Care Home: Hampton Care Ltd

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What the care home does well People are happy living at the home and feel that it meets their needs. People live in an environment which is furnished and decorated to a high standard and is well equipped in both private and communal areas. People are able to visit and find out information about the home to help them make a decision about whether they want to live there. People are supported to stay healthy. Visitors are made welcome and are able to continue to be involved with caring for their relatives if they wish. People are able to chose from a variety of freshly prepared food. The home is well managed and there are good systems to monitor health and safety and customer satisfaction. What has improved since the last inspection? The service was registered in September 2008 and this is the first inspection. Since the home opened the Manager, Owner and staff have worked hard to support people to move there and to feel settled and happy. They have set up a number of systems and procedures which help the smooth running of the home. Twenty-three people have successfully moved to the home and continue to live there. What the care home could do better: There needs to be changes to the environment, planned activities, staff skills and knowledge to improve the service for people who have dementia. There needs to be improvements to the information written about people so that the staff have a better understanding about individual likes, preferences and interests. People living at the home should be invited to read and agree with the information written about them and should be given copies of this to keep. There needs to be changes to the way in which activities are planned and organised so that everybody has the opportunity to participate in organised events which appeal to them and they are interested in. There needs to be closer monitoring of the way in which medication is managed to reduce the risks of error. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hampton Care Ltd Upper Sunbury Road Hampton Middlesex TW12 2DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Hampton Care Ltd Upper Sunbury Road Hampton Middlesex TW12 2DW 02082035678 02082035222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hampton Care Ltd Name of registered manager (if applicable) Kathryn Jane Desmond Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is: 76 The registered person may provide the following categories of service only: Care Home with Nursing - Code N To the 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Hampton Care is a home for older people who have care and nursing needs. The home opened in September 2008. The home is on the main road from Hampton Court to Sunbury, close to shops and public transport in Hampton. The building is well equipped with extensive communal facilities including a cinema and gym. All bedrooms are equipped with wall mounted TV and have en suite WC, wash basins and showers. Ground floor bedrooms have patio doors leading to the gardens. There are adjourning Care Homes for Older People Page 4 of 37 care home 76 Over 65 0 76 76 0 Brief description of the care home bedrooms for people who wish to share. The home is privately owned and is staffed throughout the day and night. The owner has produced a welcome pack for people who wish to move to the home and this includes the aims and objectives. The fee range is £550 - £1,200. Care Homes for Older People Page 5 of 37 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 the people who use this service experience good quality outcomes. As part of this inspection we visited the home on 28th January 2009. We met people who live there, staff, visitors and the Manager. We looked at the environment and records used at the home and we observed how people were cared for. We wrote to people who live and work there and asked them to complete surveys about their experiences. We asked the Manager to complete a quality self assessment. Care Homes for Older People Page 6 of 37 We looked at all the information we have received about the home since it was registered in September 2008. Some of the things people told us about Hampton Care were 11 out of 10 Terrific! Bright and colourful! 10 out of 10, no that is not enough they deserve 20 out of 10! There is a wonderful atmosphere. The staff are very caring. It is lovely here. The people here do not know how lucky they are. Hampton Care is a lovely place and is so inviting and friendly. The staff are all excellent and make you feel very much at home. What the care home does well: What has improved since the last inspection? 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 set out on page 4. Care Homes for Older People Page 8 of 37 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need and opportunities to visit the home to help them decide if they wish to live there. They have their needs assessed to make sure the staff at the home are able to meet these needs. Evidence: The home was registered in September 2008 and since this time the owner and manager have worked hard to advertise the service, encourage people to visit and to help people who have decided to move there to settle in. At the time of our visit 23 people were living at the home. There is a brochure of information about the home, including the statement of purpose and aims and objectives. Copies of these are given to anyone interested in moving to the home and are also available in all bedrooms. Care Homes for Older People Page 11 of 37 Evidence: Each person has a selection of other information, including details of their key member of staff and named nurse, leaflets on local services, activity