Care Home: Grey Gables

What the care home does well Staff knew what the needs of the people living in the home were and how they wanted to be cared for. Comments from the expert by experience included: `The staff at the home were very welcoming and there was a sense of a comfortable feeling and peaceful ambiance throughout the inspection. ` `All the residents said that the staff tried their best to meet their needs.` `All the residents were happy with the visiting and contact arrangements that they have with their families and friends.` `I have been informed by the residents that they were able to exercise preferences about the meals on offer. All residents that I spoke with said that the food was good and varied.` `In general, the attitudes of staff towards the residents were good and friendly.` People have access to a range of health care professionals to ensure that all their health care needs are met. The home has an open visiting policy so that people can see their visitors as they choose and can continue to maintain relationships that are important to them. There were systems in place to ensure people were safeguarded from abuse. People could personalise their own rooms to reflect preferences and tastes. Staff had undertaken training to enable them to care for people safely. What has improved since the last inspection? The systems in place for care planning and risk assessments had improved giving staff more robust information about how to keep people safe and meet their needs. People were being transferred safely and as they needed. Medicine management had improved ensuring people received their medication as prescribed. Practice at meal times had improved making it a pleasant experience for people. There had been further improvements to the environment enhancing the comfort and accessibility of the grounds for the people living in the home. The systems in place to ensure the service was improved on an ongoing basis for the benefit of the people living in the home had improved. What the care home could do better: Assessments should show how the home have decided they can meet the needs of individuals being admitted to the home. All risk management plans must be up to date so that people are kept safe. People should be cared for in their preferred way. Staff should ensure they show respect for the people living in the home at all times. Staff should follow the advice of health professionals to ensure that people`s health needs are met. The expert by experience commented: `I would suggest the home consult the residents to find out what activities and resources were needed in order to provide activities that were creative and meaningful.` Food records should be available to show people are receiving a varied diet. People should have knowledge of the complaints procedure so they can get any concerns addressed. Key inspection report Care homes for older people Name: Address: Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brenda ONeill     Date: 1 8 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 33 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 33 Information about the care home Name of care home: Address: Grey Gables 39 Fox Hollies Road Acocks Green Birmingham West Midlands B27 7TH 01217061684 01217062025 reception@greygables.org.uk www.greygables.org.uk Grey Gables Committee care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Date of last inspection Brief description of the care home Grey Gables is a care home, which is registered to accommodate up to 40 elderly people. It is close to public transport links. It is set in a large, extended property. The home is owned and run by an unincorporated registered charity, Grey Gables Trust, and representatives of the committee visit the home regularly. The home has a selection of sitting rooms and dining rooms and although the people living at the home may choose where they spend their time, they are grouped in units according to their level of dependency. The home has one double bedroom and the Care Homes for Older People Page 4 of 33 Over 65 40 0 Brief description of the care home rest are single rooms, the vast majority have en suite facilities. The home has ample assisted bathing facilities including one assisted shower. There are parking spaces at the front of the building and to the rear is a large, accessible and well-maintained garden. The homes main entrance has steps but there is a separate access point for people with mobility difficulties. The home has two passenger lifts that ensure all areas of the home are accessible. The most recent inspection report was on display in the home. The range of fees charged at the home were detailed as between three hundred and fifty and four hundred and seventy five pounds per week in the service user guide. Items not included in the charges include dry cleaning, hair dressing and telephone calls. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us, the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This is the second key inspection of this service this inspection year. It is recommended that this report is read in conjunction with the report from the previous key inspection which was undertaken on August 11th 2009. Due to concerns around the care planning, medicine management, risk assessments and manual handling practice that were raised at the last key insepction a random inspection was undertaken at the home in November 2009. This was to monitor the homes progress. During this visit we looked at care records, risk assessments, medicine management and observed staff interactions. The findings from this visit are included within this report. Care Homes for Older People Page 6 of 33 This inspection was carried out by two inspectors over one day. The inspecting pharmacist visited the home on a different day to look at the management of the medicines in the home. An expert by experience came with us on the inspection. Experts by experience are people who are or have used services we are inspecting. This experience makes them experts. Their role is to bring a different and independent view to the inspection process by working alongside inspectors observing and gaining the views of people who use the service. Four of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing three people living in the home for a period of 2 hours and recording their experiences at regular intervals. During the course of the inspection we spoke with five of the people living in the home, the manager and five staff