Care Home: Green Gables Nursing Home

What the care home does well Under the heading of `what the home does well, a residents commented, ` I would have to go a long way to find a better home than Green Gables,` and another recorded, `the home does most things well. The home is not new, but the staff always present it in the best manner`. All the residents, who completed surveys, confirmed that the home always makes sure they get the medical care they need, and a relative commented, `my relative has been bed bound for four years and has never had a bed sore.` The home cares for the residents well and comments from relatives included, `the quality of the care is the thing the home does best, and it would appear to be very satisfactory`, `the home looks after my relative very well and he is very happy`, and `my relative has been very happy with their placement at Green Gables, she receives such wonderful care and respect.` A variety of social activities and entertainment, the promotion of relatives` involvement in the lives of the residents, and the provision good quality and nutritious meals meet the residents` needs. A resident, who received a soft diet, commented in the survey they completed, `the food is nicely presented. One resident, who was a vegetarian, stated they were well catered for and that, `the food is excellent`. One relative commented on what the home does well, `It provides good quality meals and gives assistance to those who are unable to feed themselves.` The majority of the carers had either completed a National Vocational Qualification or were working towards one, and the home ensured that other staff were given the opportunity to work towards a qualification to support them in their roles. A relative commented in the survey they completed on behalf of a resident, `the home`s main asset would be the staff. Whenever we visit our relative, they are clean, tidy and wellpresented. The staff are very caring and dedicated,` and another recorded, `the staff are always cheerful and have time for the residents, even if they are short of staff`. A health care professional commented in the survey they completed, `the staff are very professional, polite and helpful.` What has improved since the last inspection? Since the previous site visit, care plans had been personalised and included more information about the likes and dislikes of the residents, how they prefer to spend their time, and their preferences with respect to the routines of daily living. A social and working life history of the individuals, referred to as a `Tree of Life` had been collated with the residents and/or their relatives, to promote the understanding of the staff and to aid reminiscence with the residents. Lockable facilitities had been provided in residents` bedrooms, in which to store valuables, and risk assessments had been completed with respect to the provision of keys to bedroom doors. An appropriate facility for the storage of controlled medications had been purchased for their safe storage. The bathroom on the top floor is now in use and a bath hoist is available for the convenience of the residents, and doors had been provided so that the residents would not be able to view the sluice areas on their way to the bathrooms. Since the previous site visit, a maintenance person had been employed, and maintenance records confirmed that work had been undertaken on a weekly basis to ensure immediate issues had been attended to. Staff recruiment had improved and the home was making sure that applicants did not start work before important checks had been received for the protection of the residents. A development plan and a rolling programme of repair and maintenance had been completed, with timescale to confirm that the new build project would be completed in phases so that the residents would be disturbed as little as possible, and to confirm that the whole home would benefit from modernisation for the comfort and enjoyment of the residents. Visits on behalf of the provider are being carried out and reports are available to the manager with planned actions as a consequence. What the care home could do better: More information about the ability of the home to cater for the specialist dementia needs of prospective residents, including staff training, and of how the accommodation has been adapted to meet the need of people with dementia, would be helpful to prospective residents and their representatives in deciding if the home is able to meet their needs. Currently, there are only eight single bedrooms, which means that thirty residents have to share bedrooms, not always from choice. The manager wrote in the AQAA that one of the things the home could do better was, `to further develop our activity programme to include more dementia orientated activities and to get the staff to be more involved with the day-to-day activities rather than only the personal and nursing care.` Some relatives and staff thought the thing the home could do better was to provide more staff. Comments included, `the home needs more staff to attend the residents, they are always in a rush and they are not given enough time to enjoy their breaks`, and `more staff are needed`. Key inspection report Care homes for older people Name: Address: Green Gables Nursing Home Church Lane Grayshott Hampshire GU26 6LY     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: Christine Bowman     Date: 2 9 0 1 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Green Gables Nursing Home Church Lane Grayshott Hampshire GU26 6LY 01428604220 01428604220 matron@greengablesmatron.