programme and menu within a folder in their bedroom. People we spoke to said that they had enough information about the home and they knew about the facilities and services offered. People who are interested in moving to the home have their needs assessed by the Manager and these are recorded. People are invited to visit the home and spend time there before they make a decision about moving there. One person told us, we were shown round by a very supportive lady who took her time and put my mind at rest. We looked at a sample of care records. In some cases we did not see evidence of review meetings, where the person, their representatives and representatives of the home had discussed whether the placement was suitable. The Manager should make sure everyone has the opportunity to meet and discuss their placements to make sure they are getting the right care and support. There should be evidence of these meetings. Everyone who lives at the home has been given a contract which outlines their terms and conditions of residency and fees. We saw copies of these. Care Homes for Older People Page 12 of 37 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 are supported to stay healthy and are well cared for. People are generally able to make choices but these are not always clearly recorded. People are supported to manage their medication but some practices need to be improved to make sure people are not put at risk. People who have dementia are not always given the support and understanding they need. Evidence: There is a record about each person (care plan) which outlines their needs and tells the staff what they need to do to support the person. People do not have their own copy of these records and should be offered one so that they can refer to this whenever they wish. Not everyone had signed a copy of their care plan and they should do to show that they have read and understood these. We looked at a sample of care plans and other related records. The language and terminology in some of the care plans was unclear and could be Care Homes for Older People Page 13 of 37 Evidence: confusing to people. Some of the things staff had written were their opinions and not facts about the person. For example, one person was referred to as aggressive and someone else was called abusive. Another care plan said staff should minimise the unacceptable behaviours of a particular person. One care plan stated that the person was activity intolerant. The staff should try to use plain English which can be more easily understood by everyone and should make sure they write care notes in a way which the people they are about would chose. The care plans were a good record of health and personal care needs and we saw that these were closely monitored by staff. Some care plans outlined principles of good practice about offering choice and respecting people. However, we felt that there was not enough information about peoples preferences, likes and interests or how to give them the individual care and support they would chose. Care plans recorded peoples preferred names. We saw that one persons care plan recorded their preferred name was their title and surname. However, we heard all the staff who spoke to them refer to them by a shortened version of their first name throughout the day. We also found that some care plans were confusing as some information in one part of the plan was not recorded in another part and this sometimes lead to contradictions about the care someone should receive. For example two profiles about people recorded allergies, however their care plans did not mention the allergies. We also saw that a lot of standard forms and paperwork, including guidance on how to complete certain records, were included in plans. The care plans should only really include information about the person and their needs and additional things should be removed to make the important information easier to access. The information about peoples lives before they moved to Hampton Care was very limited and brief. The staff should try and get as much information as possible so that they have a better understanding about each individual and the important events of their lives. This is particularly important where people are confused and may not be able to tell the staff themselves. We saw that when people took risks these had been carefully assessed and ways to support people had been recorded. These risk assessments had been reviewed. Everybody is registered with local GPs and one surgery visits the home weekly. The Manager told us that she has started to build up links with local health services. Some Care Homes for Older People Page 14 of 37 Evidence: private services such as chiropody and aromatherapy have started to visit people at the home. Nursing staff work at the home throughout the day and night and the Manager is a registered nurse. We met a visiting health professional who told us that the staff provided a good service and communicated well with other professionals. Peoples health needs are recorded within care plans and we saw that these were monitored regularly. The staff showed us that they had a good understanding of individual health needs. A physiotherapist visits the home twice a week. There is a gym and people can use the equipment with the physiotherapist or on their own to improve health and mobility. One person said, the physiotherapist is a miracle worker. Some people told us that the staff had supported them to get better after an accident or hospital treatment. One visitor told us that the health of their relative had improved beyond what they had hoped for since they moved to the home. One person said, this home has brought my relative back to life. People are able