to get their views on the home. We sent ten Have your Say surveys to people who live in the home and eight to staff. A total of eight were returned, six from people living in the home (some of which had been completed by relatives), and two from staff. These views have been included in the report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 33 Assessments should show how the home have decided they can meet the needs of individuals being admitted to the home. All risk management plans must be up to date so that people are kept safe. People should be cared for in their preferred way. Staff should ensure they show respect for the people living in the home at all times. Staff should follow the advice of health professionals to ensure that peoples health needs are met. The expert by experience commented: I would suggest the home consult the residents to find out what activities and resources were needed in order to provide activities that were creative and meaningful. Food records should be available to show people are receiving a varied diet. People should have knowledge of the complaints procedure so they can get any concerns addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 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. People have information to enable them to make an informed decision about whether they would like to live at the home. Pre admission assessments ensure people know their needs can be met prior to moving in. Evidence: The service user guide for the home had been updated and told people what they could expect from the service, what the fees were and what was not included in the fees, for example, hairdressing. The document was available in large print for those with impaired sight. Five of the six surveys returned to us before the inspection indicated that people had received enough information to help them decide if the home was the right place for them. The people spoken with during the inspection were satisfied with the service they were receiving at the home. Care Homes for Older People Page 11 of 33 Evidence: The pre admission process was looked at for three people who had been admitted to the home since the last key inspection. Records showed that the home had undertaken an assessment of two of the peoples needs. The assessment document for the third person could not be found. We were assured the assessment had been undertaken. This person did have an assessment undertaken by a social worker and there was a copy of this available detailing the individuals needs on admission. The homes assessment documentation covered the majority of the areas of individuals lives including such things as likes, dislikes and preferences and any general health needs. The assessment highlighted where people needed assistance and what they were able to do for themselves. The assessment did not include any summary or say how the decision had been made that the home could meet the persons needs. One of the assessments also included a record of a pre admission visit made by the individual to the home to see if they liked it. Two other people spoken with said they did not visit the home before going to live there. They said their son made all the arrangements for them. Staff told us they had visited the home but that they had forgotten. Staff had not made any records of the pre admission visits. The individuals were very content and described the home as smashing. The arrangements in place should ensure that peoples needs are known to staff before they are admitted to the home and that they can be confident they will be met. No evidence was seen that any reviews of the placements at the home had taken place after the four week trial period. It was confimred by the manager that these meetings had not taken place. The review meeting should take place to ensure that the people living in the home are satsified with the placement and feel that their needs are being met. It also gives the staff at the home the opportunity to raise any issues they may have with the placement. The home does not provide intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place did not ensure people received the care they needed in the way they wanted on an ongoing basis. The medicine management has improved to a safe standard. Evidence: People living in the home had care plans in place. These are an individualised plan about what the person is able to do independently and states what support is required from staff in order for the person to meet their needs. At the time of the random inspection in November we looked at four care plans. The care plans seen had been updated and included a lot more information about the individual needs of the people living in the home. Further details could have been included about peoples preferences and how their social care needs were to be met. We spoke with staff who were generally very knowledgeable about the needs of the people living in the home and how they liked their care delivered. On the whole what staff told us cross referenced to the care plans and what we observed during the visit. Care Homes for Older People Page 13 of 33 Evidence: However we were concerned that staff were not aware of one specific care need and this could lead to this person not having their needs fully met. At the time of this key inspection we looked at a further four care plans. On the whole the improvements in the details included had continued and some further progress had been made. For example, the care plans for peoples preferences in relation to how they spend their leisure time were much more detailed and should enable staff to ensure people lead fulfilling lives. Staff spoken with were generally very knowledgeable about the needs of the people living in the home and how they liked their care delivered. They were able to tell us what peoples likes, dislikes and preferences were. They were also able to tell us how the needs of one individual had changed recently, these changes were not detailed on the care plan. This should help ensure people receive their care as they want and need. One care plan we looked at was not fully completed in some areas. The individual concerned had had some issues with losing weight and although it was clear that these had been followed up with health care professionals there was no care plan in place for this persons diet and weight. The individual was being weighed and staff spoken with were aware of her needs in this area. The individual was spoken with and was