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Downing (Green Gables) Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Green Gables Nursing Home is situated in the village of Grayshott on the Hampshire/Surrey border. It is a large detached house, accessed from the road via a lane, and a short drive, and there is a large car park to the rear of the building. The home was originally purpose-built as a nursing home. Grayshott village offers shops, restaurants, cafes, public houses and other local amenities and is within easy walking distance of the home. Accommodation is over three floors, and a passenger lift is provided to enable access to the first and second floors. Currently the home offers eight single and fifteen double bedrooms to residents. A building project to improve the accommodation, by making some of the double rooms into singles, adding extra ensuite single bedrooms and providing a new lift, has been approved and work is scheduled to begin by June 2010. The home provides nursing care to thirty eight people with dementia, who are sixty five years of age and over. Care Homes for Older People Page 4 of 31 Over 65 38 38 38 0 0 6 0 3 2 0 0 9 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 inspection report includes information gathered about the service since the previous site visit on 6th March 2009. An improvement plan was submitted showing the actions the home had taken to comply with the requirements made at the previous site visit. An Annual Quality Assurance Assessment (AQAA) was completed by the manager, and returned within the required timescale, giving up to date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service, and of their plans for further improvements. Nine people living at the home completed surveys, some with support from relatives or staff, giving their views on the service. Six staff members and one healthcare professional also completed surveys giving their views on the service provided. An unannounced site visit, conducted on 30th January 2009, was completed over six hours, commencing at 11:00am, to assess the outcomes of the key inspection standards for older people with respect to the people living at the home. The registered manager, Mrs Marguerite Lydon, assisted with the inspection process by making Care Homes for Older People Page 5 of 31 residents files, staff files, quality assurance documentation, the service user guide, the statement of purpose, the business action plan, the maintenance programme and records, reports of visits made on behalf of the provider, and other documents and records available to be sampled. We sampled six bedrooms and the communal living areas of the home and spoke with three residents and observed and spoke with two of the staff as they carried out their duties. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? Since the previous site visit, care plans had been personalised and included more information about the likes and dislikes of the residents, how they prefer to spend their time, and their preferences with respect to the routines of daily living. A social and working life history of the individuals, referred to as a Tree of Life had been collated with the residents and/or their relatives, to promote the understanding of the staff and to aid reminiscence with the residents. Lockable facilitities had been provided in residents bedrooms, in which to store valuables, and risk assessments had been completed with respect to the provision of keys to bedroom doors. An appropriate facility for the storage of controlled medications had been purchased for their safe storage. The bathroom on the top floor is now in use and a bath hoist is available for the convenience of the residents, and doors had been provided so that the residents would not be able to view the sluice areas on their way to the bathrooms. Since the previous site visit, a maintenance person had been employed, and maintenance records confirmed that work had been undertaken on a weekly basis to ensure immediate issues had been attended to. Staff recruiment had improved and the home was making sure that applicants did not start work before important checks had been Care Homes for Older People Page 7 of 31 received for the protection of the residents. A development plan and a rolling programme of repair and maintenance had been completed, with timescale to confirm that the new build project would be completed in phases so that the residents would be disturbed as little as possible, and to confirm that the whole home would benefit from modernisation for the comfort and enjoyment of the residents. Visits on behalf of the provider are being carried out and reports are available to the manager with planned actions as a consequence. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 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 9 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. Prospective residents are supplied with most of the information they need to make an informed decision about moving into the home. The home ensures that prospective residents individual needs are assessed and that a care plan is compiled to show how their needs will be met at the home. Evidence: Since the previous site visit, the statement of purpose (SOP) had been reviewed and updated and the contact details of the Care Quality Commission had been included to inform the residents, their relatives and staff. This information had not been updated in the Residents Handbook, which referred to the regulator as the Commission for Social Care Inspection and gave out-of-date contact details. A relaxed, secure and homely environment was promised, where residents would be respected and supported to live a full and active life, free from discrimination. Colourful photographs of the exterior and interior of the home, showed the dining room with tables set with table cloths and flowers, specialist beds in the bedrooms, comfortable chairs and a Care Homes for Older People Page 10 of 31 Evidence: widescreen television in the lounge, and garden furniture and colourful borders of flowers in the garden. The AQAA recorded that the information about the home was available in large print to facilitate access to people with visual impairment. Some reference was made in the SOP to the