Care Home: Guardian Care Centre

What the care home does well During our inspection visit we noted that staff were friendly and courteous to people. Staff spoke appropriately at all times and showed evidence of a person centered approach to individuals. Privacy, dignity and respect are promoted and upheld. There were posters around the home highlighting the need for respect, maintaining privacy and ensuring for dignity and we did not see any incidence where this was not the case. Staff are carefully recruited to work for the service, ensuring that vulnerable people who live at the home are kept safe. Staff feel supported with their training needs and the training and development programme in place helps to ensure that staff are able to meet the specific and sometimes complex needs of people who live at the home. What has improved since the last inspection? The outcomes for people living on the dementia care unit - Garden View have all improved considerably since we carried out the last inspection of the service. A visitor commented "Things are much better here now than they were last year". She said that there are "More staff and they are the same staff most of the time". The Expert By Experience observed many positive changes on this unit all of which have been highlighted in this report. The approach to Safeguarding, particularly the reporting and referral of Safeguarding issues has improved considerably. The registered manager has been instrumental in bringing about these improvements and takes a keen interest in this - attending most of the local area meetings and training updates in Safeguarding. Staff are more aware of the need to report poor practice and mangers of units are supported to make safeguarding referrals. This improvement means that the service takes action to ensure that people who live at the home are protected from abuse. One staff survey contained the following statement - "Although change is not always deemed good, our new care director has implemented changes that have not only made the Company more complaint, but basics are now being addressed and implemented meaning that our people can receive a high standard of care in all aspects". What the care home could do better: The management of diabetes should be reviewed with a view to making improvements in this area in order to ensure that people are kept safe. With the current recording system it cannot always be guaranteed that people receive care based on current best practice.There were examples of some poor record keeping around the procedures for medication. The arrangements for the ordering, receipt, storage, administration,and recording of medication should be reviewed and improved. This will help to ensure that people who live in the home are kept safe. Key inspection report Care homes for older people Name: Address: Guardian Care Centre Longton Road Trentham Stoke On Trent Staffordshire ST4 8FF     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: Yvonne Allen     Date: 0 8 0 6 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 36 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 36 Information about the care home Name of care home: Address: Guardian Care Centre Longton Road Trentham Stoke On Trent Staffordshire ST4 8FF 01782644800 01782644950 ms@guardiancare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Nightingale Group Limited - The Guardian Care Centre Name of registered manager (if applicable) Mr Robert William Stanway Type of registration: Number of places registered: care home 143 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 143. The registered person may provide the following category of service only: Care home with Nursing (Code N) 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) 143 Dementia (DE) 143 Physical Disability (PD) 143 Mental disorder (MD) 143 Date of last inspection Care Homes for Older People 0 2 0 2 2 0 1 0 143 143 0 143 Over 65 0 0 143 0 Page 4 of 36 Brief description of the care home Guardian Care Centre comprises of three modern purpose built buildings, New House, Selwyn House and Mayfield Unit. It is situated in the suburban area of Trentham, Stoke on Trent and is within easy walking distance of local bus services and has good access to road networks. The home offers ample parking space and enjoys accessible gardens and its own protected private patio garden. Selwyn House is a modern purpose built two storey units providing nursing care for seventy-nine older people. Garden View first floor provides forty beds for elderly mentally ill persons aged 60 years and over. Garden Walk ground floor provides thirty-nine beds for frail elderly people also aged sixty years and over. The two floors are connected by a shaft lift. Accommodation is provided in mainly single rooms with 95percent having en-suite facilities. Both floors have their own dining room and communal areas and there are sufficient and appropriately adapted washing and bathing facilities. New House is a modern purpose built two-storey unit providing nursing care for up to forty-four people - young physically disabled adults over the age of eighteen years and younger people with learning disability. Court View first floor currently provides twenty-two beds for young adults with physical andor learning disability. Court Walk ground floor currently provides twenty-two beds for young physically disabled people and young physically disabled people with complex nursing care needs. The two floors are connected by a passenger lift. Accommodation is provided in mainly single rooms. All of the rooms have en-suite facilities. Both floors have their own dining room and communal areas and there are sufficient and appropriately adapted washing and bathing facilities. There is a central kitchen situated in Selwyn House and there are satellite kitchens to both floors in New House. Mayfield