Care Home: Hillesden House

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What the care home does well People told us that the "staff are very kind". "It`s not like home but quite comfortable". "Hillesden House has a lovely atmosphere everyone is so welcoming and pleasant". Good arrangements are in place to ensure that the home can be confident of meeting a persons care needs before they offer a place at the home. What has improved since the last inspection? The care plans and relating documentation have been improved and now provide staff with full details of how to support people with their care needs in a consistent way and to the preferences of the individual. The frequency of social and recreational activities has increased. People told us -"There is always something to join in", but that there was "not a lot of choice". At the random inspection in January 2010 we found that action has been taken to comply with the two requirements made at the key inspection. Staff are closely monitoring the dietary intake of people to ensure they remain well nourished, and staff numbers have been reviewed. What the care home could do better: The service information documents should include the level of weekly fees and the information should be reviewed at regular intervals. This will ensure that people with an interest in the service have full and correct details. Protocols and details of the `as required` medications should be available for staff reference. This will ensure that people are offered and given medications as they require them. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. Medications should be stored at the recommended temperatures as per the manufacturers instructions. This will ensure that people are not at risk of being given medications that may be incorrectly stored. Arrangements must be made to ensure medications that require extra safe storage are administered safely. This will reduce the risk of errors occurring. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. For the privacy of people in their own rooms, all staff should be instructed to follow the homes procedure for entering private rooms. All staff should be aware of when, how and where to administer medications. This will ensure that peoples dignity is upheld at all times. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The damaged window in the lounge must be replaced. This will ensure a safe environment for people. The gardens must be renovated and made safe and accessible. This will ensure that people are able to go outside to a safe area when they wish to. This was a good practice recommendation at the last inspection. A sluicing facility should be available for the safe disposal of bodily waste and for the effective cleaning of the commode pots. This was a good practice recommendation at the last inspection. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. This was a good practice recommendation at the last inspection. For general hygiene and infection control purposes, suitable hand wash facilities should be provided in areas where personal care is offered. This was a good practice recommendation at the last inspection. The audit of all the personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported safely. Staffing levels should be reviewed at regular intervals to ensure that there are sufficient staff on the premises to fully meet the needs of people. The home should achieve a ratio of 50% of trained care staff at NVQ level 2 in care or above. This will ensure that suitably qualified, competent and experienced staff are working at the care home at all times. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. This was a good practice recommendation at the last key inspection. Risk assessments should be completed for safe working practices and any other identified risks. This will ensure staff have the information they need to reduce the risk to people. Key inspection report Care homes for older people Name: Address: Hillesden House Leek Mount Road Staffordshire ST13 6NQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 1 8 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Hillesden House Leek Mount Road Staffordshire ST13 6NQ 01538373397 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): caremanager@hillesdenhouse.co.uk Mr Sarbjeet Singh Malhotra,Mrs Tervinder Kaur Malhotra Name of registered manager (if applicable) Miss Jane Mansell Type of registration: Number of places registered: care home 22 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 to be accommodated is 22. The registered person may provide the following category of service only: Care Home Only (Code PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Older People (OP) 22 Dementia (DE) 22 Date of last inspection Brief description of the care home Hillesden House is a two storey extended Victorian villa situated on a quiet road on the outskirts of Leek close to the town centre. The Home is privately owned and provides accommodation and personal care for up to twenty two people. Communal accommodation is provided on the ground floor, comprising of three Care Homes for Older People Page 4 of 33 Over 65 0 22 22 0 Brief description of the care home lounges and a dining room. There are a number of single and shared bedrooms some of which benefit from an ensuite facility.There are parking facilities to the front of the home, and a small garden at the rear. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are available directly from the service. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for this service was completed in August 2009, with a follow up random inspection in January 2010. The home did not know that we would be visiting on this occasion to conduct a full inspection of the service. We were accompanied on this inspection by an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Their comments are included in this report. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of three people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and Care Homes for Older People Page 6 of 33 staffing records. Discussions were held with people living, working and visiting at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The provider/manager completed this document and returned it to us in March 2010. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Nine were returned from people living in the home (eight people indicated that they had help to complete the form). Seven were completed and returned by members of staff. The responses and comments are included in this report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The service information documents should include the level of weekly fees and the information should be reviewed at regular intervals. This will ensure that people with an interest in the service have full and correct details. Protocols and details of the as required medications should be available for staff reference. This will ensure that people are offered and given medications as they require them. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. Medications should be stored at the recommended temperatures as per the manufacturers instructions. This will ensure that people are not at risk of being given medications that may be incorrectly stored. Arrangements must be made to ensure medications that require extra safe storage are administered safely. This will reduce the risk of errors occurring. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. For the privacy of people in their own rooms, all staff should be instructed to follow the homes procedure for entering private rooms. All staff should be aware of when, how and where to administer medications. This will ensure that peoples dignity is upheld at all times. More attention should be given to increasing the variety, frequency and range of social Care Homes for Older People Page 8 of 33 and leisure activities to meet the needs and personal preferences of all the people living at the home. The damaged window in the lounge must be replaced. This will ensure a safe environment for people. The gardens must be renovated and made safe and accessible. This will ensure that people are able to go outside to a safe area when they wish to. This was a good practice recommendation at the last inspection. A sluicing facility should be available for the safe disposal of bodily waste and for the effective cleaning of the commode pots. This was a good practice recommendation at the last inspection. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. This was a good practice recommendation at the last inspection. For general hygiene and infection control purposes, suitable hand wash facilities should be provided in areas where personal care is offered. This was a good practice recommendation at the last inspection. The audit of all the personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported safely. Staffing levels should be reviewed at regular intervals to ensure that there are sufficient staff on the premises to fully meet the needs of people. The home should achieve a ratio of 50 of trained care staff at NVQ level 2 in care or above. This will ensure that suitably qualified, competent and experienced staff are working at the care home at all times. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. This was a good practice recommendation at the last key inspection. Risk assessments should be completed for safe working practices and any other identified risks. This will ensure staff have the information they need to reduce the risk to people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home, until a full needs assessment has been undertaken. This tells the home all about the person and the support they need. Evidence: Information on the home is provided in two documents. The statement of purpose, which sets out what the service offers and the residents handbook which offers more information when a person decides to move in. Both documents are available upon request and can be available in large print. We looked at the documents and found that although there was reference to the weekly fees for the service there was no actual amount specified. We also saw reference to the previous registered manager and to the previous regulatory body. Our contact details in the documents were also incorrect. To ensure that people have the correct information they need to help with deciding if the home is suitable for them, the documents should include correct and up to date information. Care Homes for Older People Page 11 of 33 Evidence: We looked at the case file of the person who recently moved into the home. The contents in the file confirmed that information had been sought regarding this persons needs prior to them moving in. Information had been gathered from various sources and the service had completed a full assessment of the persons needs. The manager confirmed that the family of this person had visited the home prior to the decision for them to move in. The person being too poorly to visit. This person told us that she is ok, that the staff are all very kind but feels very unsettled and troubled about the future. We saw staff talking and spending time with this person many times during the day. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that details of care needs are recorded and available to staff. However, medication systems do not always follow good practice or safe practice guidelines and has needed action. Evidence: The AQAA completed by the manager tells us in great depth of the way that they ensure a persons health and personal care needs are met. A care plan for each individual resident is to be completed in full within 48 hours of admission by the senior care assistant on shift with the involvement of the resident and / or family. We selected the files of three people living at the home to look at in depth. We saw that the care plans and relating documentation had greatly improved in content and information since the last time we visited. We saw that the plans had been completed with the person (whenever possible) and/or their representative or advocate. Each plan documented the details of the care Care Homes for Older People Page 13 of 33 Evidence: required, how the care is to be provided and the expected result of the care. We observed people looking well groomed with staff being quick to attend when a persons personal hygiene became compromised. Risk assessments are completed and when a risk is identified a corresponding plan of care is completed. This information gives staff full details of the action they should take to reduce the risk of harm to the person. Nutritional risk assessments have been completed and where a risk is identified, the plan of care recorded the action needed for people to maintain good nutritional status. We saw that the care staff are carefully monitoring the diet offered and taken by people to ensure they can be certain that people have sufficient to eat and drink each day. One plan described the support and care needed to help with maintaining mobility; we saw that an assessment had been made for the equipment that was required. We looked at the systems for administering medication and observed the way staff give out the medications. Staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. Some people at the home have been prescribed medications that are to be taken on an as required basis. Staff told us that there are no written protocols or instructions for what triggers the medications to be given or for how often it can be given. We advised that