activities programme being designed with guidance from recognised bodies such as the Alzheimers society, but more information is required to inform prospective residents and their representatives of the staff training and qualifications to support people with dementia, and of how the environment is adapted to support this specialist need. The SOP includes a heading of The number, relevant qualifications and experience of the staff working at the home and the organisational structure, but does not give the number, confirm that any of the staff have had any specialist training or experience to work with people with dementia, or give any details of the organisational structure. However, eight of the nine residents, who completed surveys, confirmed that they received enough information to help them to decide if this home was the right place for them, before they moved in. The manager stated that she carried out pre-admission assessments of prospective residents, by visiting them in their current accommodation, observing, discussing with members of the multi-disciplinary team and asking the prospective resident about the type of support and help they need and want. Two residents files sampled confirmed that pre-admission assessments had been carried out covering prospective residents personal care needs, social and psychological needs, cognitive state, orientation, memory, dietary, mobility, continence, sleeping pattern, communication, hearing, eyesight, medication, hobbies, social/family/work history, preferred activities, likes, dislikes and special needs/adaptations. The admissions process described in the AQAA included, inviting prospective residents and their representatives to spend a day at the home and join the other residents for a meal, to observe or join in the activities undertaken with the residents and to gain first hand experience of what life is like at Green Gables. The home does not provide intermediate care. Care Homes for Older People Page 11 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 address the residents health and personal care needs and safe arrangements are in place for the handling of medication to protect the residents. Residents are treated with respect and their dignity is maintained. Plans are in place to improve the access to single bedrooms to improve the residents right to privacy. Evidence: Since the previous site visit, care plans sampled had been personalised and included important information such as the time residents like to go to bed, how they prefer to spend their time, and their preferences with respect to the routines of daily living. One resident liked to go to bed at 9.00pm and listen to the radio, another liked talking and sitting in the garden, and another enjoyed folding table napkins. Dietary preferences and special requirements were recorded and one residents favourites were lasagne, spaghetti bolognaise and scrambled eggs with cheese. Another resident required pureed food because they experienced swallowing difficulties. A resident, who received a soft diet, commented in the survey they completed, the food is nicely presented. In the care plans sampled, a social and working life history of the individuals, referred to as a Tree of Life had been collated with the residents and/or their relatives, to Care Homes for Older People Page 12 of 31 Evidence: promote the understanding of the staff and to aid reminiscence with the residents. Records confirmed that reviews had taken place on a monthly basis and had been signed by residents or their representatives to confirm acceptance. Residents care needs had been recorded, from their basic background details to the personal support required by individuals to assist with dressing and with mobility needs. Nutritional screening (MUST), weight records and fluid charts were kept of all residents and monitored on a monthly basis for any changes, to ensure residents would not become dehydrated, suffer from malnutrition or obesity. A full range of nursing assessments were in place to guide staff and to help reduce the possibility of accidents with respect to falls and mobility issues, and to ensure that individuals mental healthcare needs had been monitored. The manager wrote in the AQAA, the care plan focuses on independence as far as this is possible and strives to encourage the resident to optimise their abilities to reach their full potential. The AQAA recorded that four residents were bedfast, but no resident had developed pressure sores over the previous twelve months. A relative wrote in a survey they completed on behalf of a resident, my relative has been bed bound for four years and has never had a bed sore. One resident had been admitted with a pressure sore, and records, including daily notes, confirmed that the General Practitioner (GP), district nurse and tissue viability nurse had been involved in their treatment. Special mattresses were provided for the prevention of pressure sores. The manager stated that a local G P visits weekly, but residents can remain with their own GP if they wish. Other community specialists to whom residents had been referred, included a speech and language therapist, physiotherapist, dietitian, occupational therapist, psychiatric services and hospital consultants. A chiropodist visits the home every six weeks, the community dentist carries out annual checks and an optician visits annually on request, the manager confirmed. Eight of the nine residents, who completed surveys recorded that they always receive the care and support they need, and one that they usually did. All the respondents confirmed that the home always makes sure they get the medical care they need. Comments included, the quality of the care is the thing the home does best, and it would appear to be very satisfactory, the home looks after my relative very well and he is very happy, and my relative has been very happy with their placement at Green Gables, she receives