Care Home: Hayleigh

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What the care home does well Hayleigh gives people a warm, accessible and homely environment in which to live. Good management makes sure people are able to exercise their choices and respect is given to their wishes and feelings. Well trained management and staff make sure peoples` needs are met in positive and person-centred ways (person-centred means giving care that looks at a person`s whole life, history and needs. It recognises and values them as individuals with rights and choices, rather than just focussing on meeting basic physical care tasks). What has improved since the last inspection? All requirements and recommendations made at the last visit had been met. These included: Improvement in picking up and meeting needs identified before someone comes into the home, Improvement in care planning and care recording that shows how people are given the support they need in more person-centred ways, Improvement in the recording of helping people with dietary and needs around eating and drinking that makes sure they are kept safe and well, Improvement in medication recording and storage that protects people from risk of harm and: All staff including night staff have had relevant and necessary training in issues related to care of older people and working together as a team. The training they`ve had will make sure people are kept safe and treated with respect and dignity. We saw evidence that the acting manager Sharon Baker has driven the improvements and change and has many ideas about how to run the home based on peoples` wishes and needs. Staff are gaining in confidence in the new ways of working and people were positive in their comments to us about their lives at the home. What the care home could do better: No new requirements or recommendations were made at this visit. We do however recommend that the acting manager`s plans to further improve the quality of life for people living in the home happen sooner rather than later. These include: giving people a greater say in how the home is run, making sure requested activities and outings happen and continuing to work positively and closely with the local community. This will give people even more opportunities to enjoy fulfilling social lives and activities and make sure they are cared for from a truly person-centred perspective. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hayleigh Myrtle Street Bedminster Bristol BS3 1JG     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: Sandra Garrett     Date: 1 3 0 3 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 33 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Hayleigh Myrtle Street Bedminster Bristol BS3 1JG 01179039983 01179039984 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bristol City Council care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 Hayleigh care staff must undertake training in the care of older people with Learning Difficulties. This must be a rolling programme of regular training, to include any new care staff taken on after the service user is admitted. May accommodate one named person aged 64 years with Physical Disabilities. Registration will revert to OP when named person leaves. May accommodate one named person with Learning Difficulties. A specific condition is added to the Certificate of Registration for the Home in respect of this named person being accommodated there. The registration will be permanent, to lapse only when the named resident leaves the Home. Date of last inspection Brief description of the care home Bristol City Council runs Hayleigh which is a large purpose built care home. The home houses forty people and is registered in the older persons category. Its situated close to the busy shopping area of Bedminster and to local bus routes and community facilities. The home is accessible to disabled people with a lift to the first floor, selfopening front entrance and accessible toilet and bathing facilities. It has large mature gardens with trees and a patio. Fees for the service are 471 pounds per week (full Care Homes for Older People Page 4 of 33 Brief description of the care home fee). People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The certificate of registration and a copy of the last inspection report were displayed in the entrance foyer of the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before this visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. This included the Annual Quality Assurance Assessment we send to all services to tell us how they think they have performed over the last year. We also looked at notices sent to us under regulation about things that happen to people living at the home. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. Before the inspection we visited the home to do our Have Your Say survey with people. We spoke with ten people who told us they always receive the care and Care Homes for Older People Page 6 of 33 support they need. We also spoke with several people at the inspection. Comments from the surveys are included throughout this report. During this inspection we looked at a range of records including: care and medication records, complaints, staff training, minutes of residents and staff meetings and staff records. 