Care Home: Goatacre Manor Care Centre

What the care home does well The management team at Goatacre Manor have shown themselves able to develop their service and embrace new ways of working. They are able to review service provision and make improvements when needed. Improvements are introduced in such a way as to fully involve staff working in the home. Staff spoken with were keen to provide a service to residents based on what the residents wished for and needed which was based on a full knowledge of the residents` past life. The home is attractive in appearance, with a choice of two sitting rooms for residents. The home has well maintained garden areas. All parts of the home are wheelchair accessible. Goatacre Manor benefits from being in a small village, so that it can be part of the local community. People commented on services provided. One person commented "don`t matter how many people there are, you are all treated the same way", another "the residents are well cared for, they enjoy a friendly atmosphere", another "wonderful care of residents" and another "the care at Goatacre is very good". One relative summed up their opinion by stating "without doubt, this is the best care home of any I`ve seen in the N and West of Wilts". Staff commented on the home. One person reported "Goatacre Manor is a happy place to work and the staff work well together and support each other", another "the home is very nice and tries to help all the staff if they have problems or are ill", another "we create a homely atmosphere which visitors usually comment on" and another "we care about our residents". What has improved since the last inspection? Service provision at Goatacre Manor has much improved since the last inspection. The extent of improvements are shown by the fact that the home have developed their services, from a previous poor rating, to now be judged as having good outcomes for residents. The home have fully improved and developed its information for prospective residents and their supporters. Information now complies with our regulations and good practice guidelines. They have also fully revised their documentation and assessment procedures for prospective residents, so that people can be assured that the home can meet their individual needs. The home have put many improvements into their approach to assessment and planning of nursing and care. New documentation has been introduced to ensure that care is assessed and planned in an individualised manner, so that care plans are developed with residents and their supporters, around what the individual needs and wishes for. Staff at all levels complete documentation. This means that records are accurate and completed at the time nursing and care is provided. Staff are aware of individual residents` needs and the importance of reviewing plans of care when residents` needs change. Major improvements have been made in the management of medication, so that medicines are now safely stored, with full records of medication administered to residents maintained. Medicines administration was performed safely and residents fully supported in taking their medication. Activities provision has been much developed, with a dedicated activities person employed. Staff are available to support the activities person and such staff have been trained in this role. Activities now take place on a planned basis, taking into account what residents want. Full care plans relating to residents diverse needs are maintained. These are regularly reviewed. Residents are now supported in raising issues of concern with full records being maintained. Mrs Swainson, the manager showed an awareness of how important it was for residents and staff to be able to raise matters of concern to them,including matters raised verbally. All staff have been trained in abuse awareness since the last inspection and staff spoken with all showed a full awareness of their responsibilities in this area. The provider has developed the environment, replacing old items and investing in new equipment for people with complex needs. The home is now clean throughout and staff followed principals of infection control when performing their roles, including the management of laundry. Communal use of equipment used in care no longer takes place. Staff employment records have been fully audited and all required records are now in place. A training matrix has been developed. This shows at a glance which staff have been trained in which areas and staff who are due for up-dates. Training in care needs of the client group has been much developed, across a range of topics relating to residents` nursing and care. Managers have introduced a wide range of quality audits, to ensure that quality of nursing and care provision is regularly reviewed. Systems for ensuring the health and safety of residents, their supporters and staff have improved, particularly in relation to management of bed rails, manual handling practice and reviews of commonly used equipment such as shower heads and wheelchairs. What the care home could do better: As with any service which has undergone major changes, there remain some areas which the home needs to address. The main areas relate to further consolidation of the home`s improvements in care planning and documentation, to ensure that all assessments, plans and other documentation is completed to the same standard. This is particularly in relation to prevention of pressure ulceration, management of people with diabetes, management of residents who have a urinary catheters, use of thickening agents to enable people to swallow safely and reviewing all available information when peoples` conditions change. As some people were not as positive as others about the meals provided, the home would benefit from identifying if there are any trends in this area, so that improvements can be made, if indicated. Some facilities in the home would benefit from improvement, particularly bathing facilities for disabled people, the floor in the kitchen and further equipment for the cleaning of sanitary equipment. Some areas relating to prevention of spread of infection need development, this included systems to prevent the communal use of socks and tights, further consideration of how laundry can be separated at source and ensuring the clear making of residents` wash bowls in double rooms. Some