such wonderful care and respect. Medication administration records, sampled, had been completed in a satisfactory manner, showing that residents had received the required dosage of their prescribed medication, as set out by their medical practitioner, and there were no unexplained Care Homes for Older People Page 13 of 31 Evidence: gaps in the recordings. Medication records included photographs of the residents to ensure correct identification and to reduce the risk of medication errors. The registered nurse responsible for the administration of medication on the day of the site visit stated she had received the training to undertake this task, for the safety and protection of the residents. A list of the signatures and initials of the nurses responsible for the administration of medication were kept on record for identification purposes. Controlled drugs were stored in a locked metal cupboard, appropriately secured to a wall, and a random sample of residents controlled drug stock confirmed that the controlled drug register was correct. Records were kept of medication received and the AQAA confirmed that there was a contract with a specialist disposal service for the disposal of drugs and sharps. Records confirmed that new staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual, with respect for their privacy and dignity. Four of the six staff members, who completed surveys recorded that their induction covered everything they needed to know to do the job when they started, and one that it mostly did. On the day of the site visit, staff members knocked on residents doors before entering, were respectful and caring in their interactions, and listened patiently when residents spoke to them. Some residents shared their bedrooms, and screens were available to protect their privacy and dignity during personal care, and when health professionals visited them. Confidentiality is not protected in this situation, but a space for private meetings was available should this be required, the manager stated. One residents relative wrote in a survey, it would be much better if my relative had a bedroom of their own because their sleep is disturbed when sharing a room. Plans are in place to increase the number of single rooms and to build some new single rooms with ensuites. Currently, there are only eight single bedrooms, which means that thirty residents have to share bedrooms, not always from choice. Since the previous site visit, residents had been provided with a lockable facility in their bedrooms in which to store valuables, and risk assessments had been completed with respect to the provision of keys to bedroom doors. Care Homes for Older People Page 14 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. A variety of social activities and entertainment, the promotion of relatives involvement in the lives of the residents, and the provision good quality and nutritious meals meet the residents needs. Evidence: Activities at the home are arranged by an activities coordinator who works eighteen hours a week. She was not available to be interviewed on the day of the site visit, but the activities schedule for the month was displayed on a notice board for the residents to view. Regular weekly visits from a hairdresser and manicures were recorded as a pamper days and sometimes included knit and natter or shopping after lunch. Quizzes, bingo, sing-a-longs, flower arranging to brighten the home, reminiscence therapy and games also featured regularly on the schedule. Some activities such as bingo and quizzes were followed by a glass of sherry. Cookery, craft, active fun and games, church service, outside entertainment, and one to one reviews of the weeks current affairs, also undertaken with residents in their rooms, were also included for the residents stimulation and enjoyment. The home has its own activities room with equipment for arts and crafts as well as games. Along the corridors were photographs of the residents engaging in activities and social events, and some of the results of their creative endeavours were framed and displayed to enhance their self-esteem and Care Homes for Older People Page 15 of 31 Evidence: confirm that their work was a valued contribution to the community. The AQAA recorded that. themed lunches, tea parties and suppers for special days such as St Patrick, St George and Halloween, are arranged, and coffee mornings, raffles, pantomimes, music concerts, are enjoyed by all. We arranged a full Christmas Programme during December with concerts, pantomime, Christmas party, bell ringers and local school choirs. Religious services were included in the activities schedule and the manager stated that, arrangements can be made for people to attend other religious services locally if they wish. Six of the nine residents, who completed surveys, recorded that the home always arranges activities they can take part in if they want to, one that they sometimes did and two did not feel this question was applicable to them. One relative wrote in a survey they completed on behalf of their relative that activities was something the home did well, they provide entertainment each week and seasonal activities, another relative thought this was an area that could be improved upon and wrote, activities are sparse and generally on a group basis. They could be more imaginative in one to one time with residents, according to their needs and likes. The manager wrote in the AQAA that one of the things the home could do better was, to further develop our activity programme to include more dementia orientated activities and to get the staff to be more involved with the day-to-day activities rather than only the personal and nursing care. Improvements over the previous twelve months had included more one-to-one sessions with residents and more involvement with relatives in compiling the Tree of Life information available to promote reminiscence. Plans were in place to