Unit is a new twenty-bedded unit. This is a modern, state of the art unit. Care Homes for Older People Page 5 of 36 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: The Quality Rating for this service is 2 STARS. This means that the people who use this service experience GOOD quality outcomes. We carried out this unannounced Key inspection of the service over one day. All of the Key Minimum Standards were assessed and for each outcome a judgment has been made based on the evidence gathered. These judgments tell us what it is like for the people who live in the home. Prior to the inspection visit the manager had completed a self assessment tool known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment which focuses on how well outcomes are met for people using the service. Information from the AQAA was used as part of our information gathering process. Care Homes for Older People Page 6 of 36 The ways in which we gathered our other evidence were as follows - We looked at any information we had received about the service since the last Key Inspection. We spoke with some of the people who live in the home and their visitors. We spoke with some of the staff who work in the home. Discussions were held with the manager of the service. We examined relevant records and documentation. We walked around the home and visited all of the communal areas and a random selection of bedrooms. We observed staff interaction with people who live at the home. We are trying to improve the way in which we engage with people who use services so we can gain a real understanding of their views and experiences of social care services. We are using a method of working where experts by experience are an important part of the inspection team and help inspectors obtain a picture of what it is like to live in or use a social care service. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. During this inspection an Expert by Experience joined us from 9.30 am to 1.30 pm. She spoke to some of the people who live in the dementia care unit and made observations about the care they receive. She also looked around the unit and spoke to some visitors and some staff members. These comments and observations have been included in the main body of this inspection report. At the end of the inspection visit we discussed our findings with the manager of the service. The email address for the Registered Manager of the service is rob.stanway@guardiancare.co.uk Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The management of diabetes should be reviewed with a view to making improvements in this area in order to ensure that people are kept safe. With the current recording system it cannot always be guaranteed that people receive care based on current best practice. Care Homes for Older People Page 8 of 36 There were examples of some poor record keeping around the procedures for medication. The arrangements for the ordering, receipt, storage, administration,and recording of medication should be reviewed and improved. This will help to ensure that people who live in the home are kept safe. 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 36 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 36 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 are only offered a place at this home following a comprehensive assessment of their needs. People can be assured that their assessed needs will be met. Evidence: In their AQAA the service tell us that We always offer prospective residents and relatives the opportunity to visit, we complete pre admission assessments and as such we meet every resident prior to admission and provide them with relevant information in the form of brochures, questions etc. We are lucky enough to be able to offer a wide variety of options across the home due to the units being able to care for a variety of progressive needs within the Guardian Centre. Through discussions with unit managers and examination of records it was identified that the above information is a true reflection of current practice. People undergo an assessment of their needs and this is recorded. This assessment Care Homes for Older People Page 11 of 36 Evidence: often involves involvement of other relevant health and social care professionals. Care Homes for Older People Page 12 of 36 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. People feel that the service meets their personal and nursing needs and care is person centered. Staff are attentive to the needs of people and care is delivered with dignity and respect. The service will need to review and improve the way in which medicines are stored, administered, ordered and recorded in order to ensure the safety of people who live at the home. Evidence: In their AQAA the service tells us that they Ensure that all personal care is delivered by kind, caring, skilled and experienced staff. All care staff are given the opportunity to complete common induction standards and National Vocational Qualifications. We have registered nurses based on all units. We also enable access to specialized nursing services. We have an excellent relationship with the General Practitioner (GP) who covers the home. We cover all activities of daily living with individual person centered electronic care plans which are reviewed as and when needed or at least monthly. We welcome residents and relatives if they would like to in these reviews. All Care Homes for Older People Page 13 of 36 Evidence: referrals to specialist areas are made and coordinated via our retained GP or local NHS Nursing home support team. We have a good supply of specialized equipment. In line with our holistic approach to health and wellbeing we now have a team of therapists working within the home compromising Reflexologist, Aromotherapist, Physiotherapist and hairdresser. The surveys which we