developments are needed in staff support and training. Non-clinical staff who perform wound care need to be fully trained by external professionals in the area. Where staff have attended external training courses, records should be made when staff cascade information to the rest of the staff team, so that managers can assess who has been trained and who has not. As good practice job descriptions should be signed and dated by the employee and employer. Key inspection report Care homes for older people Name: Address: Goatacre Manor Care Centre Goatacre Lane Goatacre Wiltshire SN11 9HY     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: Susie Stratton     Date: 0 3 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 35 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 35 Information about the care home Name of care home: Address: Goatacre Manor Care Centre Goatacre Lane Goatacre Wiltshire SN11 9HY 01249760464/454 01249760252 jswainson@goatacre.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr John O`Dea,Mrs Margaret O`Dea care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 3 persons in receipt of terminal care at any one time No more than 3 physically disabled residents in the age range 18 - 64 years at any one time No more than 42 persons over the age of 65 years requiring nursing care Date of last inspection Brief description of the care home Goatacre Manor provides accommodation and care with nursing, for up to 42 residents. The majority of these will be people aged 65 and over. The service may also care for up to three adults in the 18 to 64 age range, if they need care due to a physical disability. Both short and long-term placements can be offered. The home is privately owned. The home is owned by Mr and Mrs ODea. The registered manager is Mrs Swainson, she leads a team of registered nurses, care assistants and support staff. Care Homes for Older People Page 4 of 35 Over 65 42 0 0 0 3 3 0 8 0 5 2 0 0 9 Brief description of the care home The home is in the small village of Goatacre, near Lyneham, Wiltshire. The market towns of Calne and Wootton Bassett are within a few minutes drive. The larger town of Swindon is also only a short distance away. The home consists of an original property with a purpose built extension. Resident accommodation is on two floors with a passenger lift in-between. There are two main lounge and dining areas, both on the ground floor. The home has wheelchair suitable corridors, bedrooms and communal rooms. There is a dedicated hydrotherapy suite including a swimming pool with hoist, and Jacuzzi bath. All residents rooms are equipped with a digital television and a telephone included in the fee. Externally there are accessible gardens and adequate parking spaces. Fees charged to service users range between 631 pounds per week to 782 pounds per week. A range of information for people is displayed in the entrance hall and a copy of the service users guide is available in each residents room. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of this inspection, the homes file was reviewed and information provided since the last inspection considered. We received an improvement plan from the home following the last inspection. This provided information on how the home were planning to improve service delivery and address requirements outlined in the previous inspection. As part of this inspection, we sent out surveys to people who use the service and staff and 11 were returned. We also received comments from users of the service sent to us by the provider, following the last inspection. We performed a random inspection of the home on 5th November 2009. This was performed by two regulatory inspectors and a pharmacist inspector. At that inspection, we concentrated on reviewing provision of health and personal care, including medicines management, and health and safety. For this inspection, we looked at the improvement plan, the random inspection and all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our visit to the home. Care Homes for Older People Page 6 of 35 This inspection of Goatacre Manor took place on 3rd December 2009, between 9:45am and 2:30pm. One inspector performed the inspection, this person is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). Mrs Swainson, the manager was on duty for the visit and we gave her a feedback at the end of the inspection. At this inspection, we met with a range of residents, reviewed documentation relating to two residents and observed specific matters for a further three other residents. We toured all of the home and observed care provided at different times of day and in different areas of the home. As well as meeting with residents, we met with two registered nurses, four carers, a domestic, the laundress, two administrators, the handyman and the training manager. We observed a lunchtime meal and activities in the sitting rooms. At this visit, range of records were reviewed, including staff training records, four staff employment records, the homes statement of purpose, service users guide and maintenance records. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Service provision at Goatacre Manor has much improved since the last inspection. The extent of improvements are shown by the fact that the home have developed their services, from a previous poor rating, to now be judged as having good outcomes for residents. The home have fully improved and developed its information for prospective residents and their supporters. Information now complies with our regulations and good practice guidelines. They have also fully revised their documentation and assessment procedures for prospective residents, so that people can be assured that the home can meet their individual needs. The home have put many improvements into their approach to assessment and planning of nursing and care. New documentation has been introduced to ensure that care is assessed and planned in an individualised manner, so that care plans are developed with residents and their supporters, around what the individual needs and wishes for. Staff at all levels complete documentation. This means that records are accurate and completed at the time nursing and care is provided. Staff are aware of individual residents needs and the importance of reviewing plans of care when residents needs change. Major improvements have been