Care Home: Hollyfields

What the care home does well Each person has a care plan. This shows staff how to support the individual to meet their needs so ensuring their well being. Health professionals are involved in individual`s care when needed. Staff follow the advice of these professionals to ensure the well being of the people living there. The home is comfortable and homely. There are many items of memorabilia around the home, which helps people to remember the things that have been important to them during their lives. Aids and adaptations are provided to ensure that people can be as independent as possible. However, this does not make rooms look clinical, particularly in bathrooms, where great care has been taken to make these homely. There is a varied menu. This includes a wide choice of fresh fruit and vegetables so ensuring that people are offered a healthy diet. People can take part in a variety of activities. Staff have information about what hobbies and interests the person did before they lived in the home. They encourage people to continue with these and develop new interests if they want to. Relatives said in letters to the home, `Our relative has found a true home at Hollyfields and we are very grateful.` `Thank you for the loving care and professionalism of the staff.` `Thank you for your care and attention of looking after our relative for the five years they were at Hollyfields.` `The nursing staff were excellent.` `I would like to thank you for the wonderful meals.` `Hollyfields is a wonderful nursing home and your patients are very lucky to have such a kind caring staff.` Staff have the training they need so they know how to support the people living there. The manager has many years experience of working with people who have dementia. She leads the staff team well so they know how to meet the needs of the people living there. What has improved since the last inspection? Some more of the bedroom furniture had been replaced to make bedrooms more comfortable for the people living there. People have more choice about what they eat. There are three different options of the main meal at lunch and dinner time so that all the people living there can have a choice. The outcome of the customer satisfaction survey had been written into a report. Suggestions made by people had been put into practice so that the home is improved in the way that the people living there and their relatives want. What the care home could do better: There should be individual written protocols for people who are prescribed medication to be taken as required. This will ensure that staff know when and how much of the medication should be given to the person so ensuring their well being. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollyfields Habberley Road Habberley Kidderminster Worcestershire DY11 5RJ     The quality rating for this care home is:   three star excellent 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: Sarah Bennett     Date: 1 6 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 31 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 31 Information about the care home Name of care home: Address: Hollyfields Habberley Road Habberley Kidderminster Worcestershire DY11 5RJ 01562514810 01562514812 hollyfields@barchester.com www.barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 41 Date of last inspection Brief description of the care home Operated by Barchester Healthcare Limited, Hollyfields is a care home offering nursing care to people with dementia type illness. Situated on the outskirts of Kidderminster the home was purpose built in 1996, and is set in extensive grounds, which it shares with High Habberley House, a separately registered nursing home, also operated by Barchester. Accommodation comprises 31 single and 5 double bedrooms all with en suite facilities. There is a large lounge, dining room, and dedicated activities room on Care Homes for Older People Page 4 of 31 Over 65 0 41 Brief description of the care home the ground floor, with an additional lounge on the first floor. Access to the first floor is via use of either of the two passenger lifts or the two staircases, with both lifts having sensors to prevent the doors accidentally closing when entering the lift. Outside, people have use of a sensory garden and a walled patio area. Fees charged are determined following pre admission assessment. The range of fees charged is stated in the Service User Guide. Additional charges are made for chiropody (private), hairdressing, and newspapers. The last inspection report is available for people and their visitors to read if they wish to. Care Homes for Older People Page 5 of 31 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is three stars. This means that the people living there experience excellent quality outcomes. This was the homes key inspection for the year 2008 to 2009. The home did not know we were going to visit. The inspection took place over one day. The focus of our inspections is on the outcomes for the people who live in the home and their views of the service provided. We look at how the home meets the Regulations, the minimum standards of practice and what they need to do to make it better. The last inspection was on 24th January 2008. The manager completed the Annual Quality Assurance Assessment (AQAA) about the home and how they think it is running. They sent this to us before our visit. We looked at some parts of the building. We looked at records about five of the people who live Care Homes for Older People Page 6 of 31 there and four staff. We looked at health and safety records. We talked to the people living there, the staff on duty and the manager. Some people are unable to communicate their views verbally so we observed what care they were receiving. We used the Short Observational Framework for Inspection (SOFI) tool. This was developed to help us to look at how a small number of people, five at this visit, are interacting with others and how staff are interacting with them. We look at how this interaction affects their well being. Three people were case tracked. This means we look at their experience of living there by meeting or observing them, talking about their care with staff and looking at their records. Tracking peoples care helps us understand the experience of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: There should be individual written protocols for people who are prescribed medication to be taken as required. This will ensure that staff know when and how much of the Care Homes for Older People Page 8 of 31 medication should be given to the person so ensuring their well being. 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. 