Care Home: Glebe House

What the care home does well The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. The home is comfortable, homely and well maintained. The house is well furnished and those living at the home have personalised their rooms and showed a sense of pride when showing us their room. Those living at the home said: "I have lived here for some time and I am very settled", another person told us; "The staff are very kind and I am well looked after". People are supported to take their medication as prescribed, there are good administration systems in this area. Staff have completed core training such as manual handling and first aid, a new training manager is in post and is completing an audit and review of staff training in order to identify further areas of development. Regular meetings are held with those who live and work at the home in order that they are consulted about the running of the home. What has improved since the last inspection? The home have ensured that care plans are in place to meet the needs of people living at the home. All of the care plans have recently been audited in order to identify individuals changing needs. The home are aware of further development that is required in this area. The home has ensured that appropriate strategies are in place to minimise the effect of one particular individuals behaviour. The home have ensured that this person was supported appropriately in line with their assessed needs. This person is no longer living at the home. People who live at Glebe House have in place a falls risk assessment and manual handling risk assessments, these are reviewed regularly. This is in order to to minimise falls and to provide clear information to guide and direct staff practice in this area and to also ensure that people are moved safely. What the care home could do better: Care Plans must be sufficiently detailed in order to ensure that all aspects of individuals health and social care needs are recorded and to also evidence how these are to be met. A record must be maintained by the home of incidences of pressure sores and of treatment provided to the service user. Pressure sores, their treatment and outcome should be monitored and records pertaining to these should be maintained. During this visit we reviewed how staff are trained in order that they have the necessary skills in order to support the people who live at the home. We reviewed the homes training records for ten staff, of these ten staff six have not completed protection of vulnerable adults training, a further two staff undertook this training in 2000. It is required that staff must undertake training in adult protection in order that they are aware of their role and responsibilities in this area, in line with both the homes and the local authority policy. Furthermore, those staff who completed their training many years ago should have refresher training to ensure that their knowledge is in line with current best practice. All people living at the home must have risk assessments based on individual circumstance. At this visit we found that risk assessments were not in place for situations which may affect the wellbeing of people living in the home, these include the use of bed rails, possible risk of choking and refusal of medication. The home must complete a full audit of areas of potential risks for individual`s who live in the home, assessments should be completed where required and appropriate measures taken to keep residents (where possible) free from harm. Consent should be sought, and recorded for the use of bed rails in order to evidence that the full implications for the use of this equipment are clear. Furthermore the home should concider the use of the term `cot sides`, for a more appropriate alternative. Staff files were all made up of `loose leaf` papers, and the files had no structure. It is recommended that consideration is given to the arrangement of information within staff files in order to make them more accessible. Key inspection report Care homes for older people Name: Address: Glebe House 5 Sundays Hill Lower Almondsbury South Glos BS32 4DS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 4 1 2 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 31 Information about the care home Name of care home: Address: Glebe House 5 Sundays Hill Lower Almondsbury South Glos BS32 4DS 01454616116 01454616118 angela.ryan@btconnect.com www.bristolcarehomes.co.uk Avonedge Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Helen Perkins Type of registration: Number of places registered: care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Manager must be a RN on parts 1 or 12 of the NMC register. May accommodate one named person aged 32 years or over. The registration wil revert to 50 years and over when the person leaves the home. May accommodate up to 5 persons between 50 and 65 years of age. May accommodate up to 53 persons aged 65 and over, who are receiving nursing care. Of the total 53 persons, the home may accommodate up to 3 persons (who must be 65 years or over) requiring personal care only. Staffing notice dated 19/3/1998 applies Date of last inspection 0 5 0 6 2 0 0 9 0 5 Over 65 53 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Glebe House was first registered as a Care Home providing nursing in 1996. It is one of three homes in the same ownership. The other homes are Field House in Horfield and Beech House in Thornbury. Glebe House is in part a converted older building with a purpose built annexe. The home is situated in wooded grounds that are well maintained and accessible to residents and visitors. Accommodation is of a high standard and is arranged on three floors providing forty-one single bedrooms and six rooms for double occupancy. The majority of rooms have en-suite facilities and others have a washbasin and a toilet within a short walking distance and there are two large lounge areas and two smaller ones for quiet occupation if wished. There is access to all parts of the building provided by two passenger lifts. The fees for staying at the Home are dependent upon the assessed needs of individuals at the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over 9.5 hours and was completed in two days. The manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including:Information provided by the manager in the Annual Quality Assurance Assessment questionnaire, completed prior to our visiting the service, from directly speaking with people who live and work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at Glebe House. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. To also review if the home had met the requirements which had been set at the previous random inspection Care Homes for Older People Page 6 of 31 in June 2009. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Plans must be sufficiently detailed in order to ensure that all aspects of individuals health and social care needs are recorded and to also evidence how these are to be met. A record must be maintained by the home of incidences of pressure sores and of treatment provided to the service user. Pressure sores, their treatment and outcome should be monitored and records pertaining to these should be maintained. During this visit we reviewed how staff are trained in order that they have the necessary skills in order to support the people who live at the home. We reviewed the Care Homes for Older People Page 8 of 31 homes training records for ten staff, of these ten staff six have not completed protection of vulnerable adults training, a further two staff undertook this training in 2000. It is required that staff must undertake training in adult protection in order that they are aware of their role and responsibilities in this area, in line with both the homes and the local authority policy. Furthermore, those staff who completed their training many years ago should have refresher training to ensure that their knowledge is in line with current best practice. All people living at the home must have risk assessments based on individual circumstance. At this visit we found that risk assessments were not in place for situations which may affect the wellbeing of people living in the home, these include the use of bed rails, possible risk of choking and refusal of medication. The home must complete a full audit of areas of potential risks for individuals who live in the home, assessments should be completed where required and appropriate measures taken to keep residents (where possible) free from harm. Consent should be sought, and recorded for the use of bed rails in order to evidence that the full implications for the use of this equipment are clear. Furthermore the home should concider the use of the term cot sides, for a more appropriate alternative. Staff files were all made up of loose leaf papers, and the files had no structure. It is recommended that consideration is given to the arrangement of information within staff files in order to make them more accessible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service understands the importance of having sufficient information when choosing a care home. Admissions are usually only made after a detailed assessment of need has been completed, to ensure the service is appropriate for the individual. Evidence: The home has in place an up to date Statement of Purpose, this document sets out the aims and objectives of the home, its services and facilities, and the terms and conditions of the placement. The home has produced a residents guide which is extremely detailed and provides information about the location of the home, the homes staffing structure, it outlines how individuals will be supported with any cultural and spiritual needs that they may have. The guide also gives information about the services and support available from other professionals and the community as well as services provided by the home. The home had in place a copy of the last Care Homes for Older People Page 11 of 31 Evidence: inspection report completed by us. The residents guide informs the reader of the homes purpose, which is; The Purpose of Glebe House is to provide you with the highest possible standard of nursing care, with the comfort and support needed for your enjoyment, for a happy and fulfilled lifestyle. Care records reviewed showed that the registered manager carries out a full preadmission assessment prior to a new resident moving into the home. The care records for the last two residents to move into the home contained very clear assessments that formed the basis in order for the home to develop working care plans. Where possible individuals visit the home prior to their admission, their admission into the home is tailored around their needs and wishes. There is a trial period of four weeks, which can be extended if required. This period of time allows time for the resident to settle, for consultation with the individual and for a full assessment of the individuals needs in order to ensure that the home is able to meet their needs. We viewed the standard contract that is given to people who live at the home, this outlines the terms and conditions of the placement and provides individuals with the information they need about the services and facilities provided by Glebe House. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans must be sufficiently detailed, be kept under review and updated when required. Clear information must also be recorded to evidence how individuals with pressure area wounds are supported. Medication administration and recording practices within the home are good. Evidence: Individuals care records were reviewed at this visit and it was found that the plans in place had been generated from either a care management assessment or the homes own assessment. Information contained within care records included: an individuals admission record which contained information about the reason for admission, health care support services involved, next of kin, family contact details and medical history. Each person also had records of health professionals visiting, daily records of individuals routines, medication information and a care plan. At our last two visits to the service a requirement had been made that Care plans must be in place for identified residents. We found that all of the people living at the Care Homes for Older People Page 13 of 31 Evidence: home had a plan of care in place. We also saw that an audit of all care records had been completed with instructions provided for staff where areas of shortfalls within the recording of information had been identified. We reviewed five care plans and we found that the plans of care had differing information about the person depending on which file was read. Information for some people was unclear and inconsistent. We told and showed the manager examples of this. However, other peoples notes were spot checked, and there have been some improvements in updating the information since the last inspection. However, further improvements are needed. For example, when we arrived at the home we asked about the special needs of residents, we were informed about an individual who was recently bereaved and was being supported by staff at the home with this area, there was no information