made in the management of medication, so that medicines are now safely stored, with full records of medication administered to residents maintained. Medicines administration was performed safely and residents fully supported in taking their medication. Activities provision has been much developed, with a dedicated activities person employed. Staff are available to support the activities person and such staff have been Care Homes for Older People Page 8 of 35 trained in this role. Activities now take place on a planned basis, taking into account what residents want. Full care plans relating to residents diverse needs are maintained. These are regularly reviewed. Residents are now supported in raising issues of concern with full records being maintained. Mrs Swainson, the manager showed an awareness of how important it was for residents and staff to be able to raise matters of concern to them,including matters raised verbally. All staff have been trained in abuse awareness since the last inspection and staff spoken with all showed a full awareness of their responsibilities in this area. The provider has developed the environment, replacing old items and investing in new equipment for people with complex needs. The home is now clean throughout and staff followed principals of infection control when performing their roles, including the management of laundry. Communal use of equipment used in care no longer takes place. Staff employment records have been fully audited and all required records are now in place. A training matrix has been developed. This shows at a glance which staff have been trained in which areas and staff who are due for up-dates. Training in care needs of the client group has been much developed, across a range of topics relating to residents nursing and care. Managers have introduced a wide range of quality audits, to ensure that quality of nursing and care provision is regularly reviewed. Systems for ensuring the health and safety of residents, their supporters and staff have improved, particularly in relation to management of bed rails, manual handling practice and reviews of commonly used equipment such as shower heads and wheelchairs. What they could do better: As with any service which has undergone major changes, there remain some areas which the home needs to address. The main areas relate to further consolidation of the homes improvements in care planning and documentation, to ensure that all assessments, plans and other documentation is completed to the same standard. This is particularly in relation to prevention of pressure ulceration, management of people with diabetes, management of residents who have a urinary catheters, use of thickening agents to enable people to swallow safely and reviewing all available information when peoples conditions change. As some people were not as positive as others about the meals provided, the home would benefit from identifying if there are any trends in this area, so that improvements can be made, if indicated. Some facilities in the home would benefit from improvement, particularly bathing facilities for disabled people, the floor in the kitchen and further equipment for the cleaning of sanitary equipment. Some areas relating to prevention of spread of infection need development, this included systems to prevent the communal use of socks and tights, further consideration of how laundry can be separated at source and ensuring the clear making of residents wash bowls in double rooms. Some developments are needed in staff support and training. Non-clinical staff who perform wound care need to be fully trained by external professionals in the area. Care Homes for Older People Page 9 of 35 Where staff have attended external training courses, records should be made when staff cascade information to the rest of the staff team, so that managers can assess who has been trained and who has not. As good practice job descriptions should be signed and dated by the employee and employer. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be given the information that they need before admission and will have a full assessment of their individual needs, so that they can be assured that the home can look after them. Evidence: Since the last inspection, the home have fully revised information given to residents and their supporters. To ensure ready availability, this information is provided in residents rooms, as well as the main entrance area. We looked at this information and found that it complied with all our Regulations and Standards, so as to inform people of the service provided. A relative commented I was very impressed when I was took round before my relative came to stay. We performed a random inspection on 5th November 2009 and during this inspection, reviewed how the home had made improvements in assessment of residents prior to admission. We found that a recently admitted resident had had a full assessment of Care Homes for Older People Page 12 of 35 Evidence: their individual needs before admission. This assessment had been carried out in detail, using an assessment record which provided triggers for staff to consider where further assessments were needed and where care plans were indicated. This persons assessments had been further reviewed on admission and thereafter, when further care needs were identified for them. For example, this persons records indicated that they were at risk of falls. They had a very clear care plan relating to this, which we noted as good practice included reports of how the person felt about this risk and matters which made them feel apprehensive and supported. This inspection showed that admission assessments continued to show the same standards since the random inspection, one month previously. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will have their personal and health care needs met by the homes revised systems in this key area. Evidence: We performed a random inspection of Goatacre Manor on 5th November 2009. This was to review progress towards meeting requirements identified at the previous inspection and we noted that the home had invested in making major developments in the provision health and personal care. This included introducing new documentation to support nursing and care provision. The new documentation is person-centered, to ensure that each individual will have their care assessed and planned according to their own individual needs. Records are now kept in peoples rooms, to ensure that residents and their supporters can be aware of, and consulted about, care planning processes. Keeping residents plans in their rooms means that nursing and care staff are also able to be fully aware of individuals nursing and care needs. Systems for documentation have changed, so that care staff now document in individual records, rather than reporting issues to registered nurses, who would then perform documentation. This means that records are completed contemporaneously and are Care Homes for Older People Page 14 of 35 Evidence: accurate. A range of staff commented on this increased accountability for staff at all levels, reporting that it had been of much benefit in providing individualised care. One registered nurse reported to us that if a persons condition changed, the carer would document this in a persons records and report the matter to the registered nurse in charge. The registered nurse would then make a decision about further action, for example if the residents doctor needed to be called in and if a review of the persons care plan was indicated. This meant that prompt review of care plans took place and there was no delay in reviewing residents changed needs. People commented about care provision. One member of staff commented in their survey I feel we look after them [i.e. the residents] well. A relative commented the care that staff give our resident is good, another medical care very good indeed and another on the flexibility where needs change. We looked at a range of different peoples records at the random inspection and again briefly at this inspection, to review if progress had been sustained. We found that care plans were reflective of what residents and staff told us and reflected what we observed. For example, we observed that a very frail person continued to be able to reach for, and give themselves, drinks and did this readily, without prompting. Care staff reported that the person drank fluids well and had a good appetite, which we observed at lunch-time. The records showed regular reviews of the persons need for assistance with taking in fluids and meals had occurred. These reviews showed that there was no need to monitor this persons fluid and food intake on a daily basis at that time. The care plan also stated clear parameters for if the persons condition changed and need for re-introducing such documentary systems if indicated in the future. Another persons records indicated that they had become increasingly frail recently and this was reported on by staff. Their records showed that relevant external health care support had been sought by the home and of the changes in their care plan. The persons care plan showed that they had been prescribed dietary supplements, which their monitoring charts showed they were being given by staff and how much of such supplements they had been able to take in. As would be anticipated, where a home has gone through major changes, there remain a few areas which still need addressing. One person who had a urinary catheter, had a very clear care plan about how their personal care needs were to be met in the light of this and how often their catheter bag needed to be changed. Their records also documented the clinical indicator for use of the catheter. However another resident, who also had a urinary catheter did not have such information documented. A resident with diabetes had a very clear care plan about actions to be taken by staff if their blood sugar levels fell out of certain levels, whilst another Care Homes for Older People Page 15 of 35 Evidence: resident did not. Mostly people who were assessed as being at risk of pressure ulceration had clear care plans which stated how often they needed their position changing, but two people did not. Most people who needed thickening agent to be added to their drinks had clear directives in their records to state how thick they needed their drinks to be, but one person only had use thickener in their records. One person had had nearly all their care plans evaluated when their condition changed, however one care plan had not been evaluated, although their daily record indicated that it needed to be. Where a frail resident needed their position changing to prevent pressure ulceration or needed to be given fluids or supported in taking in their meals, the home uses monitoring records. We observed that these were generally fully completed at the time care was provided. For example, we observed a care assistant supporting a resident in drinking a cup of coffee mid-morning, chatting to them and encouraging them to talk as they did so. When the person had drunk all they wanted to, the carer accurately documented the amount the person had drunk in their records. However, for two people at risk of pressure ulceration, one persons record did not show that they were having their position changed at the frequency directed in their care plan and another person, who did not have how often they were to be moved in their care plan, did not have a record to show that they had had their position moved as would be indicated by their condition. Where people were provided with air mattresses to prevent risk of pressure ulceration, the setting required in relation to their weight was documented in their records. For two people the dial on their setting was lower than indicated in their records and we advised that settings should be reviewed when care has been provided. All personal care was performed behind closed doors. Frail people were observed to have clean fingernails, eyes, mouths and well brushed hair. Where carers asked residents if they wished to use the toilet, this was done in a discrete manner. When staff moved residents using a hoist, we observed that this was done with full regard to ensuring that the resident remained fully covered throughout the process. Our pharmacist inspector took part in the random inspector on 5th November 2009 and found many improvements in the homes handling of medicines since the last inspection. Nurses that they spoke to were very positive about the changes that had been made and felt reassured by the extra checks that had been put into place. The medication administration records were checked daily by senior staff. These were seen