provide a sensory room for the residents with dementia and to continue to improve and increase the choice and number of activities and outings for the residents, according to their choice and wishes. The statement of purpose welcomed visitors and encouraged them to visit at any time, and tea or coffee were offered, either in residents rooms or in one of the communal lounges. With a little notice, it was possible for relatives and friends to enjoy a meal at the home with the residents. The visitors book confirmed that residents regularly entertained relatives and friends and comments made by them in the book provided for this purpose confirmed their satisfaction with the friendliness of the staff and the welcome at the home. One resident spoken with stated that they go to a day centre twice weekly and socialize, take part in quizzes, games and enjoy talks by visiting speakers. The resident stated, I particularly enjoy the tea dances, and despite being a wheelchair Care Homes for Older People Page 16 of 31 Evidence: user, I am able to join in the dancing. They also stated they enjoyed clothes and jewellery and confirmed they were able to go shopping in Greyshott, or buy from a mail order catalogue. Other outings this resident enjoyed included visiting local garden centres. They also confirmed they were able to take a bath in the morning or in the evening. The four week menu included fruit and vegetables and a vegetarian choice, and gave the residents a choice of an English cooked or a Continental breakfast. A selection of homemade cakes was offered in the afternoon with tea, in addition to the three full meals, and hot and cold drinks and snacks available on request at all times. One resident, who was a vegetarian, stated they were well catered for and that, the food is excellent. Four of the nine residents, who completed surveys, confirmed that they always liked the meals and three that they usually did. One relative recorded that their relative received a special pureed diet. The manager wrote in the AQAA, meals can be taken in residents own rooms or in the dining room. The staff assist people discreetly and sensitively with their meals, whilst chatting with them, and promote independence for as long as possible. One relative commented on what the home does well, It provides good quality meals and gives assistance to those who are unable to feed themselves. 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. Residents are confident they will be listened to, should they express concerns, and a satisfactory procedure is in place to deal with complaints, should they arise. Improvements in the recruitment of staff, protects the residents from being supported by unsuitable staff. Staff have access to suitable training for the protection of the residents. Evidence: The homes complaints procedure was displayed in the entrance hall and available in the statement of purpose and the residents handbook. A timescale of twenty-eight days was given to report back the findings of any formal investigation to the complainant. The correct contact details of the Care Quality Commission were included in the statement of purpose, but these had not been updated in the residents handbook. The AQAA recorded that two complaints had been received over the previous twelve months and that they had both been upheld and resolved within twenty-eight days. Records confirmed that the complaints had been managed in a timely manner. All the residents, who completed surveys, recorded that there is someone they can speak to informally if they are not happy, and eight of the nine respondents confirmed they knew how to make a formal complaint. The home welcomes comments from visitors and a book provided for this purpose contained a number of compliments. Some of the comments, included; sincere thanks to you for the loving kindness and attention you gave to my relative, the kitchen staff Care Homes for Older People Page 18 of 31 Evidence: deserve a pat on the shoulder, I have so many years of your care to thank you and a number of your lovely staff members for. The friendliness of everyone is very notable, the professional attention of the staff is comforting, I have the utmost admiration and respect for the care and devotion, which you and your staff have given to my relative and all the residents, and thank you for making my mother comfortable and secure in the last years of her life. The home has Department of Health literature on protecting vulnerable adults, called No Secrets and a copy of the local authority adult protection procedures. The manager holds a certificate to train staff in the protection of vulnerable adults after, completing a course run by Action on Elder Abuse, and a booklet and card giving the staff important information and helpline details had been distributed to them. The staff training matrix showed that nine staff had received this training in the previous six months, and that training was planned for a further five staff within the next month. The development plan confirmed that the remainder of the staff, including the nursing and ancillary staff would receive this training within the next two months for the protection of the residents. Improvements had been made to ensure the recruitment of new staff had been carried out safely, since the previous site visit, for the protection of the residents. There had been no safeguarding referrals since the previous site visit. Small amounts of money were held in safekeeping at the home on behalf of residents. Suitable secure storage was provided for residents monies, and recorded balances agreed with samples taken. 