protocols for all as required medications should be available for reference. We saw that the MAR is completed when the as required medications are given. Staff explained the way that some medications are given that require extra safe storage and recording. We advised that the current procedures have the potential for errors to occur and advised the manager to introduce a safer way for this. The manager and deputy manager discussed this and arranged for a revised procedure to be made immediately. We saw that the temperature of the medication fridge is being recorded each day but the readings are not within the required range. One medication has to be stored at a certain temperature. We advised the service to contact the supplying pharmacy for advice as the fridge was not at the required temperature for the medications to be Care Homes for Older People Page 14 of 33 Evidence: stored as to the manufacturers instructions. We saw that external preparations (creams and lotions) are not being dated upon opening, there is a potential for people to be given medications that may be out of date. We saw staff administering eye and ear drops to people at lunchtime without first washing their hands, not explaining what they were going to do and while the people were still eating their meal. We spoke with the manager and deputy about this; both offered an assurance that staff would be instructed to administer such medications in the correct way at a more appropriate time. We saw that staff were very patient and caring when assisting people with their care needs. Where people needed support to transfer from chair to chair we saw that staff explained what they were going to do before beginning the task. This helps people to feel at ease and aware of what is happening. We observed that some staff knock on bedroom doors before entering however not all staff are following this practice. The privacy of a person may be compromised by staff entering a private room without being invited. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the facilities. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are given the opportunity to take part in a variety of activities within the home. Evidence: The expert by experience was asked to look at the activities that are arranged and to speak with people to get an overview of how they find life at the home. The expert by experience commented in their report- There was evidence of activities underway in the morning of the inspection. There had already been an exercise activity, a small art and craft activity was in progress and flower arranging was scheduled for the afternoon. However it was clear that not all residents were able or willing to participate in activities, a number appeared to be asleep in their chairs. Activities like games, bingo, music etc, are delivered by care staff, as the home does not have a dedicated activity coordinator. It is clear that the staff have very little time to spare to organise activities. There is a Wi computer programme installed in the main lounge which I was informed has been used by several residents to play sports. I learned that there are occasional trips out and that recently there had been a trip to the theatre, with 14 people participating. The home has just two wheelchairs to take those residents who are not mobile outside, which is not many. One obvious potential Care Homes for Older People Page 16 of 33 Evidence: area of the home for activities is an accessible garden at the back, which is in acute need of landscaping and conversion into a habitable and pleasant place to sit out in good weather and gain stimulation. This would enhance the quality of life for residents, to engage with the wildlife or with planting flowers, herbs or vegetables. This would be likely to appeal to a number of the residents who come from farming or rural communities. A visitor speaking with the expert by experience said -Wonderful care and they certainly look after them. People living at the home commented -We have what we want. There is always something to join in, but that there was not a lot of choice. Another person told the expert by experience that -Things could be improved, but could not elaborate on this. Another person when asked about food and if choices were available each day commented - never ask - its a surprise. The AQAA records the plans for the next twelve months and the improvements that are to be made Re-landscape the garden, producing a sensory garden so that residents can enjoy the outdoors more. Develop a sensory area within the premises; looking at all 5 senses which is vital for residents who suffer from dementia. Pet therapy. More activities to reduce the risk of falls with our residents More outdoor activities. Staff completing our survey made additional comments - Maybe more activities and a change to the usual programme. We do do activities but I think that we could do with a more variety of things to do and for some of the staff to have more confidence in doing them. Through out the day we saw that many people were visiting the home. People told us that they were satisfied with the visiting arrangements and could call at any time. They told us that Hillesden House has a lovely atmosphere everyone is so welcoming and pleasant. The main front door is kept locked for security reasons; entry to the home is gained by staff answering the door. A domestic type lock is sited on the door for ease of exiting. No other doors around the home were seen to be locked, with the exception of storage cupboards and the treatment room, people can have free access to indoor communal areas if they so wish. Because the garden requires renovating people wishing to go into outside are escorted by staff or relatives. Care Homes for Older People Page 17 of 33 Evidence: The expert by experience was invited to have lunch and made the following observations - The food was tasty, piping hot, obviously homemade and served on hot plates. The tables were laid pleasantly with tablecloths, napkins, and salt, pepper and vinegar was available. A choice of two squashes were offered in glasses rather than the usual plastic cups! There were no menus on tables, although the days menu was chalked up on a board outside the kitchen. I was told residents are asked on the previous evening what they would like to eat the next day, but the ones I spoke with did not seem aware they had been offered any choice. They all said they enjoyed the food however, and I found it tasty. We observed good practice when staff were assisting with lunch, demonstrating a clear understanding of people requirements and needs. Again staff were very quick to assist when help and support was required. Of the nine people completing our survey, six indicated that usually they like the food at the