to manage their own medication if they wish to. The person, staff and their GP assess the risks to this. We saw records, including a care plan and risk assessment for someone who manages their own medication. Everyone is provided with a lockable facility to safely store medicines. There is a medication procedure and secure storage for all medication. We looked at a sample of medication and related records. We found that most records were accurate. However, some medication administration records indicated that people did not have allergies when other records about the same person said that they did. Some medication records did not record the amount of a particular type of medicine held at the home. An important instruction about a change to someones prescribed medication was written on a post it note and not on the actual medication administration chart. We found two items of medication which had the prescription label torn so that the persons name and administration details could not be read. We saw a small pot with three tablets in it which was not labelled with the persons name or what the medicine was. We saw that some non prescribed medication was not labelled with the persons name or administration details. The Manager told us that staff responsible for administering medication were assessed and that checks were made on records and storage. Further recorded checks should take place to minimise the likelihood of errors which could put people at risk. Care Homes for Older People Page 15 of 37 Evidence: A small number of people living at the home at the time of our visit were confused. It is intended that more people who have dementia are offered a service at Hampton Care in a designated area of the home in the future. We felt that some of the staff lacked skills and understanding about how best to support people who have dementia. For example some of the people we met liked to walk around the home. We saw many different staff repeatedly trying to make these people sit down and not allowing them to express themselves freely. We overheard one person becoming distressed and saying that they wanted to go home. The staff did not offer this person support or comfort they tried to restrict their movement around the home and told them that they could not go home. The majority of staff have had half a days training on dementia awareness. However, this is not sufficient to equip them to support people appropriately and they need further training and information to help them understand and give them the skills they need. The care plans and notes for people who have dementia did not give the staff the guidance they need to support these people. For example one persons care plan about their behaviour mostly gave information about their sleeping pattern. There was no care plan for supporting them to be occupied or about how staff should interact with them. Care notes written about some people said that they, refused to go to bed and refused to get dressed. The staff should be supporting people by recognising their reality may be different to theirs and valuing their choices. We saw two incidents where people were taken in wheelchairs without foot plates. In one instance the member of staff said that the person should hold their feet up so that they did not have to put the foot plates on and the other member of staff said that she would wheel the person backwards because they did not have foot plates. This could put people at risk. We saw most staff were very supportive and kind when talking with people. People living at the home told us that the staff were helpful and caring. One person said, we want for nothing. Another person said, the staff are caring, discreet and show dignity. One person told us, the staff listen and pay attention. One person said that some staff were not as caring as others and we overheard a staff member being rude to someone. We told the Manager about this. She recognised that this was unacceptable and agreed to take appropriate action. The staff need to be aware of how they speak to people and must not be rude or impatient with anyone. There is a beauty salon and the hairdresser offers a service twice a week. People told us that they enjoyed visiting the hairdresser and that she offered value for money. One person told us that some carers were good at helping them with their make up. Care Homes for Older People Page 16 of 37 Evidence: One person told us that they would like the staff to give them regular nail care. Toiletries are supplied in all bedrooms, although people are able to bring their own if they wish. People told us that they could get up and go to bed when they chose. One person told us that they were able to have a leisurely breakfast and spend the morning in their room until they wanted staff to help them to get dressed. One person said, we can get up when we want, eat what we want and tell someone if something is not right. Care Homes for Older People Page 17 of 37 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. People are supported to take part in a range of activities, but these do not always meet everyones individual needs. Visitors are welcome and are valued. People are able to make choices about their lives and are informed about the service. People are able to make choices from a range of freshly prepared food. Evidence: The home employs an activities officer who works from 10am to 3pm three days a week and 10am to 5pm twice a week. There is a planned programme of activities, with two activities each day. The owner should consider employing more activity officer hours so that more people can be offered support in this area for longer periods of time. This is particularly important as more people move to the