on this persons care plan about this. Within another persons care plan index it stated that an individual had a grade one pressure area, yet no plan of care, no wound plan or evidence to show that this was being responded to as required was in place. We asked the manager about this who was able to speak with the staff member responsible, the manager confirmed to us that although this important area of this persons care was known and was being responded to it had not been recorded, action must be taken to improve this. As part of the inspection process we reviewed the daily records which are completed by staff at the home, we saw that for one person there had been occasions where they had agitated behaviour towards staff and had struck out at them, how to support this person in this area had been recorded within the care plan, however, there was no risk assessment to support the resident and staff at these difficult times. The manager told us that this same person refuses their medication, that this can be a regular occurrence, this was not recorded on the individuals care plan. Furthermore, there was no risk assessment in order to support this person with this important aspect of their healthcare. For another person we saw that their care plan identified that they had choking problems. Again, there was no risk assessment for this important area of risk. A requirement in respect of this can be found within the management section of this report. The aspect of the requirement from the last key visit in respect of care plans must be reviewed regularly and as needs change, had not been met and will remain. This is in order that the home ensures that information recorded within care plans is clear and fully reflects the level of support and all aspects of individuals needs and outlines how these will be met by the home. At out last visit to the home in June this year a requirement was made by us that the home must ensure that appropriate strategy is in place to minimise the effect of one residents medical condition to the individual and other residents. This was in order to Care Homes for Older People Page 14 of 31 Evidence: protect the health and welfare of the individual and those around them. The manager confirmed to us that this situation had now been resolved and was no longer an issue for Glebe House or those living at the home. When we visited the home in December 2008 a requirement was set by us that all residents must have risk assessments based on individual circumstance. We recorded within our inspection report that those residents with recent falls must have risk assessments and these must be reviewed regularly. This was in order to minimise falls. At this visit we saw that the home had developed and implemented falls risk assessments. The requirement had been met. The Registered Manager showed us the medication administration systems in place at the home. The Manager was fully conversant with their role and responsibility in this area and the importance of adhering to policies and procedures that are in place for the safe administration of medication. A review during our visit revealed no errors. The medication was appropriately stored and was well organised. All medication records we viewed were up to date and in order. All staff handling medication are qualified to do so. The manager informed us that the staff have completed raising awareness, this is refresher training about medication management. People living at the home are supported with their health. We saw that people are supported with both physical and emotional areas of their care. We saw that specialist advice had been sought for people as expected for example we saw that the home had contacted the dietician for information when a resident had experienced difficulty in swallowing. Also during our visit one resident was experiencing pain, staff took them promptly to the dentist, they were later seen to be comfortable and pain free. During our time at Glebe House we saw and heard the manager and staff talking with the people who live at the home in a calm, friendly manner, asking them their opinion and offering choices. The manager has attended training that has been provided by South Gloucestershires Community Care and housing department about the Mental Capacity Act and legislation and some discussion took place surrounding this issue in respect of advanced decision making and arrangements for power of attorney, the manager was aware of her responsibility in this area. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at Glebe House are enabled to maintain contact with family, friends and the local community. Choices are offered in respect of mealtimes and meals. Glebe House provides those who live at the home with meaningful activities and those who live there are able to participate or not, dependent on their choice. Evidence: Individuals are encouraged to continue with any activities outside of the home. Those that are able to, can go out as they wish and there are no restrictions made on their movements. The home has transport available for residents use, we saw that this was being made good use of during our visit as someone visiting the home used this to take their relative out for the day. People living at the home were seen listening to music of their choice watching television and enjoying conversations with each other. In the entrance hall we saw posters advertising forthcoming events that residents were invited to participate in, these were Christmas Cake decorating, Puss in Boots pantomine and decorating the Care Homes for Older People Page 16 of 31 Evidence: Christmas Tree. People we spoke with at the home told us that they enjoyed the entertainment provided at the home and in particular enjoyed it when entertainers visited. People living at the home confirmed they are able to participate, or not, in activities as per their choice. There are two activity co -ordinators employed at the home in order to support people in this area. Within activity records we saw that group activities such as craft work, bowling, keep fit, skittles, flower arranging, musical bingo and quizzes are provided on a regular basis and outings out for those who wish to participate are also arranged. We saw that when people are in their private rooms they are still asked if they wish to participate and are supported with an activity in their room if they so wish. Local clergy visit the home and provide a religious service for those who wish to participate. The homes Statement of Purpose records that a church service is held at the home every Sunday and also on the first Wednesday of every month holy