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 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory arrangements for people coming into the home make sure their needs are met. People are looked after well in respect of their specialist and diverse needs by staff that are suitably trained and experienced. Evidence: From our survey filled in with people before the visit, six out of ten people said they had been given information about the home before they came in to it. Six also said they had received a contract. However four people said they hadnt been given information nor a contract. Comments about this included (about information given): I knew some of the staff from the home I was in before so I chose to come here, I was given a lot of information, I cant remember but I was more than happy to come here, I was told a lot about the place, I dont know, Yes because I was in another home and I needed somewhere with a bigger room to be able to make it my home Care Homes for Older People Page 11 of 33 Evidence: and: No I just came here. We followed up a requirement made at the last visit. This was about making sure needs that have been assessed before admission are transferred into the persons care plan done by staff at the home. The acting manager had gone through one assessment and highlighted from information given, all the persons needs and wishes. These had been transferred into a draft care plan. Care plans are worked on and fully developed during the four week assessment period. This gives people time to settle in to the home and is also time for staff to pick up additional or new needs not recorded in the assessment. A review is then held at the end of the four weeks and the care plan agreed with the person. We saw completed care plans that showed people had been involved in their development and they had signed them. Staff had also signed to say that they can meet the persons care needs. The acting manager told us that when people come to the home she makes sure they know that Hayleigh is their home and that life doesnt have to stop because theyve come into care. We saw that staff at the home had been unable to meet the needs of a person whose behaviour was negatively affecting others. People had complained formally and the matter was also discussed at a residents meeting. The acting manager acted quickly to get a re-assessment of the persons needs and s/he was transferred to a home that is better able to meet them. The acting manager had worked to help improve the environment for people with dementia or sight difficulties. A corridor had been made more accessible by means of colour coding and signs to guide people. A new sensory relaxation room had been made where people can go to chill out or have relaxing treatments. One member of staff is trained in alternative therapies and does treatments such as massage and reflexology without charge. Larger numbers have also been put on bedroom doors following consultation with people. This helps them find their rooms more easily. Staff have had training in equalities and diversity (this means meeting specialist needs of people from diverse groups such as black or minority ethnic, sexual diversity, gender, disability or religion). All staff do general equalities training as well as training in dealing with sexuality issues and dementia awareness and care. We saw emails that showed staff had been booked on to the Equalities Foundation course or an Ageing Matters course. Some staff are also being trained in doing activities with people that have dementia as this is a specialist need. Records of this training were seen together with emails from the training department regarding individual bookings. Staff are therefore trained and experienced in meeting older peoples different and specialist Care Homes for Older People Page 12 of 33 Evidence: needs. Some although not all diverse and specialist needs are included in the social work assessment given to the home before people come to it. These include cultural or dietary needs and religion. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Keeping of good and detailed care and health records shows that people are looked after well and can comment regularly on the care they get. People living at the home are looked after well in respect of their medication needs. Being treated with dignity and respect benefits people living at the home and theyre given opportunities to discuss their end of life wishes. Evidence: We spoke to people about the care they receive. One person said she had been stopped from following her favourite activity as she had got into difficulties and fallen over. She said staff had told her she couldnt do this anymore. The activity was, however recorded on her care plan as one that she enjoys and staff were to help her with. We spoke with the acting manager and advised her to do a risk assessment. The person uses a walking frame and said she did have a holder attached to it where she could keep the activity materials. She told us this had gone missing. We advised the acting manager to get another holder and let her do the activity. The acting manager Care Homes for Older People Page 14 of 33 Evidence: said the person hadnt been stopped from doing it but agreed it hadnt been made easier for her after the fall. New materials were given to the person by the end of the inspection. Comments from surveys about whether people get the care and support they need were as follows: Im looked after very well, Ive got no complaints at all, Yes Im looked after but I dont like it here and I want to go home, So far I have but Ive only been here for a week and: Theyre very good and its their job to be. If not they should go. We saw notices in the medical room written by the acting manager and put up on the wall. The notices were about making sure staff regularly write in daily records and following our last inspection, encouraging staff to write more and in more personcentred ways. Following a requirement made at the last inspection, we saw that staff were properly recording on food and fluid charts that showed a person was regularly getting good and adequate nourishment. The person had gained weight and the GP had stopped prescribing food supplement drinks for her or him. The acting manager said she was pleased about the improved recording but had to keep on at staff to make sure they do it regularly. Care plans were now being written in more person-centred ways that puts the person concerned at the heart of it and focusses on meeting her or his needs and wishes. Therefore the plans start out well with I need or I would like etc. However the actions and outcomes were still often being written in prescriptive ways e.g. (person) will need or would like. The results therefore werent clear enough about being the ones that people want for themselves. We suggested that all plans should be written from peoples own viewpoints. This will also show theyve been fully consulted particularly when they sign them. Care plans were detailed and it was clear that they were being done in ways