home. The manager should also encourage staff to be more involved with meeting peoples social needs. We met the activities officer and she was enthusiastic and dedicated to her role. She had a good understanding that peoples individual interests should be considered. She said that she was committed to keeping people healthy and supporting them to go out as much as possible. However, she needs to have more training and information about activity provision and about supporting people with dementia. Care Homes for Older People Page 18 of 37 Evidence: There are no social or activity care plans for people living at the home and information on their likes, interests and hobbies is limited. The activity officer said that she knows about some peoples interests. However, there should be better recorded information to help staff know and understand about individual social needs. There was no record about the activities people had participated in or what they had done each day. On the day of our visit the organised activity was due to start at 11am but actually started at 11.30. The activities officer did not tell people the activity was about to start, she just turned the TV off and started telling people what to do. The morning activity was exercise and people seemed to enjoy this. The activity officer engaged people and entertained them. However, at times she seemed distracted or had to attend to other tasks and she left the room without telling people what was happening on a number of occasions. At the end of the activity session the care staff walked into the room and started to escort people to the dining room for lunch. There was no distinct end to the activity and no one was told that the session had finished. The advertised activity for the afternoon did not take place and a different activity was organised instead. We over heard the activity officer telling people about this and encouraging them to join the session. People told us that they had enjoyed the days activities and generally enjoyed activities. However, it seemed very disorganised and people were not informed about what was happening. The care staff were not involved in the activity provision and the activity officer told us that at times it was difficult to run the session and attend to the needs of everyone taking part. The activity officer has not been trained in exercises for older people and should undertake training to make sure she is giving people the correct support and information. The activity officer said that she had some resources and that the manager was happy to provide any equipment and resources she needed. She told us that the home was purchasing a mini bus and she hoped to organise a number of outings in the near future. The Manager told us that she has started to make links with the local community, including local schools who had visited the home around Christmas time. She told us that musicians visit the home weekly. All bedrooms and communal areas are equipped with wall mounted flat screen televisions and free view channels. There is also a gym, cinema and beauty salon. The hairdresser currently visits twice a week although this will be reviewed as more people move to the home. Care Homes for Older People Page 19 of 37 Evidence: Visitors are welcome at any time and are able to continue to care for their relatives. We saw visitors throughout the day. Visitors are able to dine with people free of charge. There is accommodation for relatives and visitors who wish to stay with people who are ill. One visitor told us, we can come at anytime and all comment on the home and are impressed by the offer of refreshments and friendly atmosphere. We saw that staff and the Manager had a positive attitude towards visitors and valued them. People told us that they were consulted and some people told us that they had recently had a meeting. They said that they were able to contribute their ideas at this. Some of the staff were not wearing name badges and there is no photographs of staff on display. The Manager should consider creating a display of staff photographs to help people living at the home identify them. There is a good range of information given to people in their rooms about the facilities and services at the home. But, there is no notice board in communal areas and should be so that minutes of meetings, planned activities, and other useful information can be displayed. There are dining rooms on each floor and people are able to eat in their rooms if they wish. The menu was displayed. People are able to chose from a range of freshly prepared food, with two main choices at each meal and a dessert trolley. People are able to choose alcoholic and non alcoholic drinks at mealtimes. Dining rooms are attractively laid out for a pleasant dining experience and people who need support are given this discreetly and appropriately. People told us that they generally liked the food and could talk to the Chef if they had any particular needs. One person said, meals are imaginative and varied. Another person said, the food is superb, beautifully cooked, varied choices and well presented. People told us that they could take breakfast in their rooms and at a time of their choosing. They said that their were extensive breakfast options each. day. One person told us that they took a leisurely breakfast reading their paper. People told us that they could have snacks and drinks throughout the day and night. There are small kitchen areas and some people chose to make themselves drinks. People are able to request fruit for their bedrooms and fresh fruit is always available on the dessert trolley. Hotel service staff are employed to make sure people have drinks and snacks they need. Consideration should