received prior to the inspection visit contained positive comments about the care people receive at the home as follows They care, I mean really care about each individual person. They also offer family members a great deal of support and encourage them to be involved in their loved ones care and decision making. The home looks after me well and keeps me safe. They help people and when I was ill they helped me. They make me smile and have patients. They make us comfortable. The home cares for people in a physical sense. They are clean, warm and generally healthy. People are well fed and a lot of time goes in to the feeding process. Staff are patient and treat people with respect and affection. Discussions with people who live at the home confirmed that people feel that their health and personal care needs are met well there. The expert by experience spent time on the dementia care unit (Garden View) and highlighted the following - People who live on this unit appear well cared for and are appropriately dressed. Observation of a person on this unit identified that Individual Risk Assessments are in place where required. Where these indicate that extra staff supervision is needed then this is provided. The expert by experience observed that people who live on this unit are cared for as individuals and are treated with dignity and respect. We also visited the general elderly care unit (Garden Walk). We observed that staff are attentive to the needs of individual people and that people are cared for in a person centered way. The new electronic care plan system was in the process of being introduced and records were being transferred from the old system. When we visited the unit for younger adults we noted that information about some aspects for an individual person were difficult to access due to the organizations introduction of the new computer record keeping system. This is where information from the old system Care Homes for Older People Page 14 of 36 Evidence: has not yet been transferred. The service involves other health care professionals and specialists for advice and treatment where indicated. The staff confirmed that the home benefits from a good GP support service. We observed GPs visiting at the time of our inspection visit. We followed the care of a person with specific diverse needs. He said that he prefers his own company and likes to stay in his bedroom. We visited him there and carers came in to bring clean linen and towels. It was evident that the staff have good rapport with this person and were laughing and joking with him. The person told us They are all very good to me Yes they care for me very well. He confirmed that the service was meeting his needs. During our visit to New House (Court Walk) we looked at the case records of one person who currently has a hospital acquired pressure sore. We saw that this pressure sore had been mapped and recorded in the care records and treated. We looked at all the records available for one person and saw that the unit has a communications book, where information about all of the people who live on this unit is recorded for handover purposes. We were disappointed to note that there were many entries both personal and confidential information which means that the service has not acted within the law to protect peoples data and confidentiality. We saw that care plans are in place and have detailed information about the needs of the individual and the action to be taken to meet identified needs. We saw that a person had an Agitated Behavioral Scale in the records where staff can record the intensity and severity of agitated behavior. However we found that it did not provide clear guidance about the action staff should take if the behavior was deemed high risk and because we could not find a protocol or clear instruction about the use of as required medication that is prescribed. In the Medication Administration Record we found a protocol for the administration of as required Rectal Diazepam that gave a detailed description of the procedure staff are to follow in the event of that person using the service has prolonged seizures. The protocol was signed and dated by the GP but we could not see a protocol in place for the administration of as required Lorazepam, Haloperidol, or Glucagon. We saw that some MAR charts are handwritten and the sample of those we looked at Care Homes for Older People Page 15 of 36 Evidence: had not been dated. We also saw that the handwritten MAR chart in one example the dose recorded for Rectal Diazepam did not correspond with the dose of medication we saw when we looked at the supply for one individual. We have been shown that the service does undertake stock control monitoring of all medication and that there is a clear and explicit guidance for staff to follow. But we found we could not undertake and audit trail of Lorazepam when we checked the records. The stock count dated 29th May 2010 stated that 54 tablets are in stock, but on the day of this visit we counted the stock as 60 tablets. The room temperature records of the medication room in Mayfield in the left wing and in the medication fridge show that the temperatures have been consistently high for at least 4 months. We spoke to a nurse and the manager about this and have been told that the dispensing pharmacy have been consulted and are trying to find a satisfactory solution. We are concerned though that medication is being stored at these temperatures and advised the manager to contact the pharmacist with our concerns. We have also taken advice from a CQC pharmacy inspector and passed the information to the registered manager. He told us that since our visit he has made inquiries with a company to try and resolve the situation. He also told us that he has been in contact with the Pharmacy to try and resolve the situation. We