communion is held for those who wish to participate. Hymn books are also available in large print format. We saw that people living at the home are consulted about the services provided at Glebe House, this is because the manager is readily available to the residents and also because meetings are held with the residents, at these meetings people are encouraged to speak out and give an opinion. We saw that the last meeting that was held at the home took place in May 2009, areas of discussion included menus, call bell responses, activities within/outside of the home, residents were also reminded of how to raise issues of concern. The Home operates a rotating menu. During our visit the menu choices were looked at to see if people living at the home are being offered a well-balanced and varied diet. All of the choices seen were well balanced, traditional and varied with fresh fruit and vegetables available. People who live at the home told us they enjoyed the meals and that; The food is very pleasant. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that meets National Minimum Standards and Regulations, the procedure is available within the home and residents and relatives understand how to make a complaint. The Registered Manager demonstrated an awareness of the content of the adult protection policy and know what immediate action to take and when and who to refer the incident on to. Further training in safe guarding vulnerable adults would benefit staff who work at the home. Evidence: There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and South Gloucestershire Social Services. A copy is made available to the people who live at the home and their relatives should they request it. The Commission has received no complaints since our last site visit to the home. The home has in place a complaints logbook and it was seen that issues have been dealt with effectively and fairly. Care Homes for Older People Page 18 of 31 Evidence: During this visit we reviewed how staff are trained in order that they have the necessary skills in order to support the people who live at the home. There was evidence in the staff training records that some staff have had training (in the form of video) on the protection of vulnerable adults from abuse. The manager confirmed to us that she had completed this training and would be attending alerters training provided by the local authority in January 2010 and that three general nurses would be completing training in February 2010. However, more staff require training in this area. We reviewed the homes training records for ten staff, of these ten staff six have not completed protection of vulnerable adults training, a further two staff undertook this training in 2000. It is required that staff must undertake training in adult protection in order that they are aware of their role and responsibilities in this area, in line with both the homes and the local authority policy. Furthermore, those staff who completed their training many years ago should have refresher training to ensure that their knowledge is in line with current best practice. During our visit we were positioned near to the call bell response, it was evident that those living at the home were aware of how to summon assistance from staff. When we were reviewing the complaints logbook we found that a relative had complained on behalf of an individual living in the home, one of the issues was about the length of time it took for staff to respond to a call bell request for help. We spoke to the manager about this and looked at the homes response to this complaint. We saw that the manager had spoken with a member of staff and had reviewed what had occurred. As part of our visit we reviewed the minutes of residents meetings. At the last meeting which took place in May 2009 we saw recorded that people had complained about the length of time staff took to respond. This complaint had not been recorded within the complaints logbook. We spoke to the manager about this and Ms Perkins was able to tell us about the electronic recording system that is in place. This records the time, date and length of time taken to respond to the call bells. In respect of the complaint made by a relative the recording system was used as part of the investigation to determine how long staff took to respond to the call. This complaint was upheld. It is recommended that the home incorporates within its own internal quality auditing process a system to routinely monitor the staff response times to requests for assistance from residents. This is to ensure that people living at the home are assisted promptly when they need support and to evidence the homes effectiveness in this area. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of furnishings and fittings in Glebe House are good and overall a warm comfortable environment has been created ensuring individuals needs are met. Evidence: Glebe House is a spacious home and is furnished to a high standard. The Home is situated in Almondsbury and is close to private houses and a short distance from the local village and nearby to bus stops. This helps ensure that those who live at the home can be a part of the community. The Home is wheelchair accessible; and there is a lift servicing both upper floors. The Home is a three-storey building, and those living at the home have access to all communal areas. The Home is a large detached building, set in well establish grounds, these are well maintained. There are adaptations in place throughout the Home and specialist equipment including mobility aids, sensory aids, and specially adapted baths. There are people at the home who are supported for their safety by having bed rails in place. Not all care plans had this information recorded, we also found that one persons care plan said; rails are kept down, the manager told us that they are in use at all times. There were no risk assessments in place for the use of this equipment (see management section of this report) and we also found that consent for the use of this equipment had not been obtained. It is recommended that this is sought, and recorded to evidence that the full implications for the use of this equipment are clear. It is further recommended Care Homes for Older People Page 20 of 31 Evidence: that the home consider the use of the term cot sides, for a more appropriate alternative. At the time of our visit we found that the passenger lift to the top floor of the house had been out of order for ten days. The home has worked diligently in order to rectify this and to reduce the impact for the five residents whose private rooms are in this area. The home