home. Care Homes for Older People Page 18 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. If people have concerns with their care, they or people close to them know how to complain. Evidence: The AQAA tells us that - Our complaints procedure is in line with the national minimum standards and is available to all that enter the Home as it is displayed in the hallway. It is also made available to residents as the Service Users Guide and Statement of Purpose, so residents and their families have a copy for their own purpose. Responses made in our surveys indicated that six people were aware of how to make a formal complaint, three however did not. Eight people indicated that they knew someone that they could speak informally with if they had any concerns or worries. People told service user that they would speak with their family and that they would sort it out. The manager discussed the recent referral made to the inter agency adult protection team when concerns had been raised. The manager explained the investigation process and the conclusion made. The staff told us that they had received recent training in the protection of vulnerable Care Homes for Older People Page 19 of 33 Evidence: adults, and explained what action they would take if they had any suspicions of wrong doings. We saw training information flyers in the office to indicate that training in this area has been arranged and is available for all levels of staff. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home has a programme to improve the decoration, fixtures and fittings. There is a continued slippage of timescales and maintenance tends to be reactive rather than proactive. Evidence: Hillesden House is a Victorian property in a quiet residential area of the town. It has a selection of communal areas, with both single and double occupancy bedrooms. The AQAA tells of the improvements that have been made within the last twelve months, of the equipment purchased and the redecoration of some communal and private rooms. It goes on to describe the plan of future improvements -Replace linen and furniture as an ongoing plan of action. We saw that improvements have been made to the cleaning of the home with the manager explaining that recruitment for more housekeeping staff is ongoing. One area of continuing concern is the lack of accessible, safe outside space. At the registration of the home 4 years ago it was identified that the garden area needed renovation, this is still the same today thereby restricting access to the garden for people. Care Homes for Older People Page 21 of 33 Evidence: The service user guide documents weather permitting you can always spend time relaxing in our garden. We do arrange garden parties on a regular basis. It goes on to comment -entertain your visitors, enjoy a cup of tea or just lap up the sunshine in our secluded garden. The comments in the service documents do not correctly relate to the true state of the gardens and outside space that is currently unavailable for people to use. The expert by experience made the following observations - Work needs to be carried out at the earliest on refurbishing the fabric and fittings of the building and converting the garden into a pleasant recreational area to enable the residents to enjoy the outside facilities which would enhance the quality of their lives. On our look around the home we found that there are one or two areas of concerns that may be a risk to people. For instance a window is in urgent need of replacement in the lounge, the manager confirmed that contractors have been contacted to replace the whole window unit. We saw that there are no privacy indicators on the toilet and bathroom doors. There is a potential that someones privacy and dignity could be compromised when using the facilities. We saw that bedrooms have not been provided with a locking facility on the door. All bedroom doors should be fitted with a suitable lock to ensure that people have a true choice of whether to lock their door or not. The service user guide tells people -you will be asked if you would like a key to your room. The Statement of purpose states that the privacy and dignity of service users will be upheld -by providing keys to their rooms and a secure place for their valuables. Not all areas where personal care is provided have been supplied with suitable hand wash facilities for effective hand washing and for infection control purposes. Some people have commodes for use at night; there is no sluicing facility for the safe disposal of bodily waste or for effectively cleaning the commodes pots. Not all hot water outlets accessible to people using the service have been fitted with a device to ensure that the water is not too hot. The owners explained the difficulties encountered with installing such devices. At the last inspection we made a good practice recommendation for risk assessments to be completed for each room where Care Homes for Older People Page 22 of 33 Evidence: potentially a person may be at harm from scalding. We did not see any documentation relating to this in the case files that we looked at. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are generally satisfied that the care they receive meets their needs. Evidence: Of the nine people completing our survey, five people indicated that there were always staff available when they needed them. Two people responded that only sometimes was there enough staff. Of the seven surveys completed by staff, four indicated that usually there was enough staff to meet the needs of people. Additional comments made were -get more staff on at certain times. More staff please. At the time of our inspection there were sixteen people in residence being supported by three care staff. One new employee was working in a supervised role. The manager and deputy manager were also on the premises but in a supernumerary capacity. We observed the care staff being extremely busy attending to the physical care needs of people; additionally they were arranging and facilitating recreational activities. Staff told us that they were always very busy and more staff on duty at certain times would be beneficial, so that more care and attention could be given to each individual. People said the staff are very good and that they look after them very well. We observed care staff to be very attentive, caring and assisting people in an appropriate way. The expert by experience made an observation - Members of staff at this home Care Homes for Older People Page 24 of 33 Evidence: appear to be working to the limit of their capacity and to be just coping. The AQAA records some conflicting information on the number of permanent care staff and the training to National Vocational Qualification levels 2 and above. In one section the AQAA records