noted an example on this unit of where the service had failed to properly secure some medication and this had been left out on the side. Since we carried out our last inspection of the service we had been notified about a complaint received by Social Services which was dealt with as a Safeguarding. The complaint was from the relative of a person who came into the home with Diabetes. The issues contained in the complaint were surrounding the mis management and poor monitoring of a person with diabetes resulting in the person becoming very ill and being admitted back to hospital. The concerns had been investigated by the Continuing Health Care team and Social Services. Following this investigation the manager of the service Mr Stanway put together an action plan of the improvements he intended to make as a result of the outcome. During this visit we looked at the way the service cares for people with Diabetes. As part of this we looked at records for a person using the services diabetes management 2006. We saw that it stated that if Blood Sugar was over 15 then Insulin can be given but instructions did not specify what dose of Insulin should be administered. We could not be sure form the records we saw if the diabetic management plan had been followed, because the care records on the new computer system are not yet fully operating and the MAR chart had not been completed as it should be. We also saw Care Homes for Older People Page 16 of 36 Evidence: that this person is prescribed Glucagon in the event of hypoglcaemia and the and the records show that it was administered on 23rd May 2010 but when we asked about current stock we were told that a fax was handed to the GP on 3rd June 2010 for replacement stock but hadnt yet been received. We are concerned that it appears that there has not been a stock of glycogen for this person since 23rd May 2010. Nursing staff said that in the event of her exhibiting hypoglycemia they would have to contact emergency services. We cannot accept this as a satisfactory solution and require the service to maintain suitable stocks of medications to be used in emergencies so that people using the service are kept safe. We asked to see a protocol for the administration of Diazepam 2mgs. However the nurses we spoke to could not find this. We saw from the MAR chart that on 27th May 2010, 2 doses were given. We looked at the back of the MAR chart where a record of the reason for administering the PRN medication should be but nothing was recorded for that date. When we checked the care records for an entry we could not find this. We spoke to staff about this and have recommended that proper records are maintained. The service has a stock of Homely Remedies, for example Paracetamol but the service does not have a stock control system for this. We have recommended this to ensure that the service can be confident that there is no inappropriate use of Homely Remedies. Care Homes for Older People Page 17 of 36 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. The activities of daily life in the home are made flexible and varied to suit peoples expectations, preferences and capacities. People maintain contact with family, friends and representatives of the local community. People are helped to exercise choice and control over their lives People receive a wholesome varied diet which is provided at times convenient to them Evidence: In their AQAA the service tells us - We value our residents as individuals we are aware of the importance of communication and person centered care and we promote the core principles of care to ensure that all our practices are underpinned and informed by the principles of respect, dignity, choice and independence for individuals. We encourage and support individuals wherever possible to make decisions based on the experience of their needs and enhanced by appropriate professional support and guidance. We feel that this is evidence that our practice is experiencing a shift of values from professionals knowing best to professionals supporting and empowering Care Homes for Older People Page 18 of 36 Evidence: individuals to be in control of how their needs are met. We spoke to one relative in Mayfield unit who wanted to ensure that we receive positive feedback about the service her relative receives. She gave an account of her experiences in differing care settings and said, Since my relative has been here I have seen him flourish. Nothing is too much trouble for the staff and they go out of their way to ensure that my relative is comfortable and cared for. I cant praise them highly enough. We spoke to three people using the service in New House. They are very happy with the service they receive, they think that the food is good and and they get to choose what they want. One person was watching TV, another was drawing and a third was reading. The Expert By Experience visited the dementia care unit and observed the following There was a television which was switched on but it did not dominate the entire room and we were told that it is interchanged with the stereo. Although some people were asleep most were awake. At one time some people were watching the TV, others were looking at a paper, a third group was playing with a large football whilst others were sitting alone or talking to staff members or to me. I later saw the group who had been playing football with a staff member continued to play by themselves which suggested that the activity was appropriate to that group. There is a large white board with date, day and season and the special activity for the day. There was soft background music playing in the dining room and a person who had chosen to remain in there was asked if he wanted the music on and if so what he would like to hear. There is also an experience room overlooking the garden which contains items to