to be completed correctly with refusals noted. We looked at care plans that related to these refusals and saw that the details were included along with strategies for helping staff to support the person to take their medicines. The controlled drugs cupboard had Care Homes for Older People Page 16 of 35 Evidence: also been secured to the wall in the manner approved. Since the random inspection, the home had worked further on protocols for people prescribed medication on an as required basis. We looked at one specific prescription and discussed it with a registered nurse. The record described in detail when and why the person needed to be given the drug and of any indicators for discussion with the prescriber in the future. This conformed fully to what the registered nurse told us. The registered nurse reported that developments in documentation had led to improved consistency and responsiveness by staff. We also observed that the home are now using the correct lancing devices for testing blood sugar levels for people with diabetes. The registered nurses reported that they felt safer using such devices. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be able to exercise choice in their daily lives, including at mealtimes. Evidence: The home have put major developments into this area since the last inspection. All residents care plans are now fully individualised, describing their past lives, their interests and preferences. Staff we spoke with saw the benefits of this approach. One member of staff reported that the new care planning systems had enabled them to find out so much more about the residents and that they were now able to plan care in their light of this. Residents records showed details of how they wanted to spend their days, including when they wanted to get up and go to bed. One residents record included details of how they liked to be dressed and we observed that staff had respected this. A very frail residents records documented that they became tired easily when they were to of bed and so preferred to only be up at times their relatives visited. We observed that staff followed this care plan, ensuring that the person remained in bed in the morning, but were got up after lunch when their relative was due to visit. Since the last inspection, the home have employed an activities coordinator. This person works 25 hours a week and is able to work every other weekend. The activities Care Homes for Older People Page 18 of 35 Evidence: person is supported by carers and a carer is allocated to work with residents on activities in both the morning and the afternoon. As would be anticipated in a service which had gone through change, there were varied opinions about activities provision. One person commented in their survey that the home could do with more physio, OT, another person commented it would be great now and then someone could come around and listen to what you want to say. We were not able to meet with the activities person as they were not on duty when we inspected, however we did review their records. These records indicated that they were planning activities round what residents wanted and were able to do. The records showed that major seasonal events such as Halloween were being celebrated. This is important, as without recognising such events, residents with memory loss can loose awareness of seasons of the year. The records and photos showed that the residents had enjoyed visits from a rabbit recently. The activities person maintained records of activities participated in by individual residents, including benefit to the individual residents, so that they could further plan with the resident and other people about how to develop activities to benefit the resident and the home as a whole. We observed that carers also continued to support residents in diversional activities. For example during the afternoon a carer was sitting with a resident going though a magazine with them, which they clearly were enjoying. The home has two sitting rooms, and we observed that there was always one and sometimes more care assistants available to support residents. Where the home cared for frailer residents, carer concentrated on sitting with residents and chatting for short periods when the resident was awake. The home maintains clear records of contacts with relatives. For example one persons records showed that the home had held regular contacts with a residents relative about their medical condition and had reported to the relative on advice given to them by the residents GP and other health care professionals. One relative commented they keep you up-to-date on everything we have to know. A member of staff commented we get to know the residents families and involve them. People commented about meals in surveys. None of the people who responded stated that they always liked the meals. Most responded stating that they usually or sometimes did. This is an area which the home should investigate further when they next survey residents and their supporters for their opinions. One person commented specifically vegetarian meals not really catered for, another person commented that the evening meal could be better. However another person commented the kitchen staff if a resident request something not on the menu... are very helpful and another Care Homes for Older People Page 19 of 35 Evidence: the menus are well presented and nutritionally balanced. We observed a meal-time. Meals are served in one of two sitting/dining rooms and residents eat at a central table or at smaller tables, depending on what they wish. There were plenty of staff available to support frail residents at mealtimes. Where residents needed supports to eat their meals, stools were available for staff to sit with the resident, supporting them to eat. At the last inspection, we noted that the chef shewed a detailed individual knowledge of individual residents needs and preferences for meals. They were also keen to ensure that residents had well prepared nourishing meals. We observed that staff presented meals nicely and wore appropriate disposable gloves and or aprons when plating up food. Staff maintained regular contact with each other to ensure that residents had the meals that they wanted. Meals looked hot and were attractively presented. Residents in the sitting rooms gave all appearances of enjoying their meals. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their supporters will have their concerns listened to and acted upon and will be safeguarded. Evidence: The home have put much effort into changing attitudes about listening to what people have to report about service provision since the last inspection. The manager, Mrs Swainson reported that these developments have meant that the management team regards complaints and issues of concern brought up by people as an effective way of understanding how people feel about the service provided. All of the people who responded to us in surveys reported that they knew how to raise issues of concern or a formal complaint. Mrs Swainson maintains a record of complaints received and concerns brought up. The record is clear and provides evidence of developments in service provision. Since the last inspection, two issues have been considered via local safeguarding procedures relating to the home and the home have also brought up issues to safeguard vulnerable adults. Mrs Swainson has co-operated in full with both safeguarding issues and reported that she feels that she had learnt from them both and will use such issues in practice to review service provision. We did issue a warning letter about one matter, following a multi agency investigation and Mrs Swainson reports that she understands in full the matters raised and would in the future ensure that vulnerable people are fully protected by the homes practices. Care Homes for Older People Page 21 of 35 Evidence: The training manager reported that they have fully revised the homes induction and training systems. All newly employed staff receive safeguarding training early on in their induction period, generally on the first day. Regular up-dates are then given to staff, using a variety of methods including self-directed learning, via DVDs, discussions and attendance at external courses. The training manager reported on the benefits of a particular external safeguarding course and that more staff would be attending in February 2010, with a plan that attendees would cascade information to other staff. All staff we spoke with were aware of their personal responsibilities for safeguarding vulnerable people. Records in the home showed that staff felt able to whistle-blow about practice which they considered not to support a resident. There was written and verbal evidence that Mrs Swainson had taken action following being alerted to an issue, to ensure that it was investigated, the safety of a resident up-held and that staff involved were made aware of their personal responsibilities for safeguarding a resident. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs will largely be met by the home environment. Evidence: Goatacre Manor is an older building, which as been extended. Accommodation is provided on one floor at the older part of the building and on two floors at the newer part of the building. There is a passenger lift between these two floors. The home is in the centre of the village of Goatacre and looks out over lawns at the back, with a cricket field beyond and garden and courtyard areas to the front. Most of the accommodation is provided in single rooms, although there are some double rooms. A relative described the accommodation as spacious and light. There is a choice of two sitting/dining rooms in the home. Both rooms are large and provide accommodation to suit people, including people with complex disability needs. Residents are enabled to bring in items of their own if they wish and some of the rooms had a highly personalised atmosphere, reflecting the persons likes and preferences. The home was clean throughout and since the last inspection, the provider has continued to put much effort into developing the home environment. Written cleaning schedules have been put in place. These are regularly monitored. One person commented in their survey the housekeeping staff are very helpful if we have to ask Care Homes for Older People Page 23 of 35 Evidence: them to do anything for us. All deteriorated equipment, such as commode chairs have been disposed of and replaced. Staff have been advised of the risks associated with communal use of items used in care and all items such as jars of topical creams were named for a resident and kept with them. Where residents shared rooms, there were clear systems to distinguish their personal items, including toiletries. We observed that in one double room, whilst residents wash bowls were named, the names were coming off and advised that they be regularly reviewed and re-named so as to ensure that each residents own bowl was clearly marked with their name. One person commented that the home could do with more hoists/slings, however another person commented we have equipment we need. The laundress reported that hoist slings were regularly laundered. Mrs Swainson reported that most people who always needed to be moved using a hoist now have their own named hoist sling allocated to them and that the provider is regularly purchasing hoist slings, with the aim that all residents will have their own sling allocated to the during the next few months. The provider has invested in other equipment to meet resident needs, including profiling beds, for people with complex manual handling needs. Mrs Swainson reported that the provider is purchasing a few of these beds each month. The home has sitdown disabled showers and assisted baths with integral hoists. This means that people who are unable to bend at the waist or the knee may find using such baths complex. We discussed bathing facilities with Mrs Swainson and she reported that the provider is considering a range of different ways of improving bathing facilities for people with complex bathing needs. The home only has one washer disinfector for sterilising of sanitary items. Mrs Swainson reported that the provider is currently looking at a range of different options, so as to provide a second washer disinfector. At the last inspection, we inspected the kitchen and it was reported that they had a good supply of equipment and cooking utensils. The kitchen appeared clean and well managed. We observed that the kitchen floor was stained and showing signs of age. Plans still need to be developed for its improvement before it deteriorates further. We met with the laundress, who reported that all staff follow the