that fourteen staff have gained accreditation to this level. In another section the AQAA records that three staff have the qualification. It was not possible therefore to determine the staff to training ratios. We did not ask the manager at the time of the inspection about this. However, the staff that we spoke with confirmed that they had a National Vocational Qualification. We selected three staff files to look at. The manager confirmed that work is in progress to ensure that each file and information relating to employees is up to date. We advised that risk assessments should be completed for the employees working their induction period. With an agreement made with the person to work supervised at all time until all checks have been received and a decision made as to the suitability of the person. All seven staff indicated in our survey that pre employment checks had been completed before they started working at the home. The manager explained the plans for training staff in the mandatory and specialist topic areas, with sessions being arranged through out the year. The manager confirmed that staff training was up to date. Care staff told us that they feel the training is sufficient for them to do their job. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured the manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. Evidence: The provider/manager has been at the home for four years and has recently completed the Registered Managers Award. We observed good working relationships between the manager and people using and visiting the service. People told us that the manager is kind and considerate. Staff told us that the manager is supportive. The manager completed our survey in March 2010 and sent it to us within the required time. The AQAA gives a reasonable picture of the service, the improvements that have been made and the future plans for the home. Parts of the AQAA, statement of purpose and residents guide have conflicting, incorrect and out of date information as highlighted in parts of this report. Care Homes for Older People Page 26 of 33 Evidence: The manager acknowledges that the quality assurance and monitoring of the service is minimal but confirms that it is developing. There is a facility for the service to safe keep small amounts of a persons money. Separate records are maintained for each person and the money is stored individually in a locked safe. Records, documents and certificates were available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. We found that risk assessments have not been completed for some safe working practice areas. For example staff told us that there were no assessments for the control of substances hazardous to health (COSHH), the safe use of the stair lift and the hot water outlets. The manager stated that there are some areas of the building that it is difficult to control the temperature of the hot water. There may be a potential risk to people of being injured by the water being too hot. Care Homes for Older People Page 27 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 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made to ensure medications that require extra safe storage are administered in safely. This will reduce the risk of errors occurring. 07/06/2010 2 9 13 Medications should be stored 24/06/2010 at the recommended temperatures as per the manufacturers instructions This will ensure that people are not at risk of being given medications that may be incorrectly stored 3 19 13 The damaged window in the lounge must be replaced. This will ensure a safe environment for people. 24/06/2010 4 25 13 Risk assessments must be completed in all high risk areas where the temperature of the hot 24/06/2010 Care Homes for Older People Page 29 of 33 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 water outlets accessible to people cannot be controlled. To ensure that people are not at potential risk of scalding. 5 29 19 The audit of all the personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported safely. 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 24/06/2010 1 1 The service information documents should include the level of weekly fees and the information should be reviewed at regular intervals. This will ensure that people with an interest in the service have full and correct details. All staff should be aware of when, how and where to administer medications. This will ensure that peoples dignity is upheld at all times. Protocols and details of the as required medications should be available for staff reference. This will ensure that people are offered and given medications as they require them. External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. 2 9 3 9 4 9 5 10 Care Homes for Older People Page 30 of 33 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 6 10 For the privacy of people in their own rooms all staff should be instructed to follow the homes procedure for entering rooms. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. The gardens must be renovated and made safe and accessible. This will ensure that people are able to go outside to a safe area when they wish to. This was a good practice recommendation at the last inspection. All bedroom doors should be provided with a suitable locking facility, to ensure that people have a true choice of whether they wish to secure their room when they are out. This was a good practice recommendation at the last inspection. For general hygiene and infection control purposes, suitable hand wash facilities should be provided in areas where personal care is offered. This was a good practice recommendation at the last inspection. A sluicing facility should be available for the safe disposal of bodily waste and for the effective cleaning of the commode pots. This was a good practice recommendation at the last inspection. Staffing levels should be reviewed at regular intervals to ensure that there are sufficient staff on the premises to fully meet the needs of people. The home should achieve a ratio of 50 of trained care staff at NVQ level 2 in care or above. This will ensure that suitably qualified, competent and experienced staff are working at the care home at all times. The quality assurance and monitoring systems should be expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. This was a good practice recommendation at the last key Page 31 of 33 7 12 8 19 9 24 10 26 11 26 12 27 13 28 14 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations inspection. 15 38 Risk assessments should be completed for safe working practices and any other identified risks. This will ensure staff have the information they need to reduce the risk to people. Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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