stimulate and engage the senses tactile balls, textured cloths, paper mobiles, dolls, soft toys. It also has a wall mounted digital photo frame which I was told people like to watch but this was broken. I observed people who were mobile go into the room to look out at the garden and touch or pick up items. They also picked up items off experience shelves in the corridors where items are changed daily. This is what people wrote on the surveys about activities, entertainment and food at the home The puree option needs more variety. There should be more staff on busy units such as Garden Walk and Garden View to ensure that activities can be carried out. Care Homes for Older People Page 19 of 36 Evidence: I think that more effort could be made to entertain and stimulate people maybe by playing old songs on the radio. More day to day activities are needed. Food could be better. More activities and outings are needed. The service was in the process of auditing meals and had obtained the views of people in surveys. The service has also employed a new Head Cook who has had experience in customer satisfaction. On Garden Walk we observed the lunchtime meal which was turkey and ham pie with potatoes and vegetables or tuna or roast beef salad. Some people were having soft diet and being assisted to eat their meal. There was home made sponge pugging and custard to follow. We were told the puddings are very good. On Garden View dementia care unit the Expert by Experience observed the following There are official set times for meals but the unit operates a flexible approach. People had their hands washed before lunch and staff told them the reason for this. There is a natural waking philosophy and three people were having late breakfasts when I went on to the unit just after 10am. All were able to eat independently but staff were supervising and encouraging one person who had a finger food diet to promote his independence. Comments about the food included very good acceptable, not marvelous, some choice but would like more. Visitors also commented on the good standard and this was borne out by my observations. Meals are sent up individually plated and named and were well presented, hot and looked appetizing. I had a pureed meal. Each different food was separately pureed and I was able to recognize what I was eating without being told by the taste. The meal had to be reheated as I was called away to speak to a relative just as it was being served. If this is necessary food is returned to the kitchen to ensure safe practice and I was shown the record kept of when food is reheated. A weekly menu was available inside and outside the unit with copies for families and in the dining room anonymised copies of peoples nutritional charts were available to ensure they receive appropriate and nutritious diets. The home caters for special diets and although there appeared to be one main meal people who are able can ask for alternatives. One person told me I am able to choose my breakfast cereals and a cooked breakfast every day if I want. He seldom has the Care Homes for Older People Page 20 of 36 Evidence: cooked lunch provided but usually has boiled ham with lettuce, green peppers, onions and salad cream with chips or a jacket potato. There is a choice at tea time and people are asked on the day what they would like. In addition special arrangements have been made for a person who sleeps all day and is awake all night despite efforts to reset her biological clock in that food is provided when required. There are two sittings for lunch which seemed to work well and helped to minimize the time people had to sit waiting in the dining room. Cloth aprons rather than plastic were used and meals are called up individually when the person is seated and ready. There were 6 staff in the dining room and assistance was given to those unable to eat independently. It was noted that staff interacted well and engaged with the person to try and make it a pleasant and social experience rather than just putting the food in front of them. They offered assistance, said what they were doing and what they going to do - Hello its time for dinner What have we got today The pie looks tasty Are you going to try some? Staff responded promptly to requests for sauce and vinegar etc and drinks. They also discretely observed people able to eat independently to see they were managing and offered encouragement and assistance if appropriate. The radio had been turned off and the atmosphere was relaxed. One person who tends to get anxious and becomes loud and demanding was offered reassurance by staff throughout the meal to ensure he did not get upset or distress others. Cakes, snacks and drinks are available at all times. The Expert by Experience also observed the following activities taking place on this unit The Centre employs a full time activities coordinator but all unit staff engage in activities through the day. There was a was a list of activities on display outside the unit which included trips out to pubs, theatres, markets, carnivals as well as having entertainers coming into the home. My impression was that these are available to all of the people but there is limited opportunity as some are inappropriate for those with the level of cognitive impairment living on Garden View. One person said I do go out but not very much while another confirmed that they have had the Salvation Army and various singers I go but often they cant sing Several staff told me they have had training and appear to be trying to introduce meaningful activities and to be person centered in approach. The activities coordinator came onto the unit whilst I was there but I did not have Care Homes for Older People Page 21 of 36 Evidence: opportunity to speak to her as she was involved in a one to one activity with a person who was becoming agitated and