providers policies and procedures on the management of infected and potentially infected laundry. One person commented on the good laundry, although sometimes clothes get lost. As at the previous inspection, the laundress continues to re-sort used linen in the laundry. This is not regarded as good practice. Mrs Swainson reported that she is looking at a Care Homes for Older People Page 24 of 35 Evidence: range of options to ensure that used linen can be sorted at source, in accordance with good practice guidelines. We discussed un-named clothes with the laundress and she reported that this was generally not a problem, apart from socks and tights. The laundress reported that all net underwear was now named, but that this was more difficult with socks and tights and while staff had used named net bags for a period, this had now lapsed and staff tended to take items from a container to use for residents, at need. Communal use of socks and tights can lead to a risk of crossinfection, particularly fungal infection, as well as not up-holding a persons dignity. Practice in this area needs to be revised. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by a team of staff who have been safely recruited and are trained in their roles. Evidence: We discussed staff with people and observed staffing levels during the inspection. We noted that there was always at least one and often more than one member of staff available in both sitting rooms to support residents. Everyone we spoke to, including staff, reported that they felt there were enough staff on duty to meet residents needs. One person commented the staff are always cheerful and helpful. Peoples comments in surveys varied. One person commented response to calls for assistance often slow. and another temps dont always know what to do, however another person reported the staffing levels are high and another staff are well presented, knowledgeable and have a very interactive, caring relationship with [my relative]. The home could show that it actively reviews response times to call bells and takes action if response times fall outside their baseline of a two minute response. Records showed that the use of temporary staff was low. We reviewed systems for recruitment of staff. Since the last inspection, a new administrative person has been appointed and part of their role is to ensure that staff recruitment files are fully maintained and include all required information. All of the staff recruitment files we looked at were tidily kept and easy to audit. All staff files Care Homes for Older People Page 26 of 35 Evidence: included police checks, a full employment history, proof of identity, two satisfactory references and a health status check. We observed as good practice that the home are in the process of introducing an interview assessment tool to assess prospective employees suitability for their role. For one person there was evidence that the home had checked their address but a copy had not been kept on file. For another person, the home had not documented that they had verified the capacity a referee had known the person in. All staff files included the persons job description. It is recommended that the employee and employer both date and sign the persons job description to verify that both parties have read and understood the persons role. The home has clear systems for checking registered nurses pin numbers with the Nursing and Midwifery Council. We met with the training manager and reviewed training records, as well as discussing training with members of staff. The home has clear systems for induction of new members of staff. All staff complete a core induction over six weeks, on commencement of employment. New members of staff are allocated to a mentor to support them during this period and as much as possible they are placed on the same shift as their mentor. Staff work supernumerary for between two and four weeks after taking up their role, depending on their individual circumstances. Staff who are going to work nights always work on day shifts for a month before going on to permanent night duty. Induction records seen were clearly working documents with different dates and signatures relating to areas covered. At the end of the induction, new members of staff receive a supervision and their programme is signed off. Mrs Swainson and the training manager reported that the induction programme remained under continual review and could be further developed as and when indicated. A training matrix has been developed since the last inspection. This enables managers to see at a glance who has done which training and when up-dates are due for individual members of staff. The provider is supportive of NVQ training. Records showed a wide range of training undertaken since the last inspection. Such training, as well as mandatory training, has included record-keeping, dementia care, safe use of bed rails and prevention of pressure ulceration. More than one member of staff reported to us that they were paid to attend mandatory training, but not paid for other training to support them in developing their role, which they found difficult. A carer reported that they had attended an activities course and had found this very useful in extending their knowledge in the importance of the area. Discussions with staff indicated that some staff have attended certain external courses and have then cascaded information to staff. This is not documented and it should be to facilitate development of the homes training plan. Specific training as been provided when needed. For example the new activities person is booked to attend a course in the Care Homes for Older People Page 27 of 35 Evidence: area in the near future. A registered nurse reported that they had recently attended an assertiveness training course to support them in their role. At the random inspection, we identified that two members of staff lead on wound care and were required that staff who take on such roles attend external training by a relevant practitioner with accredited expertise, to support them in their role. The requirement identified at the previous inspection is not yet due. We also discussed that a useful approach to training and staff development is for people to be encouraged to take on specific areas of interest for them, such as infection control, stoke care or diabetes, these people can then become lead practitioners in such areas on behalf of the home and can ensure that people are supported in developing their understanding of such areas when caring for residents. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be supported by the homes management and administrative systems, which ensure the health and safety of people. Evidence: Goatacre Manor is managed by Mrs Swainson, who is an experienced manager and registered nurse. Both Mrs Swainson and her staff are open to developing new ways of providing care and staff supports. Since the last inspection, Mrs Swainson has been supported in developing practice in the home, modernising the homes approach to the provision of nursing and care. She has succeeded in making improvements across a wide range of areas, within a short period of time, so that the home are now judged to be providing good outcomes to residents. Since the last inspection, full systems have been put in place for audit of a range of areas, including medicines management and care planning. Mrs Swainson has performed several unannounced night visits to the home to review care provision at night and to support staff. The home now reviews response times when residents use Care Homes for Older People Page 29 of 35 Evidence: their call bell. Mrs Swainson reported that they aim for and are achieving, a response time of under two minutes from when a resident uses their bell. As documented in Health and Personal care above, there continue as would be anticipated in a service which had been subject to change, to be issues with consistency in approach to documentation. This is an area which will need regular audit, to identify issues with documentation, and staff who may need more support. There are full systems in place for safe management of residents moneys. The homes training matrix provides evidence of staff training in mandatory areas relating to health and safety, including fire safety, manual handling and infection control. Since the last inspection, the home have developed and improved their approach to the use of bed rails, so that rails are used safely and in ways which protect residents from harm. The maintenance man reported on how they regularly check all rails. A carer reported on how useful they had found recent training in bed rails and that they now understood the risks as well as any benefits presented by bed rails. The maintenance man reported on and showed us records for checks on hot water temperatures and reported on actions they took if records showed that water temperatures were outside safe levels. We observed several staff performing manual handling, where residents were not able to move themselves independently. We observed all staff performing such practice in a safe manner, explaining that they were doing to the resident and ensuring the persons privacy was upheld throughout the procedure. As noted in Environment above, practice in relation to communal use of residents underclothing does not fully up-hold principals of infection control. Care Homes for Older People Page 30 of 35 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 30 18 Where staff, including carers, 30/07/2010 are reguarly involved in performing wound care, there must be evidence that they have been recently trained by a person with accredited expertise in the area. This requirement is not yet due. Correct performance of wound care is a key area, therefore anyone who performs such dressings must be trained by a person with accredeted expertese in the area. Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 12 Systems for audit of care 26/02/2010 planning and documentation must ensure that all records are completed in accordance with the homes policies and procedures. This is to ensure that the home can demonstrate that all residents have received the nursing and care that they need. 2 38 13 Systems must be put in place to prevent the communal use of socks and tights. Communal use of socks and tights can present a risk of cross-infection. 26/02/2010 Care Homes for Older People Page 32 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Where a persons condition is changing, reviews of care plans should take into account all information in peoples daily records. Where a person needs thickening agent in their drinks to enable them to swallow safely, their care plan should always state how thick they needs their drinks to be. Care plans relating to diabetic management should always be completed to the same standard and clearly state actions to be taken by staff if the persons blood sugar levels are outside their anticipated parameters. Where a person is at risk of pressure ulceration, their care plans should always state how often they need to be moved. Records should be available at all times to show that the person has been moved in accordance with such directives and that settings on air mattresses are at the correct level indicated by their care plan. Care plans relating to urinary catheters should always state the clinical indicator for the catheter, how personal care is to be performed in the light of the catheter and when their catheter bag needs to be changed. The provider should perform a review of residents and their supporters opinions of meals provided in the home, to identify if there are any trends in opinions about meals, which they may need to take action on. The provider should further consider providing bathing facilities for people with complex disability needs. Used laundry should be separated at source, not in the laundry. The kitchen floor should be improved, before it deteriorates further. Systems should be put in place for regular review of residents wash bowls, to ensure that they continue to be clearly named with their residents name. The provider should continue to develop plans for a second washer disinfector in the home Job descriptions should be signed and dated by the employee and employer Records should be made of when staff have cascaded Page 33 of 35 2 7 3 8 4 8 5 8 6 15 7 8 9 10 20 26 26 26 11 12 13 26 29 30 Care Homes for Older People 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 information on from external courses to other members of the staff team. Care Homes for Older People Page 34 of 35 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. 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