very content and quite well. However there should be a plan in place for this to ensure all staff know how to meet the persons needs in this area. We noted two occasions where staff were not following the care plans in place. One persons care plan stated she liked to wear stockings and she was actually wearing pink socks. Another care plan stated the individual did not want to be checked at night. The instructions for the staff were to check every two hours. Records indicated that some night staff were checking the person throughout the night. These examples indicate that people do not always receive their care in the way they would like and this could lead to people becoming distressed. The expert by experience commented: All the residents said that the staff tried their best to meet their needs. All the files we sampled at the random inspection had updated risk assessments in place and these were much more robust. People had risk management plans in place for such things as falls, ongoing health concerns such as leg ulcers, manual handling, nutrition and challenging behaviours. At the time of this inspection the improvements Care Homes for Older People Page 14 of 33 Evidence: had been sustained and generally the risk assessments and management plans in place detailed how staff were to keep people safe. One of the manual handling risk assessments did not reflect the needs of the individual at the time. The person had specific handling requirements. Staff were able to tell us what these were and we observed the equipment they told us about being used during the SOFI obsevation. The changes needed to be updated into the risk assessment to ensure the person was moved safely on an ongoing basis. Some of the information on the care files could be quite confusing for staff. For example, individuals had management plans on their files. One of these stated the individual was prone to seizures it went on to indicate when staff should phone an ambulance. Further text implied staff could leave the person alone and was what was being done really necessary. This statement referred to the persons dementia and was very misleading. This could lead to this person not receiving the medical care needed when read with the information about seizures. The manager was to remove the management plans and ensure the appropriate details were put on the individual risk management plans to avoid any confusion. There was ample evidence on the records sampled that people had access to medical professionals as needed. Records showed people had visits from G.P.s, district nurses, chiropodists and opticians. There was evidence that where there had been concerns over a persons weight loss this had been followed up. One person had information on file that they had a mild infection diagnosed by an optician. There was an information sheet that clearly described how this could be easily treated. There were no records to show this had been followed. The managers were spoken with and were not aware of this. The person the information referred to was seen and spoken to and they appeared well. However staff must ensure they follow any medical advice given to ensure the well being of the people living in the home. One persons records indicated that they should be weighed weekly. There were no weight records since the end of the year. There was no specific reason noted as to why the person needed to be weighed weekly and they did not appear to be having any particular problems and had always been quite thin. However staff should ensure they follow instructions on individuals records to ensure their well being. The pharmacist inspection took place on a different day to the main inspection. It lasted two and a half hours. Five peoples medicines were looked at together with their medicines administration record (MAR) chart and care plans. The deputy manager was Care Homes for Older People Page 15 of 33 Evidence: present throughout the inspection. One person and one care assistant was spoken with. All feedback was given to the manager and deputy manager. The medicine management had improved since the last inspection. Four of the five requirements regarding medicine management were met. Storage of medicines was good. The home had changed pharmacy and the new trolleys supplied were kept in a clean and well ordered fashion making it easier to administer the medicines from. The home had installed a quality assurance system to check that the care assistants were administering the medicines as prescribed and records reflect practice. Whilst the system was time consuming it had raised the standard and this was commended. Appropriate action had been taken when the audits indicated that staff did not give out the medicines as prescribed. This had lead to the improved medicine management seen. The prescriptions were seen prior to dispensing and a copy taken to check the medicines and MAR chart received into the home. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. The care plans were still poor. They did not record all the clinical conditions and without such information it would be difficult for staff to fully support the peoples clinical needs. The manager said that it was difficult to obtain this information for all the people they looked after. All external health care professional visits were recorded together with the outcome of the visit. Staff had failed to adhere to the advice given by one doctor. The care plan clearly stated that one persons legs were to be raised on a footstool as they were very swollen. This was not seen. Staff had failed to follow the written care plan and the doctors advice. At the time of the last key inspection some issues were raised about the interactions between staff and the people living in the home and that these showed little respect for people. At the time of the random inspection this had improved there were some very positive interactions between the staff and the people living in the home. Staff were heard speaking to people politely and with respect. Staff were explaining to people what they were doing and why while assisting people with their care. At the time of this inspection we again saw some very positive interactions between Care Homes for Older People Page 16 of 33 Evidence: the staff and the people living in the home. However the expert by experience raised some concerns about the attitude of one staff member who was quite abrupt and she commented: One member of staff did not appear to have the knowledge, skills and patience that are needed to care for senior citizens. To counter balance this she also stated: The residents informed me that staff are kind, do their best to meet their needs and treat them with respect. From my observations the interactions between the majority of the staff and the residents appears to be good with mutual respect. People were able to have privacy if they wished. They were able to have keys for their bedrooms. They told us they could spend time in their rooms without being disturbed if they wished. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a choice of activities available for people to take part in which generally met the needs and expectations of all the people living in the home. The people living in the home expressed satisfaction with the meals served to them. Evidence: The people living in the home had care plans in place for their interests and hobbies and these had been improved. They included details of peoples likes, dislikes and preferences and of how staff were to support them to meet their needs. The records seen and the observations made showed that people were undertaking the activities detailed on their care plans and spending time as documented. For example, one person went out a lot with relatives, and watched a lot of specific television programmes, another person spent a lot of time in their room watching their vast collection of DVDs. This showed people could spend their time as they wished. Activity records showed that staff facilitated some activities in the home including, sing a longs, skittles, darts, exercise and colouring. The expert by experience commented: Activities are carried out by every member of staff during the day which forms part of Care Homes for Older People Page 18 of 33 Evidence: staff interaction with residents. I observed residents watching television, colouring, listening to music, playing dominoes and some were chatting in small groups. Residents stated that if they did not want to take part in activities their wishes were respected. One resident said that he would like to hear music by welsh choirs and opera. Another resident said that she likes knitting but would enjoy it more if she had patterns to knit dresses for dolls. Therefore, I would suggest the home consult the residents to find out what activities and resources were needed in order to provide activities that were creative and meaningful. However, the activities programme in the home showed there were a number of activities on offer so that people were offered some stimulation. These included, shows, church services, arts and crafts, famous faces quiz, music and exercise, motivation and musical bingo. Minutes of meetings with the people living in the home showed activities were discussed with them to get their views and to inform people of what had been arranged. Generally they indicated people commented they were satisfied with the activities that were offered. We completed a two hour observation of three of the people living in the home, this started mid morning and continued over lunchtime making recordings at five minute intervals to assess the state of being, level of interactions and engagement for them. After analyzing the data collected it was shown that the people being observed were in a positive state of being for the majority of the time. Overall the interactions by staff were very positive. Staff actively engaged with people talking to them and helping them with drinks. During the observations it was evident staff were readily available to assist people with their care and meals when needed. Records seen indicated people were able to keep in touch with people that were important to them and go out with friends and relatives if they wished. One relative commented: Visiting is allowed at any time. The expert by experience commented: All the residents were happy with the visiting and contact arrangements that they have with their families and friends. People can visit at various times within reason at the home. One resident said that I go out on frequent day trips with my friend who came and collected me from the home. However, others who do not have this facility would like to see more trips out, especially in the spring and summer when the weather is better. Care Homes for Older People Page 19 of 33 Evidence: The people living in the home were of the view that their religious needs were being met. The expert by experience saw a nun visiting several of the people living in the home. In the main the people living in the home were able to exercise choice and control over their lives in such things as choosing what they did during the day, what to wear, when to get up and go to bed and what to eat. Daily records showed that if people did not want to take part in activities their wishes were respected. The expert by experience commented: They also had control over what they wanted to wear. Residents also expressed preference if they wish to be called by their Christian or surnames. For example, I hear staff addressing some residents by their Christian names and others by their surnames. One relative commented, Residents are encouraged to be autonomous. A visitor told the expert by experience, all of these places tend to be a bit regimental but my mother felt she has some choice here. One person expressed to the expert by experience that they felt they did not have any choice, so they just felt they did what the home wanted them to do. They did not seem to be empowered to make their views and requests known. This information was passed to the manager of the home who was to speak to the person and try and address this issue. The home had a rotating menu that was varied and nutritious. Although there were no stated choices on the menu there was a list of alternatives that were available all the time if anyone did not want the main course of the day. Food records were only being kept for some people where there was a concern about their appetite. Therefore it was difficult to track what other people were actually eating and if they were having a varied menu. The food records that were seen did not reflect what was on the menu and in some cases seemed quite repetitious. People spoken with expressed satisfaction with the food they were served. Observations made at lunch time and teatime indicated people enjoyed their meals and that staff where available to assist them where necessary. One relative commented: Care Homes for Older People Page 20 of 33 Evidence: There could be more