has arranged for contractors to deal with the problem and this is being responded to. In the meantime the home has arranged for a climber to be available for use to transport people up and down the stairs. We were told that some staff have received training in order to use this equipment safely. The home is also looking into the possibility of having a stair lift installed whilst the lift is replaced. The home appears to be doing all that they can to support residents. We have asked the home to keep us informed about this situation. We also reminded the manager that risk assessments for both residents and staff must be in use for the use of the stair climber. The home is well maintained and has a homely feel, there is a pleasant dining room and a number of comfortable lounges for residents use, there are pleasant views from all of the lounges. Residents were seen to be relaxing and participating in discussion and activities in these areas. Bathrooms include specially adapted baths to assist residents who may have reduced mobility. Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. The manager informed us of the possible change of use for one bathroom to be converted into a wet room, this is due to the changing needs and wishes of residents who live at the home. Since our last visit to the service new boilers have been installed to ensure effective heating, the home has installed a new walk in shower in a ground floor bathroom. The home has also increased its manual handling aids and have purchased a further 20 glide sheets and have acquired additional hoists in order to support those living at the home in manual handling tasks. The home shows a good standard of housekeeping and no offensive odours are apparent. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safe vetting and recruitment procedures are in place. Individuals are cared for by sufficient numbers of competent staff that are provided with core training in order to fulfill their roles and responsibilities. Evidence: The manager informed us as well as duty rotas seen by us, evidenced that trained nurses are available for each floor of the home, these staff are supported by care assistants and ancillary staff in order to ensure that all needs of residents are met by staff at the home. The recruitment and selection documents for a number of staff were reviewed at this visit; staff files evidenced that full and robust practices are adhered to at the home to ensure that those appointed have the qualities and skills to work within this care environment. Appropriate adult protection checks are taken to ensure the protection and safety of residents. We found all of the information we needed to ensure all checks had been undertaken by the home and that appropriate recruitment and selection processes had been followed. We found that staff files were all made up of loose leaf papers, and the files had no structure, making it difficult to find the required documents. It is recommended that consideration is given to the arrangement of information contained within staff files in order to make them more Care Homes for Older People Page 22 of 31 Evidence: accessible. We saw that staff are issued with a job description. These provided clear information about the roles and responsibilities of the post and the expectations from the employer. Within staff records we saw that issues in respect of staff conduct are dealt with efficiently in order to ensure that this does not impact on the quality of service for those living at the home. When starting employment at the home staff complete an induction, we saw that the homes induction covers areas such as role and responsibilities, policies and procedures, health & safety, responding to concerns complaints and protection. We saw that the most recently employed members of staff to the home had commenced their induction. We saw that regular staff meetings, with all staff teams are held at the home. We saw that within minutes of meetings appropriate topics had been covered such as the homes admission process, documentation, effective communication, training and medication practices. These meetings provide an opportunity to review and reflect on practices within the home and provide a structure to inform and guide staff practice. Records seen by us evidenced that staff have undertaken training in the following areas: First aid, fire safety, manual handling, food hygiene and infection control. The achievement of an National Vocational Qualification (NVQ) is well promoted within the home. We saw that in November this year fourteen staff completed wheelchair training in order that they are skilled to use this equipment safely, also in November staff completed training in infection control, safeguarding adults, fire, along with Health & safety. The manager told us that the organisation has a training manager in post, this person is responsible for auditing the training in place and identifying areas which require further development. The manager also informed us that future training is planned to ensure that staff are further skilled in supporting the specialist needs of individuals living in the home such as tissue viability care, dementia awareness, advanced care planning, end of life care and Mental Capacity and Deprivation of Liberties legislation. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. However, some improvements are needed to ensure that individual risk assessments for residents are in place. Improvements are also needed in some areas of recording to ensure that clear information is available. Evidence: The matron/manager Mrs Helen Perkins is a first and third level registered nurse with an National Vocational Qualification with a level 4 in management. Her nursing experience spans over 30 years, in the main with elderly care. The home displays a current certificate of Employers Liability Insurance. The home has in place clear policies and procedures in areas of staff employment, legislation and health and safety, all of which have been seen by us at previous visits to the service. This guidance provides clear information to staff to inform and guide Care Homes for Older People Page 24 of 31 Evidence: their practice. The home has a number of effective quality assurance and quality monitoring systems based on seeking the views of residents that are in place. These measure success in achieving the aims, objectives and statement of purpose of the home. These include an internal quality audit undertaken in the form of surveys to those who live at the home, there are regular residents and staff meetings. A Representative of the Registered Provider visits the