that look at all needs not just medical or task focussed ones. We saw that care plans are looked at monthly and changed where necessary. We saw a list of formal reviews that are held with people, their relatives, care and management staff. Reviews that had been done were ticked off and we saw copies of these in peoples files. Daily records had also improved greatly. Some staff had done the effective recording training put on by the training department. We had joined in one of the training days and found it to be very useful in helping staff think about the way they write. Records seen gave a real flavour of life in the home for people and many of their own comments were recorded. There was much less emphasis on bodily functions and tasks done for people and more about how they enjoy life in the home. This is good practice and staff are to be commended for the efforts they are making. (Please see Care Homes for Older People Page 15 of 33 Evidence: more about this in the following outcome area). Health issues and records of health professionals involvement was properly recorded. GP and district nurse visits together with chiropody and audiology visits were recorded for each person. From the survey question do you receive the medical support you need? people told us: I see the nurse once a week, I dont know Ive never had any and: I get given plenty of tablets. We followed up two requirements from the Commissions pharmacy inspection. We saw that the medicines storage room had been redecorated and new flooring laid. The room was clean and tidy and the medicines fridge had been moved from the managers office to this room. The room is kept locked and the fridge is therefore now secure. A minimum/maximum thermometer was in place and the temperatures were being recorded daily. We looked at medication administration sheets (MAR) and saw that there were no gaps. Staff were now using codes when medicines werent being given instead of leaving gaps. The codes gave clear information about why they hadnt been given or taken. We checked a pain relieving medicine for one person and found that there were ten too many. However the MAR showed that the person was prescribed one or two and could choose how many to take or none at all. All medication was being kept safely and records were all clear. We hadnt received any recent notices of medication errors made by staff. We asked people if theyre treated with respect by staff. Comments were mixed and included: Yes (five similar comments), Yes I do I think that sometimes its some of the other residents that dont treat the staff with respect, I dont know. Im not very happy here and I want to go home (This was from someone that had just arrived) and: I think so. We saw staff using respectful language and giving people time to do things. People and staff were seen to have good relationships with each other and the atmosphere was light and positive. We looked at end of life records that the acting manager has been working on. The ones that we saw were more about wishes around death and dying rather than proper end of life care plans as set out under recent national guidance and initiatives. However the records give clear information about peopless wishes (or lack of them). Some people had given lots of information about what they want at the end of their lives whilst others had declined to give any. This was properly recorded. Several people had stated their wishes about resuscitation or not. We advised the acting manager to get more information about this as it may not be enough for someone just to say they want to be resuscitated or not. This may have to be done involving healthcare professionals and could have implications around mental capacity. Care Homes for Older People Page 16 of 33 Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to give people lots of opportunity to enjoy stimulating and varied lives where various formal and informal activities happen regularly. Encouragement of contact with the community helps people stay in touch with whats happening outside of the home. People have lots of choice and are able to live their lives in a relaxed way with few restrictions. Whilst meals at the home are well managed, provide daily variation and social contact for people, attention should be given to offering healthier, low fat options at each meal. Evidence: We looked at activities records, keytime records, residents meetings minutes and the board in the main corridor that gave information about activities, with photographs. We talked to people and the acting manager about activities and people confirmed that they enjoy those on offer. Age appropriate music was being played in the entrance hall Care Homes for Older People Page 18 of 33 Evidence: when we arrived. From our survey people commented about activities: I often chat with the staff and I love my knitting, There are plenty of activities, We have bingo now and again, Yes theres a lot to do, Theres plenty if you want to join in, I sometimes join in with the singing and that but I like to read mostly and: I quite enjoy going on the trips and I enjoy going to the woodwork classes. The acting manager told us of plans for future activities and outings. People had been asked what they wanted to do and where they wanted to go. From the minutes of two residents meetings and one meeting to talk about outings, it was clear people are able to say where they want to go. People want trips to the theatre, local landmarks, river and ferry trips, steam train trips, museums and places like Ashton Court park. Some people said they werent bothered where they go and were fine as they were but would think about going on any trips when they knew where they were going to. The notes of this meeting showed that: almost all residents asked said they preferred smaller groups or one to one for outings. A new leaflet rack had been put up close to the managers office. This has a range of leaflets for places to go and things to do. The acting manager said that leaflets are disappearing from the rack and people are approaching the staff about trips to the places advertised. The residents meeting of 3 March 09 stated: If residents inform a member