then left. This person used to be a painter decorator and his family had been asked by the care supervisor to bring in some of the tools of his trade and it has been found this relaxes him as he paints the walls and talks about this work. I saw firsthand that this did achieve the desired result and the person became calm and engaged with staff. Several people were cuddling therapy dolls or soft toys and also played with tactile balls either independently or with staff on a one to one basis. In the main lounge there was a folder containing The Way We Were Newspaper articles which is used for topics at the regular coffee social mornings, which are often cross unit. Staff informed me that they also play Giant Dominos and other games at these events. Movement to music and Pamper Sessions are organized by unit staff and they recently had a Gents Day which was based on the idea of the old Barbers Shop. On an individual basis several people were given simple musical instruments such as a drum, tambourine and appeared to be enjoying the experience of playing them albeit for a limited time. People go out into the garden and I was told that there was a gardening club who have planted flowers and shrubs to create a secret garden. This was confirmed by a person who likes to be taken into the garden, and a visitor who was going to help her husband in the planned potting plant activity today. The manager informed me that they are trying different daily living craft activities they recently had a cake decorating session and are looking at Rummage boxes as they have found the use of tactile cloths to be very beneficial. The home now has an activity budget and the manager and staff are very eager to develop activities tailored to individual people rather than just group activities. Relatives are involved where possible and although they do not use life story books they try to find out as much as possible about the individual prior to and after admission. There is a brief personal profile and photograph of each person in their room to aid communication especially for new staff who do not know the person well. Religious and spiritual needs are recognized and there are regular church visitors including a Roman Catholic priest on Sundays. Care Homes for Older People Page 22 of 36 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. People who live in this home can be assured that any concerns they may have will be listened to, taken seriously and acted upon. People can be assured that the systems in place at the home help to keep them safe from harm or abuse. Evidence: In their AQAA the service tells us - Suggestion/comments are now encouraged, recorded and reflected upon. Safeguarding reporting is now comprehensive, this is also monitored by the use of weekly unit status sheets and liaison with social care and CQC. The whole day mandatory training on Safeguarding is now in place and being rolled out across the whole workforce. Through our discussions with people who live at the home, staff who work there, and through examination of relevant records, we identified that the above is a true reflection of this outcome area. There is a formal complaints procedure in place and we saw that people have access to this. The service keeps records of the concerns and complaints it receives and how these are addressed including any action taken to make improvements. Care Homes for Older People Page 23 of 36 Evidence: People who live at the home and their representatives told us that they know who to raise concerns with should they have any. The systems in place help to protect people and keep them safe from harm or abuse. Staff are carefully selected to work at the home and are given training to make them aware of what constitutes abuse and poor practice and how to report this. Managers are also given training in this area and are aware of their roles and responsibilities in relation to the Safeguarding of vulnerable adults. The manager has brought about many positive changes in this outcome area and personally attends many local meetings and training events in relation to Safeguarding. There is now a more open and transparent culture at the home in respect of handling complaints and safeguarding people. This outcome area has improved considerable since we carried out the last inspection of the service. Care Homes for Older People Page 24 of 36 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. People live in a safe, well maintained environment which has been adapted to meet their needs individually and collectively. The home is clean, pleasant and hygienic. Evidence: In their AQAA the service tell us that We feel that we are very lucky as far as the resources and the environment we have. All units are now the subject of rolling programmes of decoration and refurbishment. The Operations and Care Directors carry out regular environmental inspections and formulate specific action plans for any areas which need attention. The plans are actioned by the estates manager using a team compromised of maintenance, decorating personnel, housekeeping and cleaning services, plumber and electrician. A high proportion of our bedrooms have electrically profiling beds where this equipment has been identified as being beneficial for special clients. Where this is not the case, the furniture in residents bedrooms is in a more homely style. Where possible, residents are encouraged to bring in pieces of their own furniture or belongings. All equipment and fittings are maintained and services as required. All ground floor units have direct access to well maintained outdoor areas. We walked around the units throughout the home and found that the home is clean, well presented and adapted to meet the needs of the people who live there. Care Homes for Older People Page 25 of 36 Evidence: There is an ongoing programme