Care Home: Halvergate House

What the care home does well The Home provides a good standard of accommodation to the residents. There is a choice of rooms in the older part of the Home as well as newer rooms in the extension. All of the bedrooms are ensuite and the newer rooms have ensuite showers. There is an ongoing programme of redecoration and upgrading of the accommodation. The care staff are positive and enthusiastic about working at the Home. We observed staff supporting residents in a kind and respectful manner. When we spoke to them they had a good understanding of their responsibilities and of how to meet the residents needs. Residents spoke highly of the staff, including comments such as: Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 ‘I am very happy here’ ‘If we ask for something then it is always done’ The Home is well managed. Ms Kalnins is an experienced and well qualified Manager who provides good support to all of the residents, staff and relatives. Comments were made about her style of management, such as: ‘very good manager, she is great’ ‘Liz is very supportive, you can always talk to her’ ‘’Liz brings everyone together, she is very approachable’ ‘this is a safe warm home for life, staff are kind, cheerful and efficient’ ‘I am very happy here’ The Home is managed in a way which puts the needs of the residents first. There are systems in place for regularly monitoring the quality of the service provided. This includes regular auditing of specific areas of care and also the use of questionnaires for residents and relatives. The Home offers a range of activities. The activities organiser has good links within the community and has used these to encourage volunteers to become involved in the provision of activities, both in groups and with individual residents. The staff receive good training and support which enables them to carry out their roles effectively. The care records contain effective assessments of residents needs and care plans are then written based on the assessments. These are regularly reviewed. Staff are aware of the content of the care plans. What has improved since the last inspection? The staffing levels have increased in response to increasing needs of the residents. The turnover of staff is much lower now than it was previously. The Manager has carried out recruitment and the staff said that the staff team are working well together and morale is higher. Additional equipment, such as profiling beds, have been purchased to meet the increasing frailty of residents. A part time activities support worker has been appointed to work alongside the activities organiser. The support worker mainly concentrates on providing 1:1 activities with individual residents. Work has started with regard to improving communication across all areas of the service provided. Communication books have been introduced to enable relatives and staff to leave each other non-urgent messages. Photographic menus are available to assist residents with choosing their meals. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 What the care home could do better: There is a need to ensure that all staff have received training about working with older people with dementia. There are always staff on duty who have received the training but it would be beneficial for all staff to have attended this training. There is a need for individual risk assessments to be carried out for those radiators which are not covered to ensure that unnecessary risks are not being taken. Improved signage around the Home may assist those residents with dementia to be able to find their way around independently. Key inspection report CARE HOMES FOR OLDER PEOPLE Halvergate House Nursing & Residential Home 58 Yarmouth Road North Walsham Norfolk NR28 9AU Lead Inspector Lella Hudson Key Unannounced Inspection 28th May 2009 09:00 DS0000015642.V375610.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 2 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 Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halvergate House Address Nursing & Residential Home 58 Yarmouth Road North Walsham Norfolk NR28 9AU 01692 500100 01692 407474 halvergate@eachltd.co.uk www.eachltd.co.uk East Anglia Care Homes Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Elizabeth Kalnins Care Home 50 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (50), Physical disability (2) of places Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home operates only as a Care Home with Nursing. Fifty (50) Older People, not falling into any other category, may be accommodated. Two (2) people who are no younger than 45 years of age, are in need of nursing care due to their physical disabilities and are in need of respite care may be accommodated. The maximum number of persons accommodated should not exceed fifty (50). Fifteen (15) who have dementia may be accommodated. 4. 5. Date of last inspection 3rd June 2008 Brief Description of the Service: Halvergate House is a large period residence that has been adapted and extended over the years to provide accommodation to a maximum of 50 older people who require either nursing or residential care. The care home is located on the outskirts of North Walsham, standing within its own grounds with offroad parking. Qualified nurses are employed to give twenty-four hour cover in the nursing care part of the home. Care staff and additional ancillary staff including chefs and kitchen assistants make up the staff compliment available in the home. In March 2008 the Home became registered for 15 older people with dementia. The total registered number remains at 50. The fees currently range from £532 to £650 per week. The fees are dependent on residents needs and so further information about these should be obtained from the Home. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Home provides 2* GOOD quality outcomes for the residents who live there. This report contains information gathered about the Home since the last Key Inspection in June 2008. An inspection was carried out by the Pharmacy Inspector in July 2008 and at that time it was found that the outstanding requirements with regard to medication had been met. Prior to the visit we received the Annual Quality Assurance Assessment (AQAA) which the Manager had completed in a detailed and informative manner. During our visit we cross referenced information we found with information provided in the AQAA and found that this was an accurate document. The report contains information gathered during an unannounced visit which was carried out between 9am and 5pm on the 28th May 2009. During the visit we were shown around the Home, spoke to the Manager, Proprietor and to three staff, residents and a volunteer. We also looked at a selection of records. This report also contains information provided within completed surveys which we received from residents and relatives (8), from visiting professionals (2) and from staff (2). There were 41 residents living at the Home on the day of our visit. Brief feedback was provided to the Manager and Provider at the end of the visit. What the service does well: The Home provides a good standard of accommodation to the residents. There is a choice of rooms in the older part of the Home as well as newer rooms in the extension. All of the bedrooms are ensuite and the newer rooms have ensuite showers. There is an ongoing programme of redecoration and upgrading of the accommodation. The care staff are positive and enthusiastic about working at the Home. We observed staff supporting residents in a kind and respectful manner. When we spoke to them they had a good understanding of their responsibilities and of how to meet the residents needs. Residents spoke highly of the staff, including comments such as: Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 6 ‘I am very happy here’ ‘If we ask for something then it is always done’ The Home is well managed. Ms Kalnins is an experienced and well qualified Manager who provides good support to all of the residents, staff and relatives. Comments were made about her style of management, such as: ‘very good manager, she is great’ ‘Liz is very supportive, you can always talk to her’ ‘’Liz brings everyone together, she is very approachable’ ‘this is a safe warm home for life, staff are kind, cheerful and efficient’ ‘I am very happy here’ The Home is managed in a way which puts the needs of the residents first. There are systems in place for regularly monitoring the quality of the service provided. This includes regular auditing of specific areas of care and also the use of questionnaires for residents and relatives. The Home offers a range of activities. The activities organiser has good links within the community and has used these to encourage volunteers to become involved in the provision of activities, both in groups and with individual residents. The staff receive good training and support which enables them to carry out their roles effectively. The care records contain effective assessments of residents needs and care plans are then written based on the assessments. These are regularly reviewed. Staff are aware of the content of the care plans. What has improved since the last inspection? The staffing levels have increased in response to increasing needs of the residents. The turnover of staff is much lower now than it was previously. The Manager has carried out recruitment and the staff said that the staff team are working well together and morale is higher. Additional equipment, such as profiling beds, have been purchased to meet the increasing frailty of residents. A part time activities support worker has been appointed to work alongside the activities organiser. The support worker mainly concentrates on providing 1:1 activities with individual residents. Work has started with regard to improving communication across all areas of the service provided. Communication books have been introduced to enable relatives and staff to leave each other non-urgent messages. Photographic menus are available to assist residents with choosing their meals. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have good information about the Home to help them make the decision about moving in. The residents needs are assessed prior to them moving in and only those residents whose needs can be met at the Home are admitted. EVIDENCE: The Home has a Statement of Purpose and a Service User Guide which provide information about the services provided at the Home. A copy of the Service User Guide is provided in all of the bedrooms so that residents can refer to them whenever they like. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 10 Within the AQAA it states that effective pre admission assessments are carried out prior to a decision being made about whether the Home can meet the residents needs. We saw a sample of these assessments and they include information gathered from the resident, their relatives if appropriate and any health/social care professionals involved in the residents care. The Manager gave examples of situations where they have not admitted a prospective resident as they did not feel that the Home was able to meet their needs. The residents/relatives surveys state that the residents had received enough information prior to moving into the Home. On the day of our visit a resident had just moved into the Home. Staff were seen to spend a lot of time with the resident, explaining to her where she was and introducing her to other residents. The member of staff was kind and patient. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents personal and healthcare needs are met. Residents feel that their privacy and dignity is respected. Medication is managed in a safe way. Residents, and relatives, are supported with care, sensitivity and respect at the end of the residents life. EVIDENCE: The responses within the residents surveys with regard to whether they get the care and support they need are mixed with 4 stating ‘always’, 2 stating ‘usually’ and 2 stating ‘sometimes’. The responses are equally mixed in response to the question about whether there are enough staff. They all state that the staff listen and act on what the residents say. Additional comments were made such as: ‘I am very happy here’ Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 12 ‘If we ask for something then it is always done’ ‘staff are friendly and helpful but there are not always enough’ ‘it is frustrating to wait to use the toilet’ We observed staff supporting residents throughout the day, in different areas of the Home. At all times the staff were kind and patient. Staff explained to residents what they were doing and in some instances this had to be done several times due to the residents communication difficulties. The Manager said that improvements have been made with regard to communication since the last Inspection. For example new communication books have been introduced. These are kept in the residents bedrooms and enable relatives and staff to leave non urgent messages. Menus are now available in photographic format to enable residents to more easily understand what is available at mealtimes. The Manager continually reviews signage around the Home and some areas have this. There are plans for the newer wing of the Home to