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. Residents live in a comfortable, safe and well-maintained home, which fulfils their needs and is clean, fresh and odour free. Evidence: The home is a detached, three story building, which had originally been built as a nursing home. It was located close to the centre of the village and residents spoke of shopping and using other local amenities in the village. The lane leading from the road to the homes drive was full of deep holes, which the manager confirmed would be attended to as soon as the weather improved. There was a large car park to the rear of the home and a garden with flower beds and shrubs, which was mainly laid to lawn at the side and front of the building. Garden furniture was provided for the residents to use in the warmer weather. A vase of flowers on the hall table in the entrance hall was welcoming, and the area had been recently redecorated, and domestic lighting had been provided to make it more homely. Communal areas included a dining room, furnished with tables, covered with table cloths and small vases of silk flowers, set for three or four residents, and solid wooden chairs. There was a view of the shrub bordered drive from the double French windows. At one end of the room was a sitting area with comfortable chairs and occasional tables, which the manager stated was used as a quiet area, where residents could meet with their visitors. A book shelf, full of books and ornaments, a Care Homes for Older People Page 20 of 31 Evidence: large mirror over the fireplace and framed pictures made this space homely. A hatch and door led to the kitchen, which the manager stated, had been recently updated and supplied with modern equipment. A recent visit from the environmental health officer had awarded the home an excellent rating for cleanliness. Another large lounge had a conservatory attached, and a number of residents were enjoying the light and airy space. This area had been provided with comfortable chairs, a television, nice carpets and plants for the residents enjoyment and entertainment. The large lounge had clusters of chairs, a large flat screen television, video player, music centre, a DVD player and compact discs and videos for the residents entertainment. Covered jugs of cold drinks were available to ensure the residents did not become de-hydrated. Some residents were reading newspapers. Domestic wall lights made this room more homely. Along the corridor was the activities room, equipped with art and craft materials, games, musical instruments, and puzzles. Displays of work completed by the residents covered the walls and ledges. There were pained ornaments, mobiles, wind chimes and framed photographs of residents involved in activities such as cooking and enjoying visiting entertainers A lift was available to access the upper floors, and the carpet in the corridor of the first floor had been replaced since the previous site visit, the manager stated. Since the previous site visit, a maintenance person had been employed, and maintenance records confirmed that work had been undertaken on a weekly basis to ensure immediate issues had been attended to. The bathroom on the top floor is now in use and a bath hoist was available for the convenience of the residents. The middle floor has two bathrooms each with an assisted bath and the ground floor also has a bathroom with an assisted bath. Some of the bedrooms viewed had been personalised with residents personal items, photographs and bedside lamps to make them more familiar and homely, but some of the double bedrooms did not have a homely feel. They had been provided with the necessary furniture, but some did not match, and some of the beds looked old and in need of replacement. Since the last site visit, residents had been provided with a lockable drawer in their bedrooms, in which to store valuables, and risk assessments had been carried out with respect to offering keys to their bedroom doors. The AQAA recorded that, plans have been passed by East Hants District Council, which will enable us to convert our existing double rooms into single en-suite rooms and the building of additional rooms, keeping the same number of rooms overall, plus Care Homes for Older People Page 21 of 31 Evidence: an extension to the kitchen and the laundry room and for the provision of a new lift. In addition, the home will undergo a complete refurbishment programme with new furniture and fittings for all of the rooms. The manager stated that the environment would be more personalised and painted in brighter colours, that the corridors would be made into lanes, streets, closes, terraces, and bedroom doors would be painted in colours of the residents choice and door knockers and letter boxes will be added so that the residents bedroom door becomes their house on the street. The plans for the proposed new build were inspected and they clearly showed that there would be a separate entrance to the sluice rooms from the corridor when the new build was completed. In the meantime doors had been provided so that the residents would not be able to view the sluice areas on their way to the bathrooms. The plans also confirmed the start date for the new build to begin and showed how the work would be phased in to affect the residents as little as possible. The home was clean and smelt fresh throughout on the day of the site visit. Five of the nine residents, who completed surveys, recorded that the home was always clean and fresh and three that it usually was. The laundry was quite small, but plans were in place for an extension, as observed in the building plans. All the necessary equipment for laundering the residents clothes was provided and one relative commented, clothes are always checked, washed, folded and returned to the residents own wardrobe, and the beds are always immaculate. The AQAA recorded that the home had an action plan to deliver best practice in the prevention and control of infection, and that three staff had received training in the prevention and control of infection. A report on a recent visit on behalf of the provider confirmed that plans were in place for more staff to receive this training. Gloves and aprons were available for the protection