variety in meals provided. Each day seems to be very similar with little variation. The expert by experience commented: I have been informed by the residents that they were able to exercise preferences about the meals on offer. All residents that I spoke with said that the food was good and varied. I heard a resident asking a member of staff what was on the menu that day. The member of staff informed the resident that it was fish. The residents said that she did not want fish. The member of staff went away and came back and told the resident that there was also corn beef available. Two residents stated that although the food was good, the portions were small and that they had asked for more food which was forthcoming. The staff at the home had mixed views about the food served. Some felt it was very good, there was always adequate amounts and plenty of choice. Others felt the amounts of food were not adequate particularly at tea time and gave some examples of when some foods had run out. We observed both lunch and tea time. People were asked if they wanted seconds at lunch time. At tea time people could have had one or two faggots or sandwiches and half a doughnut each. There was also soup available but this did run out but a further supply was fetched form the other dining room. It was suggested to the manager that some observations were made of meal times to ensure peoples nutritional needs were being met and people were getting adequate amounts of food. Care Homes for Older People Page 21 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lack of knowledge of the complaints procedure could lead to them not having their concerns addressed. There were systems in place to ensure people were safeguarded from abuse. Evidence: The service user guide for the home included the complaints procedure and detailed that people could contact us if they wished. The address and telephone number had been included in the document since the last inspection however it was not the most current details. This could make it difficult for people to contact us speedily. Of the six completed surveys returned to us only three stated they would know how to make a formal complaint. This could lead to people not having their concerns addressed. The observations we made showed us there were good relationships between the staff and the people living in the home. People were comfortable in the presence of the staff which would give them the confidence to raise any issues they may have. The expert by experience commented: From my observation the interactions between the majority of the staff and the residents appears to be good with mutual respect. She also said that she saw staff sitting listening to what people were saying. Care Homes for Older People Page 22 of 33 Evidence: One complaint had been logged at the home since the last inspection. We had also received a copy of this. An investigation had begun by the manager and was also being followed up by the responsible individual for the home. Managers at the home have shown they know when to raise safeguarding issues and who with and what part the home have to play in the procedure, for example, suspending staff. Staff spoken with confirmed they had received training in adult protection issues. The staff spoken with had a good awareness of safeguarding issues and the importance of reporting them. They were able to tell us who they would report any issues to other than the manager at the home. This should ensure people are protected from harm. Care Homes for Older People Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a safe, comfortable and generally well maintained environment in which to live. Evidence: There had been ongoing improvements in the home to ensure the home was safe and comfortable and people could move around easily. Since the last inspection some new furnishings had been purchased and access to the garden had been greatly improved. This made it much easier and safer for people with mobility difficulties to access the extensive gardens. Some issues were raised with the manager at the time of this inspection. These included new carpets needed particularly in some of the upstairs corridors, one of the lounges and dining areas was in need of decoration and some of the corridors needed painting. Quotes had been obtained to have the flooring replaced and the majority of the issues raised were included on the homes refurbishment plan. It is inevitable in a home of this size that there will be ongoing refurbishment and renewal of furnishings and decor to ensure it is kept to an acceptable standard for the people living there. There is adequate communal space in the home. Furnishings and fittings are generally of good quality. As stated some areas needed decoration. People were observed to be very comfortable. Care Homes for Older People Page 24 of 33 Evidence: The bedrooms seen were comfortable and personalised to the occupants liking. There were a variety of aids and adaptations in the home to help people move around and maintain some independence including hand and grab rails, shaft and stair lifts and an emergency call system. There were assisted bathing and showering facilities available for those people who needed assistance from staff. The home was clean and odour free making it a pleasant environment for people to live in. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were being cared for by a well trained staff team that were able to meet their needs. Recruitment procedures were robust and safeguarded the people living in the home. Evidence: We were told the home was fully staffed and that staff turnover remains relatively low which is good for the continuity of care of the people living in the home. The staffing rotas indicated that there were generally six or seven staff on duty throughout the day and at times there were more. This was evidenced on the day of the inspection. This should ensure there are adequate numbers of staff to care for the people living in the home. The relationships between the staff and the people living in the home were observed as being generally very good. The expert by experience commented: All the residents said that the staff tried their best to meet their needs. A relative commented: The home has helpful and caring staff. We looked at three staff files and these contained all the required information to show that only people suitable to work with the elderly are employed so that people were safe from harm. Care Homes for Older People