be given to offering fresh fruit throughout the day. Care Homes for Older People Page 20 of 37 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. There are procedures in place designed to protect people. The staff have had training and are aware of these procedures. Evidence: There is a complaints procedure and people have been given a copy of this. People told us that they knew who to speak to if they had any concerns. There have been no formal complaints since the service opened. There are procedures on protection of vulnerable adults and whistle blowing, including the local authority procedures. The staff have had training in this. The staff we spoke to said that they knew what to do if they suspected someone was being abused. Care Homes for Older People Page 21 of 37 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 excellent 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 spacious, attractive, comfortable and safe home. They benefit from extensive facilities and equipment. Evidence: The home was newly built in 2008 to a high standard and people benefit from attractive and well equipped private and communal accommodation. People told us that they liked the home. Some of the things people said were, we love the gardens and we sit and look out at them, I have everything I need in my room, the home is decorated beautifully, the home never smells, our clothes are cared for and well laundered and we are lucky to live in such an attractive environment. There is a reception area which is staffed throughout the day. Each floor has a nurses station where staff keep records. All bedrooms have en suite shower, WC and hand wash basins. They are equipped with wall mounted televisions, wall mounted full length mirrors, individual telephone lines and free line rental, and a range of furniture. All doors are equipped with magnets to keep them safely open which close in event of a fire. People are able to bring their own furniture if they wish to and we saw that some people had done this to personalise Care Homes for Older People Page 22 of 37 Evidence: their rooms. People who wish to share can be allocated two interconnecting rooms. Most ground floor rooms have patio doors leading to the garden. Corridors, bathrooms and communal areas are light and spacious and equipped with hand rails. Bathrooms include specialist baths and showers for people with reduced mobility. Communal areas are attractively designed and furnished. The home is heated by under floor heating. Each room is equipped with an individual thermostat to control this. The home was clean and fresh on the day of our visit and we saw fresh flowers throughout. There is a dining area and lounge on each floor. All floors are accessed by a lift or stairs. The garden is divided into different areas, including patios directly outside some bedrooms and communal areas. There is a separate garden which the Manager told us would be developed into a sensory garden. Areas of the garden have been planted with trees, flowers and herbs and there are raised beds for people who wish to be involved in gardening. All rooms are equipped with a call alarm system and the Manager told us that additional portable alarms were going to be provided to people who needed these. The service aims to provide accommodation for people who have dementia within a dedicated unit. There needs to be improvements to this area of the home to make it more suitable to meet the needs of people who are confused. These improvements should include better orientation for people and communal areas which provide stimulation and interest. The communal bathrooms are well equipped but they appeared rather clinical and should be improved to make them more homely and inviting. The home has its own car park. Communal facilities include a gym, beauty salon and cinema. There is a bedroom with en suite facilities available for family members or other visitors who wish to stay if their relative is unwell. There are staff facilities including changing rooms, showers, rest rooms and kitchen. There is a dedicated and well managed laundry service. There are good systems for managing hygiene and infection control. These include equipping all staff and bathrooms with alcohol gel and on site destruction of clinical waste. Care Homes for Older People Page 23 of 37 Care Homes for Older People Page 24 of 37 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 living at the home are cared for by well trained and supported staff who have been suitably recruited. Evidence: People told us that the staff were generally kind and caring and gave them the support they needed. One person told us that some staff were better than others. Another person said, the staff are understanding and always available for care and support even when they are busy. There is a team of staff, many who have worked at the home since it opened. The staff team is increasing as more people move to the home. The Manager told us that she has recently recruited some new staff. There is a team of domestic, laundry, catering and hotel service staff who make sure peoples needs are met in these areas. The Manager conducts staff interviews and we saw evidence of these. We looked at a sample of staff recruitment records and saw that thorough checks had been made on staff, including criminal record checks. We saw that one staff file did not evidence two reference checks. The Manager told us that they had received verbal confirmation of a reference and were waiting for a written reference. There should have been a record to evidence this and there was not. Care Homes for Older People Page 25 of 37 Evidence: The application form for staff could be improved to allow more room for staff to record their