of staff Hayleigh will arrange for visits e.g Bingo and Church. Residents are encouraged to continue living like they used to. From 6 April over 60s swim for free this could be organised. Hayleigh has a choir made up of people living there and staff. The acting manager takes a lead role in organising and acting as musical director. People enjoy the choir and the residents meeting minutes showed its going well with lots of support. The acting manager said she had brought in her daughters Wii console that people had enjoyed trying out with the sports package. This had proved so successful that money will be found to buy one for the home. It has the added benefit of helping people get gentle exercise. A residents committee has been set up and the first meeting was to be held shortly after this visit. The aim of the committee is for a few people who are more confident in raising issues with the management team to be able to speak on other peoples behalf. The make up of the committee will be four people living at the home, a care assistant, a domestic staff member, a cook and one assistant manager. The aim of the committee is to discuss ideas, suggestions, concerns or possible improvements for the service. This is good practice. People told us about being on the committee and said Care Homes for Older People Page 19 of 33 Evidence: they were looking forward to the first meeting. From looking at the residents meeting minutes its clear that people are engaged with life both in the home and in the wider community. Issues such as a pension rise, community events, the new deprivation of liberty law, the future of residential services, peoples wishes about changes to mealtimes and feedback about staff performance had all been discussed. Other activities such as cooking, gardening and woodwork are planned or have started. The gardening has yet to start as (dead) trees need to be cut down in the large garden and an area cleared to make a vegetable patch. Cooking has started and the manager showed us a small kitchen area in what used to be the staff flat that will be used for this activity once a cooker has been installed. Records were well written with lots of comments to show people enjoy the various activities. Staff do a range of things with people including relaxation therapies such as massage and reflexology, foot spa, manicures, reading to them etc. The records give a good idea about what life is like in the home and how people spend their time. Of particular note was the improvement in recording of Christmas and birthdays. Every persons record we looked at had their enjoyment of Christmas recorded and what was done for them on their birthdays. This is commended for being good person-centred practice. The acting manager has worked to improve peoples contact with the local community. She had contacted another local service provider that runs sheltered accommodation. They have a woodwork club that three or four people from Hayleigh now go to regularly. This has proved a success and one person told us about it. Some people had also attended a community singing group in Ashton. From looking at peoples key time records we saw that they go out with their key workers for shopping trips and coffee. All of the above shows that people living at Hayleigh get lots of choice about what they want to do and are encouraged in all sorts of ways to make those choices known. We commend the acting manager and staff for the improvement in activities provided, community contact and writing of records. We followed up a recommmendation made at the last visit about making sure menus offer healthy meal choices. We looked at the menus that had only had minor changes made to them. We remain concerned that the traditional menu for older people of that generation has a high proportion of red meat or high fat meals. An example was that Care Homes for Older People Page 20 of 33 Evidence: from breakfast to supper on one particular day each week the menu showed a high fat cooked breakfast, a substantial red meat or high fat choice at lunchtime and further high fat/high carbohydrate choices at teatime. We discussed this more with the acting manager who accepted our comments and said she would re-visit the menus to add healthier choices. The acting manager said that people had been asked for their menu choices but residents meeting minutes didnt show this. She told us later that the cook had visited each person individually to find out what they like and want and comments had been recorded in each persons own record. Some of the meals requested e.g. cheeseburgers had been put on the menu but then people found they didnt like them! People did however request more pasta dishes and more vegetarian options (although no-one living at the home currently is a vegetarian). As weve found previously, meals at Hayleigh are of an excellent standard. Meals are well prepared, tasty and give people lots of choice. There are two types of main course at lunchtime (lunch is served over two sittings) as well as other personal choices if people dont want to eat whats on the menu. At least five choices of dessert are always available that includes two sorts of hot pudding, cheesecake, ice-cream, yoghurts and fruit. We spoke to the cook about meals for people that have diabetes. She told us that she tries to make all meals with ingredients that will be suitable for people with diabetes to have. Plain biscuits are served at coffee time to these people and yoghurts are always available. She also said that district nurses give information to staff about blood sugar test readings so that staff know when to give sugar rather than withholding it. People are served meals plated up. Cold drinks are readily available including squash, cranberry juice or water. Pots of tea are served on each table after the meal so that people can help themselves. People told us they enjoy the meals and survey comments also showed this: The food is excellent, Its not posh but its all right, I really enjoy the food, I have to have my food minced, which they always do for me and yes the food is good and: Some of its all right but I never complain about it. Care Homes for Older People Page 21 