Page 26 of 33 Evidence: The rotas indicated that twenty one of the thirty staff employed at the home had completed a National Vocational Qualification (NVQ) Level 2 or level 3 in care. This is above the national minimum standard and should ensure that the staff have the knowledge and skills to care for people individually and collectively. The training matrix for the home shows staff have received training in first aid, manual handling, incontinence, medication management, food hygiene, care planning and malnutrition over the past year. Staff confirmed they had had this training and that training was ongoing for them. They felt they received all the training they needed. Staff were receiving induction training in line with the specifications laid down by Skills for Care and some of the completed work books for this were seen. This should ensure people have the appropriate skills and knowledge to care for the people living in the home. At the time of the last inspection there were occasions when staff were observed not putting their training into practice, for example, manual handling. This had improved at the time of this inspection. This should ensure people are cared for safely. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made in the home ensuring the home was run in the best interests of the people living there. Evidence: There have been no changes in the managers in post at the home since the last key inspection in August 2009. The manager and deputy manager were present throughout the inspection and both demonstrated a good knowledge of the needs of the people living in the home. This the second key inspection for the home this inspection year and they have also had a random inspection as several issues were raised at the first key inspection. Several improvements were noted during this inspection and the random visit. Improvements included much more detailed care plans, more robust risk assessments, medicine management and much improved manual handling by staff. These improvements should ensure people are cared for safely. Care Homes for Older People Page 28 of 33 Evidence: Areas noted for improvement during this inspection included, staff not always following care plans so that people were cared for as they wished and staff not always following medical advice to ensure peoples well being. these were discussed with the managers and they were to address. There was a quality monitoring system in the home that included in house audits against the National Minimum Standards, satisfaction surveys being given to the people living in the home and other stake holders and meetings with the people living in the home and staff. from the outcomes of the quality monitoring the home had two development plans one for the environment and now also one to improve the service directly for the people living in the home. This improvement plan included such things as a garden area for the people living in the home to be create so they can do their own planting and improving the range of outside entertainers going into the home. As at the last inspection the home did not handle any finances on behalf of the people living there. The manager was satisfied that they got access to as much money as they required. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices. The records for the servicing of the equipment in the home were sampled. These indicated that generally the servicing of the equipment in the home was up to date. We were told the gas equipment had just been serviced and the certificate had not been received. This was forwarded to us after the inspection. There was no evidence seen that the bath hoist seat had been serviced but this was also sent to us after the inspection. The in house checks on the fire system were sampled and found to be up to date and regular fire drills were being undertaken to ensure people would be safe in the case of a fire. Care Homes for Older People Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 26/02/2010 ensure that the advice given by health care professionals is followed. This will ensure the well being of the people living in the home. 2 8 13 Risk assessments and management plans must be updated to reflect the changes in the needs of the people living in the home. This will ensure people are fully safeguarded. 26/02/2010 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 3 Review meetings should be held after the 28 day trial period so that it can be determined if people are happy living in the home and that their needs are being met. Assessments should include detail of how the staff have Page 31 of 33 2 3 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 decided they can meet peoples needs. This will ensure an informed decision has been made as to whether they can meet the individuals needs. 3 5 Records should show if people have visited the home before admission and if they liked it. This will show people are able to visit the home before admission. Staff should ensure they follow the care place. This will ensure people receive their care in the way they would like. Care plans should include all the current needs of the people living in the home. This will ensure they receive person centred care. It is advised that the care plans include the clinical information of the people they look after and staff adhere to them. Staff should ensure they treat people with respect and consider their feelings at all times. This will ensure people are cared for appropriately. There should be further consulation with the people living in the home to establish what activities would make their lives more meaningful. The quantities of food available at meal times should be reviewed to ensure there are adequate amounts to satisfy the people living in the home. Records of the food served to all the people living in the home should be kept to show people are receiving a varied and nutritious diet on an ongoing basis. Efforts should be made to ensure people are aware of the complaints procedure. This will ensure people know how to make a formal complaint if they wish to. The current contact details for the Commission should be in the complaints procedure. This will ensure people can contact us if they wish The refurbishment plan for the home should be followed to ensure the home is kept to an acceptable standard for the people there. 4 5 7 7 6 9 7 10 8 12 9 15 10 15 11 16 12 16 13 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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