employment history and relationship to referees. The Manager should think about ways in which people who live at the home can be involved in recruiting and selecting staff. Some temporary staff are employed from an agency. The Manager showed us that she recorded checks on the PIN numbers of nursing staff employed on a permanent and temporary basis. She should also keep records to show that temporary staff have up to date training in manual handling and other key areas. The staff have attended a range of training courses and these have been recorded. There was no record of the content of these courses and the manager told us that she was getting details of this. We saw that the staff had had training in manual handling, protection of vulnerable adults, health and safety, fire safety, food hygiene and infection control. They had also had an induction into the home. We saw that the staff had only had half a days training in dementia care and this is not really enough for them to have an understanding about how to support people. There has been one staff team meeting since the home opened and the Manager told us that she plans to hold more regular meetings. The Manager said that individual supervision meetings with staff had just started. Care Homes for Older People Page 26 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed service and are able to contribute their ideas and opinions. Evidence: The Manager is experienced and worked at and managed two other residential nursing homes before taking up her post at Hampton Care. She is a qualified nurse and is undertaking additional management qualifications. She keeps herself updated with other relevant training. She started work before the home was registered and has therefore been involved in developing procedures and systems. The Manager had a good understanding of the things that needed to be addressed at the home and had plans to work towards continuous improvement of the service. She demonstrated a commitment to addressing the concerns we raised during the inspection visit. Care Homes for Older People Page 27 of 37 Evidence: The Manager was very positive about the staff team and said that they had worked hard and were committed. The Manager has a good knowledge of the service and about the people who live there. People we spoke to respected her and found her kind and supportive. One person said, she is kind and very caring. Another person said, I can speak to her at anytime and she is very patient. The Manager told us that the Owner employs a consultant who had offered support and guidance. The Owner should make sure the Manager is also offered regular clinical supervision. The Manager told us that she had introduced quality satisfaction surveys and started to distribute these. She told us that she planned to introduce further monitoring to look at specific services and facilities and to ask people who use the service what they think of these. We saw that there was a selection of thank you cards and letters from people who had lived at the home and their relatives. Some of the comments people made in these letters were, excellent staff, wonderful, thank you for making my stay so successful, you helped bring me back to life, we had the most fantastic service, a safe happy and clean environment, thank you for making my relatives last few months as comfortable as possible. There is a suggestion box in the main reception and the Manager plans to hold regular meetings for people at the home and their relatives. The consultant employed by the owner visits the home each month and carries out a quality inspection. He writes a report of his findings. We saw that records at the home were well organised and clear. There are good systems for recording checks and monitoring staff information, training, peoples health, accidents and health and safety. The home does not take responsibility for managing any ones finances. However, people can leave small amounts of cash with the Manager for safekeeping. The Manager told us that they prefer to invoice people for any expenditure. We saw that cash belonging to people was kept safe and there were appropriate procedures regarding this. Records of cash held were accurate and expenditure was clearly recorded with receipts. Shortly before our visit a health and safety audit was carried out on the environment. Recommendations for improvements were made in a report. The Manager told us action was being taken to address these. Care Homes for Older People Page 28 of 37 Evidence: We saw that regular checks are made on health and safety, including fire safety, water temperatures, electrical safety and general maintenance. These checks are recorded and we saw that action was taken to address concerns. The dedicated fire officer has spent time with the electricians who installed the fire alarm system to make sure he understands this. He has trained all staff and the fire procedure and notices are displayed throughout the home. Steep steps leading from the garden to the lower ground floor did not have a gate at the top of them. People using the garden could be at risk of falling down these and appropriate action should be taken to make the area safer. Care Homes for Older People Page 29 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 37 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 7 15 The Registered Person must make sure care plans are accurate and information is clear. Because inaccuracies or unclear information may mean that people do not get the care and support they need. 27/02/2009 2 7 12 The Registered Person must: 30/04/2009 1. Make sure everyone is offered a copy of their care plan to keep. 2. Make sure everyone signs their care plan, or their chosen representative does this, to show that they have read and understood it. 3. The language and terms used in records and care notes should be written in a way which the people they are about can understand and would chose. The staff Care Homes for Older People Page 31 of 37 should not record their own opinions unless unless they are stating it is their opinion. 