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory complaints management and recording makes sure people living at the home can be confident in raising concerns about any aspect of their care. Proper management of abuse issues including staff training keeps people protected from risk of harm or abuse happening to them. Evidence: We looked at the complaints records and spoke to people about their ability to raise concerns. As mentioned above, the new residents committee may help people that may be less confident in raising concerns and give them a voice. Comments about complaints included: I know what to do all right, I would get a complaints form from the office and: Im not sure about that yet. When asked Do you know who to speak to if you are not happy? people said: I would just go up to the office (three similar comments) although one person said: No I dont. Four complaints had been made since our last visit. Two of these had been about a persons behaviour (the person has since moved to another more suitable home), one was about the smell in one room and one was about not getting a clear TV picture. All complaints had been dealt with quickly and followed up within the 28 day timescale. Complaints had been discussed at the residents meeting on 3 March and people were Care Homes for Older People Page 22 of 33 Evidence: reminded about the procedure and that they each have a form in the pack of information in their rooms. The complaints leaflet is also displayed close to the main entrance hall of the home. We followed up a requirement about making sure all staff have training in safeguarding adults from abuse. We saw records of training done by all staff including night staff. Safeguarding is also discussed in new staff induction and in supervision and yearly appraisals of their work. Safeguarding adults from abuse alerts had been sent to us quickly and dealt with properly. The acting manager had met with the Safeguarding Adults Co-ordinator and ourselves to discuss protection issues for people wishing to leave the home who may lack capacity and therefore be at risk. The acting manager had strived to make sure peopless rights were respected whilst keeping them safe from harm. This is commended. Care Homes for Older People Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment thats well decorated and looked after, physically accessible and meets their needs. Evidence: We followed up a good practice recommendation from the last visit. This was about drawing up a list of minor repairs and refurbishment of all areas of the home. The list had been put into action and covered problems found, the date, the relevant person or company contacted and the date it was fixed. On walking around the home it was clear that much refurbishment and redecoration has been done since our last visit. Sixteen bedrooms had been redecorated and people had chosen the wallpaper and furnishings. All looked cosy and comfortable. Lounges and the ground floor corridors had also been redecorated and all looked fresh, bright and homely. One of the lounges had been turned into a reminiscence room and had lots of furniture and ornaments from past generations. These included an oldfashioned coal scuttle, a Fifties footstool, an old sewing machine, a flat iron and old recipe books. Identity cards used in the last War were also seen. Attention had been given to making areas of the home accessible for people with sight Care Homes for Older People Page 24 of 33 Evidence: difficulties or dementia. Larger sized numbers had been put on each bedroom door that people said they found easier to see. Pictures of old fashioned toilets and baths had been put up on toilet and bathroom doors. New signs in corridors showed people where to go to find their rooms. A big whiteboard in the main corridor had large easy to see letters. The board showed the date, which staff were on duty and who was doing activities and key time. The activities board had information about a round the world evening in March - sampling dishes from other places and a family tea on Easter Sunday for people and their friends and relatives. The activities room had shelves of large print books and videos. The relaxation or chillout room upstairs had a very large armchair and footstool, a proper massage couch, a foot spa and CDs of relaxing music. The menu for the day was written up on a whiteboard in the dining room and a copy of it was pinned up on a board on the first floor. We asked people if the home is kept fresh and clean for them. Comments included: Yes they do it every day (two similar comments), As far as I know its kept clean, Yes definitely and: Theyve certainly got enough cleaners here. All areas of the home were exceptionally clean and staff were seen working around the home cleaning all areas. It all smelled fresh and pleasant. One member of staff was seen shampooing the carpet outside the dining room. We saw that cleaning and refurbishment matters were discussed at staff meetings. Separate meetings are held for day and night care staff and domestic staff. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well trained care staff are employed in sufficient numbers to meet peoples needs. Evidence: We looked at staff rotas, minutes of all staff meetings including those for night and domestic staff and records of staff training including safeguarding, dementia, effective recording, team building and equalities. We saw emails from training department with names of night staff booked on to the equalities training. We had sent out staff surveys but none had been returned. Rotas showed that a number of staff were absent through illness and the acting manager confirmed this. She said staff had struggled to cope recently due to both illness of people living at the home and staff. We asked people if there were enough staff available to meet their needs. Comments were mixed and included: Not always. Sometimes I have to wait a long time when I ring my buzzer, I dont usually use the buzzer unless I really need to, As far as I know, Theres always plenty about, Usually the staffing isnt bad and: They could do with a few more on the weekends. We also asked people if staff listen to and act