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 31 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 31 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. Arrangements are in place so that people can be confident their needs will be assessed and they have all the information they need so they can make an informed decision about whether they want to live there. Evidence: People have the information they need in the statement of purpose and service users guide so they can make a choice as to whether or not they want to live there. These had recently been updated so they reflect the current staff team and their roles. The range of fees charged as stated in the service users guide are from 778 to 895 pounds per week. In addition to this are costs for personal specialist items such as hairdressing and chiropody. The manager said that since the last inspection six people had been admitted to the home. There were thirty two people living there on the day of our visit. Before people are admitted to the home an assessment is completed to see if their needs can be met Care Homes for Older People Page 11 of 31 Evidence: there. Records sampled included a comprehensive assessment that was completed before the person moved in. This was then used to help to develop their care plan when they moved into the home. During the afternoon two visitors arrived. They apologised that they did not have an appointment but wished to have a look around the home. The manager said that she would prefer that people arrived unannounced as this gives them a view of the home as it really is. The Head of Care showed them around and completed an enquirers form with them. The manager said that in a few days if the visitors had not made contact they would be contacted by the home to see if they are interested. If they are, arrangements would be made for an assessment to be completed to see if the needs of their relative can be met at the home. The home does not provide Intermediate Care. Therefore standard 6 that relates to this was not assessed. Care Homes for Older People Page 12 of 31 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. The health and personal care needs of individuals are met so ensuring their well being. Evidence: The records of five of the people who live there were looked at, three of these were looked at in detail. They included a detailed, individual care plan. This showed staff how to support the person to meet their needs and ensure their well being. Care plans had been regularly reviewed and updated where the persons needs had changed. Where a person had an infection or a short term health need a care plan was put in place to ensure that staff knew how to support the individual. Records sampled included information about the person and the things they have done in their life including their interests and hobbies. This gives staff a broader understanding of the individual helping them to provide more holistic care to the people who live there. Some of the people who live there have difficulty in swallowing so may be at risk of Care Homes for Older People Page 13 of 31 Evidence: choking as a result. Input from a Speech and Language Therapist (SALT) is needed to advise staff as to how to ensure that the risk of choiking is minimised. The manager said and records sampled showed that for people who have dementia living in Worcestershire there is not a SALT service available. Referrals have been made but as the people have dementia the SALT had responded saying this service is not available. Despite this, risk assessments are in place developed by nursing staff that state how staff are to reduce these risks and what to do if the person should choke. All staff have updated training in first aid and there are always staff who are appointed first aiders on duty. Due to an incident in the home where staff did not respond appropriately to a choking incident all staff receive training every three months as to what to do if the emergency call bell is sounded. Records sampled for another person showed that staff responded appropriately when a person was choking on their food so reducing their distress and ensuring their comfort. Records sampled showed that other health professionals are involved in individuals care as needed. Records showed that staff folllowed the advice of health professionals to ensure the well being of the person. Since the last inspection a tool that assesses how well the person is nourished had been used. From this assessment a care plan had been developed to ensure that staff know how to support each person to receive the nutrition they need to be well. Weight records were kept and monitored so to ensure that the person was not losing or gaining a significant amount of weight, which can be an indicator of an underlying health need. Some peoples assessment showed that they needed to be weighed weekly and records showed this was done. Some people are unable to be weighed using scales so the circumference of their arm was measured so their weight is monitored and if needed action is taken to ensure their well being. Some people were at risk of constipation. Their care plan for this stated that staff are to record their bowel movements so action can be taken to reduce their discomfort if they are constipated. Each person had a chart in their records to record these. The charts of two of the three people case tracked had not been completed regularly but their bowel movements had been recorded in their daily records. However, this makes it more difficult to monitor if the person is at risk of constipation and could affect individuals well being. The manager said that two people had sore skin, one person had returned from hospital with sores on their feet. Records sampled showed that where a persons skin had been identified as being sore, a care plan had been put in place so that staff knew how to support the person so their sore would be healed. Pressure relieving equipment Care Homes for Older People Page 14 of 31 Evidence: was used to try and prevent the sores from developing or becoming worse. Records sampled showed that when people did have sore skin this had healed indicating that staff were giving the support needed to the individual. Records sampled included individual risk assessments that detailed how staff were to support the person to minimise the risks to their health and well being. These included the risk of them falling, the risk of there being a fire, the risk of them not taking their prescribed medication and the risk of them being malnourished. Medication is stored in locked cabinets in a room that has an air conditioning unit so the effectiveness of the medication