provide accommodation for the residents with dementia. This will take some time to achieve as the Manager does not wish residents to have to move if they do not want to do so. There are plans to make this environment more suitable for residents with dementia through the use of colours and improved signage. The majority of the residents at the Home have nursing needs. There are always qualified nurses on duty as well as care staff. There are currently fifteen residents with dementia and there are always staff on duty who have undertaken training about working with people with dementia working with these residents. The Manager is aware of the need for additional training so that all staff have a good understanding of working with people with dementia. Two of the residents have learning disabilities as well as additional nursing needs. Staff have received some training about working with people with learning disabilities and there are plans for further training. Training is provided about individual residents needs when needed. For example the Speech and Language therapist has provided training about the support needed by one of the residents at mealtimes. The nurses are encouraged to attend workshops and training updates about issues such as tissue viability, venapuncture, dressings and other nursing tasks. Referrals are made to healthcare professionals where appropriate, such as the continence advisor, speech and language therapists, tissue viability nurse. The nurses in the Home are now taking the lead for particular issues such as palliative care, nutrition and tissue viability. The Manager said that this is to enable at least one nurse to maintain training and up to date knowledge about a particular area and that they are then responsible for passing on the Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 13 knowledge to the rest of the nurses and carers where appropriate. They also liaise with any healthcare specialists in that field. The Manager is currently providing training sessions about palliative care. Staff told us that this has been very useful and informative. Some staff have attended training provided by external trainers about palliative care. Staff told us that they are always encouraged to spend time with residents at the end of their life if there are no relatives to do so. We saw some cards that relatives have sent to the Home in which they have particularly thanked the staff for the care provided to their relative at the end of their life. We looked at three of the care plans during our visit. Some of the records are difficult to read due to the fact that they are handwritten. The care plans each have a brief summary of how each resident likes to spend their day and the care that they need. This provides a good, quick reference guide to staff. In general, the care plans that we saw provide good information to the staff about how to meet residents needs. There are some nice details about providing personal care that may seem minor but will actually make a big difference to someone’s day. For example, one of the care plans includes information about a resident preferring to wear a jumper every day and also little details about how they like to have their hair washed. There are some areas where further detail would be beneficial to ensure that all staff are providing consistent care. For example, one of the residents care plans state that they should have frequent small meals during the day but there is no information about who is responsible for ensuring that these are offered to the resident. The Manager said that the kitchen staff are responsible for this. However, there is a need for the care plan to clarify this so that all staff are clear. The care plans include a range of assessments such as continence, mobility, pressure care, behaviour and the care plans are then based on the results of these assessments. There is evidence of regular reviews and of advice from health professionals being incorporated into the care plan. The GP visits the Home on a regular weekly basis but will also attend if needed between planned visits. The survey that we received from a health professional states that the staff always seek advice and act on it and that staff have the right skills and experience to meet the needs of the residents. The staff who spoke to us spoke positively about working with the residents and said that they enjoy working at the Home. The staff surveys that we received were mixed with regard to whether they receive up to date information about the needs of the residents. One stated that this ‘always’ happens and one stated that it ‘usually’ happens. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 14 Staff were clear about their roles and the role of the qualified nurses. They gave consistent answers when asked about issues such as pressure care. They were clear about the need to notify the nurses when certain situations occur. The deputy manager takes the lead in ensuring that medication is ordered and managed appropriately. Regular audits take place by the deputy manager and the Manager about the safe administration of medication. These show that the previous difficulties with regard to medication have been addressed and the requirements met. Accurate records are kept and there were no gaps in the administration records. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are offered to residents to join in with if they wish to. Relatives are made to feel welcome at the Home. Residents are offered a choice at mealtimes and receive the support they need to eat their meals. EVIDENCE: The responses in the surveys from residents/relatives all, except for one, state that there are always activities offered to residents to take part in. Additional comments were made such as: ‘excellent activities’ The Home employs an activities organiser and in the last few months have also employed a part time activities support worker. The activities organiser also provides a lot of in house training and so her time is divided between the two roles. She said that the care staff are now more involved in the provision of activities than they have been in the past. The activities organiser has good Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 16 links with the local community and has used these to encourage involvement in the home by local groups. The local school have put on concerts and local preachers provide services within the Home. The activities organiser has encouraged volunteers to take on particular responsibilities. For example, one of the volunteers organises regular Bingo and art/craft sessions whilst another volunteer organises