4. Make sure care plans record individual interests, likes and choices and information about how the staff can support people to live the life they would chose. Because everyone has the right to be involved in planning and reviewing their own care and support and to know what others plan to do to support them. 3 9 13 The Registered Person must make sure all medcines are clearly labelled with the persons name and administration details. Because people may be at risk if medication is not properly labelled. 4 9 13 The Registered Person must make sure mediaction records state any allergies people have, record the amount of each type of medicine held in the home and give clear instruction about any changes to the prescribers instructions. Because people may be at risk from poor record keeping. 13/02/2009 13/02/2009 Care Homes for Older People Page 32 of 37 5 10 13 The Registered Person must make sure the staff always support and move people safely. Because people may be at risk if staff do not move them safely. 13/02/2009 6 10 12 The Registered Person must 30/04/2009 make sure the staff have the skills and knowledge to work with people who have dementia and that they recognise and value each persons choices and reality. Because people need to have the care and support which meets their individual needs. 7 10 12 The Registered Person must make sure the staff call and refer to people by their preferred name at all times. Because everyone has the right to chose how they are addressed. 13/02/2009 8 12 13 The Registered Person must make sure staff supporting people with exercises are trained to do so. Because untrained staff might give people incorrect advice or support and this may put the person at risk. 13/02/2009 9 12 16 The Registered Person must 30/04/2009 make sure there are planned activities and resources which meet the needs of people who have dementia. Care Homes for Older People Page 33 of 37 Because peoples social wellbeing is an essential part of their care. 10 12 12 The Registered Person must 31/03/2009 make sure peoples interests and social needs are recorded within care plans and are given the same importance as other care and and health needs. Because peoples social wellbeing is an essential part of their care. 11 29 19 The Registered Person must 13/02/2009 make sure there are at least two written references for all members of staff employed. Because people may be at risk if unsuitable staff are employed and these records are evidence that thorough checks have been made. 12 30 18 The Registered Person must make sure the staff have adequate and suitable training so that they can meet the needs of people who have dementia. Because people with dementia need special support and care from people who understand their needs. 13 38 13 The Registered Person must 28/02/2009 make sure the steep steps leading from the garden to the lower ground floor do not present a risk to anyone. 30/06/2009 Care Homes for Older People Page 34 of 37 Because someone could fall and injure themselves. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The Manager should make sure everybody has their needs reviewed to make sure they are getting the right care and support. The staff should find out and record information about peoples lives before they moved to Hampton Care so that they can get to know people and their needs better. The Manager should make regular recorded checks on medication storage and records to minimise the risk of errors. Consideration should be given to training and equipping the staff so that they can support people with nail care. Activities should be correctly advertised and appropriately organised so that people know what is happening and can make a decision about whether to participate in these. Care notes should include information on peoples social and emotional wellbeing and what they have done each day. There should be a record to show how many people have participated in organsied activities and their enjoyment. This record should be used to help plan future activities. There should be a fuller and more extensive range of activities and more than one person supporting people to take part in organised activities. The Manager should consider creating a display of staff photographs to help people living at the home identify them. The environment where people with dementia are going to be living needs to be improved to support better orientation and to provide more stimulation and interest. It is important that people within this area of the home have the facilities and equipment they need to alleviate boredom, allow them to feel comfortable and safe. The Owner should consider improving the communal Page 35 of 37 2 7 3 9 4 5 10 12 6 12 7 12 8 12 9 14 10 19 11 21 Care Homes for Older People bathrooms so that they feel more homely and inviting to use. 12 13 29 29 The Manager should consider ways to involve people who live at the home in recruiting staff. The application forms for staff jobs should be improved to allow more room for them to record their employment history and relationship to referees. The Manager should make sure she has evidence to show that temporary staff have had the training they need to keep people safe. The Manager should be offered regular clinical supervision. 14 30 15 32 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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