on what they say. Comments included: I dont ever ask for anything, Sometimes they do but youve got to have a bit of give and take and: Yes. Theyre pretty good like that. Care Homes for Older People Page 26 of 33 Evidence: There were three staff on duty each morning during our visit. Agency staff are used but wherever possible kept to a minimum. From the Annual Quality Assurance Assessment (AQAA) we ask managers to fill in before the visit, we saw that of eleven care workers, five had gained their National Vocational Qualification (NVQ) in Care at Level 2. A further 4 were working towards it. The acting manager updated us at the visit. Six day care staff now have the qualification, three night care staff have it and three havent. Domestic staff also do NVQ at Level 1. Three have it and two are working towards it. The figures for those staff trained to NVQ therefore meet the 50 target recommended in the National Minimum Standards. From looking at staff meeting minutes we saw that training and teambuilding issues had been discussed. The way jobs are done had also been discussed and staff had been able to give their comments and concerns about this. Minutes of meetings showed that staff are given lots of information necessary to them to help them do their jobs and the acting manager had made positive comments about things such as care recording that had improved. This is good practice. We followed up a requirement about training that must include night staff. We saw that all staff including those on nights had done training in the subjects required i.e. dementia awareness, sexual issues, and effective recording. Dates were recorded for each person. A good practice recommendation also made at the last visit had been met. Staff had had team building sessions to help improve their morale and working practice. All staff (including those on nights) had attended the sessions that had been held in October 2008. The management team had done separate team building sessions in June 08. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both people living at the home and the staff team continue to benefit from an experienced (acting) manager who shows an open style of management. Satisfactory management particularly in staff training, supervision and health and safety, makes sure all aspects of running the home meets the needs of people living there. However closer attention to looking after peoples money is needed to keep them safe. Evidence: We looked at the AQAA, plus an internal survey of care quality done by the acting manager, peoples cash records kept by staff and supervision records of night staff. The acting manager Sharon Baker has been in charge of the home since the registered managers unavoidable absence of nearly three months. During this time Mrs Baker had made sure requirements were met and good practice recommendations adopted. Care Homes for Older People Page 28 of 33 Evidence: It was clear from speaking with her, watching her relationships with others and looking at records that she is committed to giving people the best possible care, running the home in their best interests and supporting staff to do so. She was welcoming and open to the inspection process. We saw a number of people coming to the office while we were there and at all times she and other staff were welcoming and helpful to them. We discussed the results of our Have Your Say survey with Mrs Baker. She told us that she had done her own internal survey of people using similar or more detailed questions e.g about meals and involvement in decision making around their care. Fifteen people had filled in the homes own survey. The scoring of this was similar to ours e.g. meals had scored highly as did the environment. Twelve out of fifteen people said that they felt their privacy and dignity are respected (eight out of ten did on our survey). However only six people out of fifteen said they had enough time with their key worker, four said they didnt and four said it could be improved. We advised Mrs Baker to put together an action plan to work on issues such as key time raised in the survey. The team manager for the home visits regularly and was present at our feedback session. The team manager is kept informed of all issues affecting the home and peoples care. We did a spot check of cash held for people and kept safe. We saw that basic cash sheets were all correct and balance sheets matched the amounts kept for each person. However we picked up that sheets put in place to safeguard peoples money when staff take it to buy things for them, werent being filled in properly. Neither was the policy (for all Bristol local authority homes) being followed that was put in place after a requirement we made about the issue at another Bristol home, last July. This could lead to peoples money being mis-handled by staff or to actual financial abuse. We discussed the forms and policy with the acting manager and also with the service manager of the team responsible for each local authority home. The service manager took immediate action and an amended policy was sent to us. The acting manager also took immediate action to make the forms clearer and to make sure staff know the right procedure to use. We checked a sample of supervision records. These showed that the management team of the home had discussed training with them and the importance of doing it to keep people safe. We saw that the inspection report is also discussed and staff are encouraged to read it. The records confirmed that training (as mentioned above) had been done. Supervision was recorded as happening regularly although some records were brief. Care Homes for Older People Page 29 of 33 Evidence: We checked the homes health and safety records. These showed regular checking of fire safety and other electrical equipment and water temperatures. Fire drills had happened regularly and were properly written up with comments and discussion. Night staff also had regular fire walk-throughs that simulate drills. Staff had also done regular fire safety training, as had all new and agency staff. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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