the different religious services. One of the volunteers told us the Home has much improved since Ms Kalnins has been the Manager and that the home is an ‘excellent place for the residents’. The activities organiser has also liaised with the local Volunteer organisation and volunteers are now coming in on a more formal basis to ‘befriend’ residents and to provide 1:1 activities such as going shopping. One of the members of this organisation completed a survey for us and this states that the volunteers receive good induction and support and that there is good communication between the Home and the organisation. Activities are organised in both group and individual sessions. There are posters around the Home of what is available. The activities organiser and the Manager are both aware of the need to provide more 1:1 activities, particularly for those with dementia. The residents/relatives surveys are mixed with regard to whether the residents enjoy their meals but the majority state that they ‘always’ enjoy them. Additional comments were made such as: ‘the food is good’ ‘lovely choice of food’ We observed part of the lunch time meal. Residents who need support to eat meals were provided with this in a respectful manner. Residents were offered a choice at mealtimes and one of the residents told us that they can always have more if they want to. The care plans that we saw all contained a MUST nutritional assessment with details about the dietary needs of residents. As previously mentioned there is a need to ensure that the care plan includes information about the kitchen staffs responsibilities with regard to nutrition and not just those of the care staff. We did not speak to the kitchen staff during our visit to the Home. The Manager showed us a letter received from the Environmental Health department which awards the Home 4 Stars (out of a maximum of 5) for Food Safety. This was awarded following an inspection in November 2008. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives are confident that their complaints are listened to and acted upon. Procedures and staff training are in place to protect residents from abuse. EVIDENCE: The complaints procedure is displayed around the Home. One of the residents told us that the staff would deal with any concerns they may have. All of the responses within the residents/relatives surveys state that the staff listen and act and that they know who to speak to if they are unhappy about something. Both of the responses in the staff surveys state that they know what to do if someone wants to raise a concern. The Manager keeps a record of complaints. From this we can see that she takes even seemingly minor issues seriously and that a full investigation is carried out with clear records kept. Action has been taken to address any issues raised by relatives or residents. The Commission has not received any complaints about the Home since the last Inspection. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 18 Staff who spoke to us said that they had received training about Safeguarding vulnerable adults as well as an introduction to the subject in their induction. They were all confident that the Manager would deal appropriately with any concerns/complaints that they may raise with her. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the 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 provides accommodation which is comfortable and homely. The Home is clean and mostly free from unpleasant odours. EVIDENCE: The Home offers residents a choice of accommodation in the older part of the Home or in the newer purpose built extension. The Manager said that residents usually have a preference about which part of the Home they would like to live in. However, residents are encouraged to move around the whole Home and to spend time in whatever lounge they would like to. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 20 All of the bedrooms in the Home are ensuite and the bedrooms in the extension have ensuite shower rooms. The Home has a choice of communal areas with three lounges and two dining areas. The Manager has also created a small, cosy sitting area on the landing upstairs to provide somewhere for smaller groups of residents to sit. The Manager entered a competition at the end of last year and won first prize which was a ‘makeover’ for one of the lounges. This provided a lot of excitement for residents who told me that they were involved in choosing new furniture and curtains. A party was held to celebrate the ‘grand opening’. The Manager said that discussions are taking place with staff about how to make the bathrooms more homely as currently some of these are rather functional. Equipment is provided in the bathrooms such as raised toilet seats and bath hoists. Since the last Inspection the Proprietor has purchased several profiling beds to meet the needs of the residents. There are handrails along the corridors and the Home has a passenger lift to the first floor. The Manager said that the windows on the first floor have restricted opening. She also said that the hot water temperatures are regulated. The majority of the radiators are covered to prevent scalds/burns but there are some in the bedrooms which are not covered. A generic risk assessment was carried out in 2007 but there is a need for individual risk assessments to be carried for the these radiators to ensure that unnecessary risks are not being taken for individual residents. The Home employs a good level of domestic and laundry staff who work hard to maintain good standards in the Home. The majority of the Home was clean with no unpleasant odours. There are a couple of bedrooms in which there is a problem with odours but the Manager and domestic staff are aware of this and various options are being tried to address the problem. The Home has a large garden which is well maintained. There is a also a small patio area with raised beds which are used by the residents gardening group. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents needs are met by staff who receive appropriate training and support to carry out their roles effectively. The Home follows good recruitment practices. EVIDENCE: The section about staffing in the AQAA states that over 50 of staff have achieved at least Level 2 NVQ and that currently 5 staff are undertaking NVQ Level 3. Staff receive a thorough induction when they first start work and there is an ongoing programme of mandatory and specialised training available for the trained staff and the care staff. Staff told us that they are encouraged to undertake training and that the Proprietor supports them to attend training sessions. Some of the care staff have received training about working with people with Dementia and these are the staff who work with the residents with dementia. The Manager is aware of the need for all staff to attend this training. Some of the senior staff have attended more in depth Dementia training and are intending to carry out some Dementia Mapping work. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 22 Both of the staff surveys state that the staff receive relevant training and additional comments were made about this: ‘regular in house training’ ‘Learning Disability team has provided us with information’ ‘we have regular meetings’ Records show that regular staff meetings take place and that action is taken to address issues as they arise. The staff who spoke to us said that staff morale is much higher now that there is a lower rate of staff turnover. They said that the staffing levels have increased in response to increasing needs of the residents and that the care staff all work well together as a team. The Manager confirmed that the turnover of staff has decreased and that the staff team has been stable for some time now. She said that the staff team work well together and that they are enthusiastic about working with the residents. The residents/relatives surveys are mixed between ‘always’ and ‘usually’ with regard to whether there are enough staff available. Additional comments were made about the staff, such as: ‘very good staff, kind and helpful’ ‘staff are friendly and care but there are not always enough of them’ ‘this is a safe warm home for life, staff are kind, cheerful and efficient’ ‘I am very happy here’ The usual staffing levels are for there to be 2 nurses and 8 care staff on duty between 8am and 2pm. There are 2 nurses and 6 care staff on duty from 2pm to 8pm. Overnight there is 1 nurse and 3 care staff on duty. In addition to this, during the day there are also domestic, laundry, administrative and kitchen staff on duty. The Manager works full time but is not counted as part of the staff hours. The deputy manager works mainly shifts but does have some administrative time to carry out management tasks. The nurses are responsible for planning where staff will work. The staff told us that the way in which staff are deployed around the Home works well and that there are always staff on duty with additional training about working with people with dementia. We looked at a selection of staff files and can see that appropriate checks are carried out prior to staff working at the Home. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 People using the 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, in a way which puts the needs of the residents first. Staff receive good support and supervision from the management team. Measures are taken to protect the health and safety of residents and staff although risk assessments need to be carried out for some of the radiators. EVIDENCE: The Manager has been in post since March 2007 and has attended appropriate management training as well as being a qualified nurse. She has also attended Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 24 training with regard to the provision of Dementia care and, more recently, training about the Mental Capacity Act and Deprivation of Liberty Act. All of the people whom we spoke to spoke very highly of the Manager and of the improvements that have been made at the Home since she started working there. These were also confirmed in the surveys that we received. Some of the comments made were: ‘the manager is approachable’ ‘manager is excellent’ ‘very good manager, she is great’ ‘Liz is very supportive, you can always talk to her’ ‘’Liz brings everyone together, she is very approachable’ The Manager meets regularly with the Proprietor and there are also joint meetings with the Manager of the other Home that is owned by the Proprietor. Regular monthly visits take place as per Regulation 26 and a report is provided following these. The Manager uses questionnaires to obtain the views of residents and relatives. We saw the most recent responses and these contain very positive remarks. The Manager takes action to address any issues that may be raised in these questionnaires, however minor they may seem to be. The staff told us that they receive regular supervision, both individually and in groups. Regular staff meetings take place and minutes are kept of all meetings. The Manager carries out a range of audits on a monthly basis and action is taken to address issues. We looked at a selection of health and safety records and can see that regular maintenance and servicing of equipment takes place. The Manager said that the person responsible for carrying out the fire risk assessment has recently visited and started to update the assessment. She also said that the Homes electrical equipment has been checked recently by an electrician. The electrical equipment is not PAT tested although visual checks are carried out with regard to equipment. We were told that a full electrical check was carried out in the Home in March 2009. As previously mentioned in this report, some of the bedroom radiators are not covered and therefore there may be risks to some of the residents. A generic risk assessment was carried out in 2007 but there is a need for individual risk assessments to be completed to ensure that residents are not being put at unnecessary risk. The Home are responsible for looking after small amounts of money for some of the residents. We looked at the records relating to this for one of the residents and found that these were clear. These are audited on a regular basis. It is recommended that the care plan contains information about the Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 25 arrangements in place for looking after residents money where this is applicable. Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 2 Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13 Requirement It is required that a risk assessment is carried out for the radiators that are not covered Timescale for action 31/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP35 OP30 Good Practice Recommendations It is recommended that the care plans contain information about the arrangements in place for looking after residents money where appropriate It is recommended that all staff receive training about working with residents with dementia Halvergate House DS0000015642.V375610.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle NE1 4PA National Enquiry Line: 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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