of the residents and staff, when carrying out nursing interventions and personal care, and liquid soap and paper towels were provided at all hand washing facilities sampled. Care Homes for Older People Page 22 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. The residents receive safe and appropriate support because recruitment checks are completed to make sure the staff who support them are suitable, and they are cared for by well-qualified staff, who have access to relevant training to support their needs. Evidence: The AQQA recorded that a total of twenty one care and nursing staff were employed at the home, nine of which were part-time. One staff member was employed as an activities coordinator, another as an administrator and six staff were employed in catering, housekeeping and maintenance. The staff rota showed that five care staff and one or two registered nurses covered the day shifts, and three care staff and one general nurse covered working night duties. On the day of the site visit, observations confirmed that these staffing levels were maintained. The manager is also a registered general nurse and her working hours are additional to the above. Of the six staff surveys returned, no staff thought there were always enough staff to meet the individual needs of the people who use the service, three thought there usually were, two that there sometimes were, and one that there never were. Comments included, staffing levels could be better, as the clients deteriorate, caring becomes harder and takes more time, and you cannot hurry when caring, we could do with a cook to do the suppers, instead of taking a care assistant off the floor to deal with the kitchen, and we need two domestic staff to do the cleaning. Relatives Care Homes for Older People Page 23 of 31 Evidence: also thought that one of the things the home could do better was to improve staffing levels. Three relatives commented in surveys, more staff are needed, and one relative commented on what the home could do better, the staff need more time to attend to the residents, they are always in a rush, and they are not given enough time to enjoy their breaks. The AQAA recorded that three staff had left the homes employment over the previous twelve months. The homes Business Action Plan confirmed that three overseas staff had been recruited, but were awaiting the return of recruitment checks, before commencing in post, that there was also a vacancy for a day time general nurse, and that the post had been advertised. The AQAA workforce report recorded that, of the eighteen permanent care workers, nine had achieved a National Vocational Qualification (NVQ) at level 2 or above in care or health and social care, which fulfils the fifty percent target to be achieved by April 2008. The staff training matrix recorded that five carers are also currently undertaking this qualification, and that the home had supported the administrator, the activities coordinator and kitchen and laundry staff to achieve appropriate NVQs. Two domestic staff were in the process of completing NVQs in hotel and catering. The AQAA workforce report also confirmed that seventeen of the eighteen care workers had completed an induction as recommended by TOPSSE England/Skills for Care. The common induction standards provide an introduction to the caring role and promote the residents rights to be treated as an individual with respect to their equality and diversity issues. Residents and their relatives were complimentary about the staff and commented in the surveys they completed, the homes main asset would be the staff, they are very caring and dedicated, the staff always respond to the challenge posed by an awkward and sometimes difficult resident with patience and good humour, and the staff are very friendly and obliging and always up to date whenever I ask a question about my relative. Following the previous site visit, an immediate requirement had been made, because recruitment procedures had not been followed. The homes action plan confirmed that action had been taken to ensure that no new staff would take up employment until all the necessary recruitment checks had been carried out. Three staff files examined, confirmed that Protection of Vulnerable Adults first (POVAFirst)/ Independent Safeguarding Authority (ISA) and Criminal Record Bureau (CRB) checks and references had been received prior to confirming the applicants in post. However, application forms had not been fully completed and much of the required information had been supplied in Curriculum Vitae (CV) format. Full employment histories with dates of commencing and leaving employment, and reasons for leaving were Care Homes for Older People Page 24 of 31 Evidence: recorded, and there was no evidence of gaps in employment. All this information should be required on the application form, signed and dated by the applicant, to confirm it is a true account. The staff training matrix showed that fire training had been updated in a timely way, but there were gaps in the training of some of the staff for moving and handling, food hygiene, safeguarding adults, infection control, health and safety, the administration of medication and first aid. The manager stated that mandatory training is carried out at induction for new staff and annually for all staff, and that some of the planned training had not taken place due to the transport problems caused by the snowy weather. A training plan was in place, confirming that all the staff would be appropriately updated over the next three months. Other training completed by the majority of the staff, and recorded in the training matrix, included dementia care to support the specialist needs of the residents. Some staff had received training in continence and catheter care, wound care, palliative care, managing swallowing difficulties, and the Deprivation of Liberty safeguards. Planned training over the next three months included