of refurbishment and redecoration and it was evident that this is underway. There have been improvements made to decor on the elderly care mental health unit (Garden View) and this has enhanced this unit, making it more adapted to meeting the needs of people here. The Expert by Experience visited this unit and noted the following It was quiet and there was a calm and relaxed atmosphere. It was clean and on the whole in satisfactory decorative order. Many of the people living on this unit have continence problems but there was no smell of urine in the unit, or in the individual bedrooms I saw. These were personalized to a varying degree. The home employs an aromatherapist and diffusers are in situ and oils are used as mood enhancers. lemon in the dining room to enhance appetite, marjoram to calm. Although I noticed the different aromas when first going into the unit their use is subtle and not overpowering. The small lounge is newly decorated and the large lounge due to be painted soon. Seating in the large lounge is arranged in pods rather than around the edge of the room to facilitate a more homely feel and enable different activities to be undertaken. The dining room is plain and functional and there are no cloths or condiments on the table at mealtimes. The room is used for one to one and group activities. The corridors are painted in different colors to aid orientation. Previous inspections reported problems with going into rooms of residents of the opposite sex and to try and reduce the risk there are now male and female corridors. There are large brightly colored individual symbols on the door of each room to aid recognition. Care Homes for Older People Page 26 of 36 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 who live in this home are cared for by a staff team who are caring and supportive and who have the skills to meet peoples needs. Evidence: IN their AQAA the service tell us - In house training/support, a dedicated HR/training department together with the managers has enabled us to standardize disciplinary protocols etc. We spoke to staff on many of the units throughout the home and observed their care practices and interaction with the people who live there. We found that staff are attentive to the needs of people, they listen to people and they treat people with dignity and respect. Staff are aware of the needs of people and have the skills required to meet these needs. On the dementia care unit the Expert by Experience noted that staff did have time to interact with the residents and engage in some one to one activities. There were people with challenging behaviors but staff dealt with any issues as they arose in a caring, sensitive practical manner. It was evident that the staff on duty that day were very familiar with all the people and skilled in caring for them as individuals. Visitors on this unit told us Care Homes for Older People Page 27 of 36 Evidence: All the staff are lovely and so kind to us both. There always seems to be enough here when I come, but they do work hard and deserve more money. There is usually a member of staff in the main lounge and in the dining room at all times. My relative came here from hospital and he has come on in leaps and bounds in such a short time. The staff have got him mobile with assistance and the hospital said he wouldnt walk again. He thinks the staff are his family and he is really content. Nothing is too much trouble for the staff. A second visitor commented things are much better here now than they were last year She said that there are more staff and they are the same staff most of the time. There was a poster outside the unit with photographs of all staff members and their roles which one visitor had found useful especially as her relative had only recently come to the home. Staff who work at the home feel very supported with their training needs. The staff group on duty all spoke of the ongoing training now provided. The care supervisor on the dementia care unit informed us that he had been given dementia and awareness training before he was transferred to the unit. We interviewed a member of staff in New House who said that she is happy with her role and the level of support she receives, she confirmed that she receives 121 supervision regularly, and attends team meetings. She stated that since the new manager has been in post she feels the senior management team have become much more approachable and inclusive, and encourage care workers to discuss any concerns or ideas they may have to improve the lives of people using the service. The service has adopted a robust recruitment procedure where staff are carefully selected to work at the home. We looked at several staff files and these all contained the required information and relevant checks had been carried out including Criminal Records Bureau (CRB) checks. Staff had also undergone checks to ensure that they are suitable to work with vulnerable adults. We spoke with the administrator who oversees the Human Resources activities including staff recruitment and training. The service has developed an effective staff training and development programme which ensures that staff are equipped with the skills and expertise necessary to meet the needs of the people who live in the home. Care Homes for Older People Page 28 of 36 Evidence: Staff feel well supported with this and told us The home provides encouragement and training for staff which enables staff to improve care for the people. I feel that the homes training scheme is brilliant and there are always courses available. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and is run in the best interests of the people who live there. Evidence: In their AQAA the service tells us - Our care centre has a well defined and fully accountable management structure. The directors maintain a close involvement and the dedicated Care Director is also the registered person with a full time position at the centre, enabling him to be fully involved in the day to day activity and running of the facility. The Care Director also chairs weekly managers meetings where all unit managers and heads of departments are invited and are enabled to provide feedback or receive constructive criticism. These meetings are also used as the main avenue for cascading down information about new initiatives and changes this means that practices are standardized and that all managers are given time to prepare for any changes prior to the introduction or implementation at unit level. All staff receive induction and relevant training. Policies and procedures are regularly reviewed and updated as required and are made available to all staff members on a generic login Care Homes for Older People Page 30 of 36 Evidence: which forms part of the documentation used within the centre. All units have suggestion books and forms for feedback and relatives and residents are frequently invited to provide informal feedback on all aspects of the organization and structure. We met with the registered manager of the service Mr Robert Stanway. At our last inspection of the service Mr Stanway had only recently been appointed and was still acting manager. Mr Stanway has now had several months in his role as manager to bring about some of the changes and improvements he set out to do. During our inspection of this service we have identified that there have been obvious improvements made in many of the outcome areas. Staff feel empowered and the service is run in an open and inclusive way. People who live at the home and their representatives have a voice and are listened to. Managers of the various units feel supported in their roles. This is what staff told us on the surveys we received prior to our inspection visit In respect of quality assurance - Regular inspections are made to ensure that health and safety, medication, care p[plans, maintenance are in place and effective. In respect of the manager - Our new Care Director has implemented changes that has not only made the Company more compliant with requirements but basics are now being addressed and implemented meaning our clients can receive a high standard of care in all aspects. Management and the Care Director are 100 approachable and supportive. I have much respect for them. People who live at the home and their representatives told us I like the unit managers. I feel that they know me and I know them. I know that I can speak to them and they will act on my concerns. The ethos of the home has improved. The service offers a secure facility for the safekeeping of monies and can manage personal allowances for people should they prefer this. We looked at the way the service does this. We looked at the records in respect of this including receipts and other relevant documents. We identified that there is a clear audit trail of the management of personal accounts. People are also able to access their monies whenever they wish to. This process is managed well by the administrators of the home. Care Homes for Older People Page 31 of 36 Evidence: The manager oversees Health and Safety within the home and works alongside staff to ensure that the home remains a safe environment for people to live and work in. There is a Health and Safety policy statement in place and risk assessments, both individual and generic are undertaken and regularly reviewed. The registered manager ensures compliance with relevant legislation including Fire Safety, Environmental Health and the Health and Safety Executive. The Estates Manager works closely with the Registered manager to ensure safety of the environment, including equipment used. Care Homes for Older People Page 32 of 36 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 33 of 36 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 9 13 13(2) The provider must ensure that medication is stored within the recommended temperatures. 05/07/2010 2 9 13 13(2) The provider must ensure that medication is securely stored. 05/07/2010 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 8 The service should review the use of the communications book so that personal information is not recorded in this communal record. This will help to ensure that peoples confidentiality is maintained. The service should ensure that Diabetes management plans are clear, to be confident that people using the service receive the correct dose of medication. A stock control system for any Homely Remedies should be introduced, so that the service can be confident that it can carry out an accurate audit trail this type of medication. Page 34 of 36 2 9 3 9 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 4 5 9 9 The service should ensure that it maintains adequate stock of PRN medication so that when required it is available. The service should ensure that MAR information corresponds to other records relating to the administration of medication. So that there is no confusion about the dosage to be administered. The service should review its stock control methodology, to be sure that it is robust. The service should ensure that protocols are in place for any medication prescribed on an as required basis. This is so that staff have explicit guidance about the circumstances under which the medication should be given. The service should also review its stock control methodology to be sure that this is robust. The service should also ensure that medication administration record sheets, if handwritten, are properly recorded and dated. This is to help ensure that medication is stored and administered safely and in accordance with guidance. 6 7 9 9 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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