home each month and audits areas within the home to ensure that standards are being maintained. The Annual Quality Assurance (AQAA) completed by the manager prior to our visit to the service was sufficiently detailed. Within the section of What the service does well, the manager had recorded; Our service provides a high standard of care to our local community. We provide a clean, odour-free, friendly and warm environment to support those who are unable to continue living independently, and a reliable, open and happy home for relatives to entrust their loved ones. We encourage independence, and freedom within a safe environment, and we support the local community in giving opportunities to learn and experience a different type of life. Our catering is of a high standard, achieving a four star rating at a recent inspection, and our residents enjoy the society that goes with communal eating. GP practices are very close by and the doctors offer us a very good service and we access additional palliative care through the local hospice.We take a pride in our surroundings and keep our home an inviting place to live in, and this extends to our garden and grounds. As previously recorded, records such as care plans, risk assessments, records of pressure area care and treatment must be better maintained, kept under review and updated at needed. To ensure that individuals needs are known and responded to as required. The home is completing the appropriate checks on the fire equipment and recording of training and testing of equipment were satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The home has a fire risk assessment in place, this was reviewed by the manager earlier this year, no areas of concern were identified. We saw that the home has in place house hold risk assessments, these identify what the hazards are, who/what could be harmed, how the hazard could occur, what existing measures are in place and what new controls can be implemented to reduce the risks further, we saw that assessments in place included; electrical leads, storage of oxygen within the home and fire escape procedure. We saw that these assessments had been reviewed in June 2009. As reported earlier within the personal Care Homes for Older People Page 25 of 31 Evidence: care/healthcare section of this report we have recorded that risk assessments are not in place for situations which may affect the wellbeing of people living in the home, these include the use of bed rails, possible risk of choking and refusal of medication. The home must complete a full audit of areas of potential risks for individuals who live in the home, assessments should be completed where required and appropriate measures taken to keep residents (where possible) free from harm. We reviewed accidents and incidents which had occurred at the home, those seen by us were situations that could be expected to occur. Accident reports had been well written and showed what had happened, what injuries had been sustained and what the home had done to support the person involved and measures taken in order to try to prevent recurrence. The home keeps us informed of incidents which affect the wellbeing of individuals who live at the home. During this visit we reviewed incident/accident forms, individuals daily records and spoke with the manager about incidents which have been reported to us. The home deals with incidents appropriately in order to ensure the safety and wellbeing of the individuals involved, we saw that the home contacts specialist healthcare services as required with additional support also being provided by the home when needed. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 The home must ensure that 30/06/2009 care plans are sufficiently detailed in order to meet the assessed needs people living at the home. The care plans must be reviewed regularly and as needs change. To meet the individuals needs Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 17 A record must be maintained 15/01/2010 by the home of incidences of pressure sores and of treatment provided to the service user. Pressure sores, their treatment and outcome should be monitored and records pertaining to these should be maintained. 2 18 13 The Registered person, shall make arrangements by training staff to prevent service users being harmed or suffering abuse. This is to ensure that all staff are aware of their role, responsibilities and duty to protect people who live at the home. 14/03/2010 3 37 17 The home must ensure that all documents required in respect of each service user must be in place. 15/01/2010 Care Homes for Older People Page 28 of 31 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 Records such as care plans, risk assessments, records of pressure area care and treatment must be better maintained, kept under review and updated at needed. To ensure that individuals needs are known as responded to as required. 4 38 13 The Registered Person shall 30/01/2010 ensure that activities in which service users participate are, so far as is reasonably practicable free from avoidable risks. Risk assessments are not in place for situations which may affect the wellbeing of people living in the home, these include the use of bed rails, possible risk of choking and refusal of medication. The home must complete a full audit of areas of potential risks for individuals who live in the home, assessments should be completed where required and appropriate measures taken to keep residents (where possible) free from harm. Care Homes for Older People Page 29 of 31 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 16 The home should incorporate within its own internal quality auditing process a system to routinely monitor the staff response times to requests for assistance from residents. This is to ensure that people living at the home are assisted promptly when they need support and to evidence the homes effectiveness in this area. Those staff who undertook training in adult protection many years ago should undergo refresher training in order to ensure that they are aware of their responsibilities in line with current good practices and the local authority policy. Consent should be sought, and recorded for the use of bed rails in order to evidence that the full implications for the use of this equipment are clear. The home should concider the use of the term cot sides, for a more appropriate alternative. Consideration should be given to the arrangement of information within staff files in order to make them more accessible. 2 18 3 22 4 5 22 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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