person-centred care, diabetes awareness, the Mental Capacity Act, managing challenging behaviour, equality and diversity and appraisal training. Five of the six staff, who completed surveys, confirmed that they were being given training which is relevant to their role, helps them to understand the individual needs of the residents with respect to equality and diversity, and keeps them up-to-date with new ways of working. Care Homes for Older People Page 25 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. Improvements have been made in the management of the home, for the benefit of the residents, and further improvements are planned. Residents are consulted about the service provision and their opinions contribute to the development of the home. Systems are in place to promote the health, safety and welfare of the residents. Evidence: The registered manager is a registered general nurse with many years of experience of working with elderly people, and more than twenty years of management experience. She completed the registered managers award five years ago and is currently undertaking a Foundation degree in Health and Social Care, which includes a branch of leadership and management, the AQAA recorded. The manager stated that she had completed train the trainer refresher courses in safeguarding adults, the Mental Capacity Act and the Deprivation of Liberty Safeguards, to enable her to cascade this training to the staff team. She recorded that she had undertaken training in change management and dementia care, and keeps herself up to date with mandatory training, and by accessing up to date information from appropriate Care Homes for Older People Page 26 of 31 Evidence: websites on the internet. Recently, the provider company had engaged an operations manager to provide support to the manager and to carry out visits to the home their behalf. Reports viewed gave a full picture of outcomes for residents observed at the visits, any matters arising and actions to be taken as a result. Quality Assurance questionnaires had been competed by the residents and their representatives. The results had been fully collated and presented as a chart, which was posted on a notice board for all to see. The manager stated that the overall response was better than expected, and results showed high levels of satisfaction with respect to care, residents rights, and access to staff, services and facilities. The AQAA recorded that there were plans, to commence meetings with service users families to seek their opinions with respect to the running of the home. An annual development plan (Business Action Plan) had been completed showing planned improvements to the home for the benefit of the residents. This plan confirmed that the building regulations for the new build, to convert double rooms into single rooms and to provide extra privacy and dignity to the residents, had been submitted and that work was to commence in June 2010. A rolling programme of repair and maintenance had also been compiled, confirming that the home was being appropriately maintained in the meantime, and that some redecoration had been completed, and that carpets and other items had been replaced. According to the plan, all the upholstery fabric replacement would be completed by the end of the year to modernise the environment for the comfort and pleasure of the residents. The manger stated that she has an open door policy and is available to residents, their relatives and staff, to meet with her at any time. A relative commented in the survey they completed on behalf of a resident, the staff, and particularly the manager, have been very helpful when needed. Supervision records sampled, showed that staff had been regularly supported. The mangers stated that the registered nurses and senior carers provide this support to the care staff. Residents received financial support and assistance from relatives and advocates, but the manager does act on behalf of one of the residents in relation to their financial interests. Full records were kept. Small sums of money were held in safekeeping for the residents convenience at the home. Records were kept of monies held, and balances checked corresponded with those recorded, confirming safe practice to safeguard the residents interests. Although all the mandatory training was not up to date at the time of the site visit, Care Homes for Older People Page 27 of 31 Evidence: training plans confirmed dates for the completion of moving and handling, infection control, food hygiene and first aid to ensure the health, safety and welfare of the residents was promoted. Fire training was up to date for all the staff and a full fire risk assessment had been completed. The AQAA confirmed that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body for the safety and protection of the residents. Samples of certificates viewed on the day of the site visit were dated within the previous twelve months. The manager stated that the water was thermostatically controlled and a random test confirmed this was set at a comfortable temperature. Radiators were covered to protect the residents and chemicals were locked away in the COSHH (Control of Substances Hazardous to Health) cupboard. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 More information about the ability of the home to cater for the specialist dementia needs of prospective residents, including staff training, and of how the accommodation has been adapted to meet the need of people with dementia, would be helpful to prospective residents and their representatives in deciding if the home is able to meet their needs. To be sure there are enough staff to cater for the changing needs of the residents, the manager should undertake the residential forum, which is a tool designed to ensure the staffing levels are sufficient to meet the assessed needs of the residents. 2 27 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!