range between £390- £450 per person per week. Additional costs are charged for chiropody (approx £10) hairdressing, newspapers and magazines, charges are made for any activity not provided by the care staff. Care Homes for Older People Page 5 of 26 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: one star adequate 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 inspection took place over two visits, the first site visit was on the 30th June and lasted from 9.30am to 11.15am. The second visit was on the 6th July starting at 9.30am and lasting for 3.5 hours. The inspector saw staff interacting in a positive manner with residents and had the opportunity to talk with one resident and their visiting relative. The inspector looked at the care that three service users received in the home, examining the care plans and the associated documents such as risk assessments and activity plans for these individuals. Other documents examined were copies of notifications, accidents and appointments and evidence of external reviews. The complaints procedure, staff recruitment files and the plan for staff training were also seen as were a sample of the sheets which record the administration of medication, the duty rota, menus and the policy on nutrition in the home. Care Homes for Older People Page 6 of 26 The inspector spent time with the Deputy Manager, one care team member, one senior carer and the cook. The inspector also observed other staff interacting in a positive manner with service users during the inspection During the inspection the inspector saw residents in the lounge and dining area. The inspector also saw the kitchens, bathrooms and the three bedrooms of the service users case tracked. In the report the inspector has included comments from people met on the day of the inspection. Information was also taken from the AQAA which was filled in and returned by the due date. However this document did have conflicting information in it that wasnt found on the day of the inspection. An example of this would be around the infection control procedures in the home. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 26 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 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive information about the home prior to making a decision to live there and are involved in the admission process. The Registered Manager ensures they obtain relevant information prior to offering a prospective resident a place within the service. Evidence: As part of the inspection the inspector judged the care that three service users receive in the home. The inspector had the opportunity to speak with one relative, the senior carer, care team member, cook and the Deputy Manager. As part of the case tracking the inspector examined the care plan documents used as a basis for the delivery of care and the associated documents such as risk assessments and activity plans for these individuals. Also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. Care Homes for Older People Page 11 of 26 Evidence: The home has had no new admissions since the last inspection; however the home has a policy in place with regard to confirming in writing the homes ability to meet the persons need in writing. Evidence was supporting to confirm that service users are involved in the admissions process and are given choice, the service had comprehensive assessment document in place which were used to assess someone referred to the service. Also available to view was collated information with regard to service users in the home, and their referring documents. This highlighted that the Registered Manager obtains background information and up to date CPA and mental health assessments if applicable prior to offering a place in the service. Intermediate care is not offered by this home. Care Homes for Older People Page 12 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and procedures in place are sufficient to ensure that a good provision of health care and personal support is provided to service users by the home. Care is administered in way that protects residents privacy and dignity. Medication procedures are in order. However residents are placed at risk by poor quality risk assessments which are out of date and confusing documents to follow. Evidence: As part of the inspection the inspector judged the care that three service users receive in the home. The inspector had the opportunity to speak with one relative, the senior carer, care team member, cook and the Deputy Manager. As part of the case tracking the inspector examined the care plan documents used as a basis for the delivery of care and the associated documents such as risk assessments and activity plans for these individuals. Also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The documents used as a basis to provide care to the residents were comprehensive, Care Homes for Older People Page 13 of 26 Evidence: detailed and included areas and examples of good practice. This showed that the staff and Registered Manager have insight into the residents mental and physical health care needs and are supportive in their delivery of care. Health issues are addressed and documents were in place to confirm this. However risk assessments were old and confusing documents which require attention to make them up to date, comprehensive and clear documents for staff to work from. The home does record accidents in the home but they appear to do no analysis of the events. A high percentage of accidents had happened in the dining room of the home and no action had been taken to address the possible cause of these accidents. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence was supporting to confirm that activities are on offer in the home, and that the home welcomes relatives into the home. The menus in the home have been recently developed following informed guidance. Evidence: As part of the inspection the inspector judged the care that three service users receive in the home. The inspector had the opportunity to speak with one relative, the senior carer, care team member, cook and the Deputy Manager. As part of the case tracking the inspector examined the care plan documents used as a basis for the delivery of care and the associated documents such as risk assessments and activity plans for these individuals. Also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. Evidence was supporting to confirm that relatives feel welcomed into the home. The Deputy Manager has very recently developed the menus in the home and is working from guidance from the Alzheimers society producing a nutritional policy for the home to work from. The inspector received the following comments with regard to the food Everything that is ordered is delivered, There is always enough food, There is Care Homes for Older People Page 15 of 26 Evidence: always soft fruit for in between meals or chocolate. Larders, fridges and freezers were stocked with food on the day of the inspection. The Deputy Manager has also revisited the activities schedule in the home and there is now an activity on offer daily, these range from hand massage and knitting to home style activities such as laying the table. This ensures residents are provided with activities that help them retain social and memory skills. Friends and family are welcome at any time and in accordance with service users wishes. Evidence was supporting to confirm that relatives feel welcomed into the home and are able to spend individual time with their relatives. A hairdresser was visiting on the day of the inspection. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Provider must ensure there are effective procedures in place to record and address complaints in the home. Staff training in Protection of Vulnerable Adults has been arranged. Evidence: During the inspection the inspector examined copies of notifications, and accidents and appointments, evidence of external reviews, and the complaints procedure. The home has no procedure for recording complaints in the home and must ensure that all complaints are recorded in full with the outcome and action taken to address them. However evidence was supporting to confirm that the Deputy Manager has a good understanding of peoples needs within the home. Protection of Vulnerable Adults training had been booked for staff for the day following the inspection. The service has has one recent safeguarding referral raised due to concerns about the environment, food and staffing levels in the home. This investigation is still open. Care Homes for Older People Page 17 of 26 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. There are plans currently underway to improve the environment in the home and policies are now in place with regard to infection control procedures in the home. However the Registered Provider must ensure that these areas continue to be addressed and a safe, clean environment is provided for the residents placed. Evidence: During the inspection the inspector saw residents in the lounge and dining area. The inspector also saw the kitchens, bathrooms and the three bedrooms of the service users case tracked. Following the initial site visit four main concerns were raised three were in relation to health and safety matters. This resulted in the inspector making a referral to the health and safety executive. On the subsequent site visit the Deputy Manager had ensured that these issues had been addressed. Window restrictors had been ordered a carpet company had been called to fix the carpet, and a builder had been instructed to make the garden area safe for residents to access. The fourth area of concern was around the infection control procedures in the home. The Deputy Manager had removed a bed in the downstairs room replacing it with a new one, staff were cleaning and shampooing the carpets on the day of the inspection and infection control training had been booked for the 17th July. Care Homes for Older People Page 18 of 26 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 recruitment procedures are effective and protect service users from potential harm or risk associated with poor recruitment practices. However the Registered Provider must ensure sufficient staff are on duty at all times to meet the needs of the residents placed. Evidence: As part of the inspection the inspector examined the recruitment files of two newly recruited staff to the service, these were found to be in good order. The inspector also looked at the staffing rota, staff meeting minutes and list of previous staff supervision. There is now a plan for staff training in the home. Staff attend team meetings. However the last supervisions carried out for staff were in December 2008. Comments received on the day of the inspection were not enough staff in place at the weekend to meet the needs of the residents placed, It is a rush at the weekend as there is only two staff on, and one of these has to do the dinner, the weekend roast has been changed to mid week as there is not enough staff on to allow for one staff member to cook a full roast. The Registered Provider must ensure that the needs of the residents are being fully met by the number of staff on duty. Care Homes for Older People Page 19 of 26 Evidence: Evidence was supporting to confirm that residents have independent advocates in place. Care Homes for Older People Page 20 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Provider and Registered Manager have not demonstrated that the current staffing levels can meet the needs of people living in the service. Risk assessments and complaints processes are not in place putting service users at risk of harm. People who use the service do not have their views sought on how the service is run. The Registered Provider and Registered Manager must also ensure that information provided in the AQAA is correct and reflective of the practices in the home, and that the home has a procedure in place to gain the views of the residents and interested parties in the home. Evidence: Currently the Registered Manager of the home is on maternity leave and the Deputy Manager is in charge of the management and day to day running of the home. The Deputy Manager has demonstrated that they can work well with the CQC. Following the initial site visit where four main concerns were raised, three were in relation to health and safety matters, on the subsequent site visit the Deputy Manager had ensured that these issues had been addressed. The Deputy Manager has worked hard Care Homes for Older People Page 21 of 26 Evidence: to ensure that a full training schedule had been put in place for staff following the initial site visit. However based on evidence collected over the two site visits and judgements made about the care plans and associated documents, the inspector concludes there is further work to be done to ensure that residents are protected and receive a good level of care in the home. The Registered Provider must ensure that risk assessments are completely updated and reflect comprehensive risks for the residents placed in the home and that they address the risk with regard to residents falling and having accidents in the dining room. These accidents have been centred on the dining chairs. On the day of the inspection this was raised with the Deputy Manager who immediately started to source more appropriate seating. The service must ensure it records and maintains a list of the complaints in the home and the action and outcomes taken. The Registered Provider must ensure they have sufficient staff to meet the needs of the residents placed in the home, especially at the weekends. The Registered Provider must ensure that staff receive supervision in line with the national minimum standards and that standards with regard to health and safety in the home are maintained. Information was also taken from the AQAA which was filled in and returned by the due date. However this document did have conflicting information in it that wasnt found on the day of the inspection. An example of this would be around the infection control procedures in the home. Care Homes for Older People Page 22 of 26 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 23 of 26 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 1 16 22 The Registered Provider shall 01/10/2009 ensure that any complaint made under the complaints procedure is fully investigated. To ensure that complaints made by or on behalf of service users are taken seriously and investigated fully. 2 27 18 The Registered Provider must 01/10/2009 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. . 3 33 23 The Registered Person shall 01/10/2009 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. They must also ensure that information provided in the AQAA is reflective of current practice in the home. 4 36 18 The Registered Provider must 01/10/2009 ensure that persons working at the care home are appropriately supervised. To ensure that all service users needs are met. Care Homes for Older People Page 24 of 26 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 8 13 The Registered Manager 01/09/2009 must ensure that all parts of the home to which the service users have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risk to the health or safety of service users are identified and so far as possible eliminated. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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