is not damaged by being stored in too hot a room. The nurses give the medication to the people living there. Boots supply the medication to individuals as prescribed by their GP. Where possible this is provided in pre packed individual blister packs so that the risks of staff making an error in giving the person the wrong amount is reduced. At the front of each persons Medication Administration Record (MAR) there was a photograph of the individual so that unfamiliar staff would know who to give the medication to. MAR sampled showed that staff had given people their medication as prescribed. Some people are prescribed Controlled Drugs (CDs). These are stored in a separate cabinet as required. A register of each CD medication is kept that was signed when it had been given. A total of how much of the medication stored was made in the register. This cross referenced with the amount kept in the cabinet for each medication sampled indicating that these are being given to individuals as prescribed. Some people are prescribed as required (PRN) medication. It stated on the MAR when this medication should be given to the individual. However, it was not clear that this would always be given as required. For example, one person was to be given medication as required when they were agitated. It was not clearly stated in a protocol how they would behave when they were agitated and at what point they should be given the medication, in what dosage and what gap there should be before this was given again if needed. These should be in place as all staff may interpret the term agitated differently, which could result in the medication being misused. Records sampled showed that individuals medication was regularly reviewed by their GP or psychiatrist to ensure it was still effective in meeting the persons needs. Observations using the SOFI tool showed that generally staff engaged with the people living there. This was generally positive. Where it was identified to the manager that it was not positive she addressed this immediately indicating that it is not acceptable for Care Homes for Older People Page 15 of 31 Evidence: staff to behave in a way that is not positive to the people who live there. Staff were observed chatting to people and offering them choices about their day to day life. Some people were observed to be sleeping for long periods. The records of these people were looked at. These indicated that either they had not slept well during the night or they had a health need that would cause them to be sleepy at times as they were not well. Throughout the day staff were observed responding to peoples needs in a positive way. When people asked staff to help them or called them staff responded immediately to ensure their well being. During the day staff were observed respecting the privacy and dignity of the people who live there. Staff were observed talking to people in a respectful way. Each person has a door knocker on their bedroom door. Staff were observed knocking on bedroom doors before entering so respecting peoples privacy. Care plans included peoples wishes at the end of their life. Where the person wanted this had been discussed with their relatives. Details were written as to whether or not the person wanted their religious beliefs to be considered towards the end of their life or at their death. Peoples health needs are monitored as their condition deteriorates so that the persons wishes can be met as much as possible. Health professionals are involved so that the person can be as comfortable and as free from pain as possible. Care Homes for Older People Page 16 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people live there are supported to have a meaningful lifestyle that is of their choice. Evidence: An activity co ordinator is employed to work there full time. They were off on the day of our visit. The manager said and records indicated that there were fewer activities taking place than there would normally be. The activity co ordinator from the home next door spent some time working with people in the home and chatting to individuals. Written records and photographs seen showed that people take part in a range of activities within the home. Care plans sampled included what interests and hobbies the person has to guide staff as to how to support them to maintain these or help them develop new ones. Care plans stated if the person had any religious or spiritual needs and how, if they wished to, they would be supported to follow these. Care plans and records considered the cultural background of the person and what was important to them as an individual. There is a separate activity room but activities also take place in the lounge. There are many items of memorabilia around the home that enable people to remember the Care Homes for Older People Page 17 of 31 Evidence: things that are important to them so they can talk to staff about these. There is a light box so that people can spend time stimulating their sensory awareness. Art and craft materials were provided. Photographs showed that people do cooking activities. Musical instruments are provided including a piano in the activity room. One of the maintenance staff had made a tool box that contained items of plumbing materials, screws and handles. This enabled people who had previously worked in practical jobs to have an opportunity to practice their skills in these areas providing them with appropriate stimulation. Cultural festivals and Special Days are celebrated. The week before they had celebrated Red Nose Day with an entertainer and some people, their relatives and staff had dressed up. They were planning celebrations for St Patricks Day the following day. Several people were planning to come for lunch with their mothers on Mothers Day. The manager said that they order corsages for all the women that live there to wear on Mothers Day. Relatives visited throughout the day and records showed that people can visit regularly and have a meal with their friend or relative if they want to. Relatives can be involved in the care of their relative if they want to. This includes social activities and photographs showed that relatives had attended and took part in these. Relatives had donated some of the memorabilia items. The home has a minibus that can be used to take people out. The AQAA stated that in the next year they hope to increase the use of this so that people who want to can go out more. The AQAA stated that menus had been reviewed since our last visit and now include a vegetarian option and state what is provided for supper. The menu for the day was displayed in the home. Breakfast included a choice of cereals, fruit, breads and a cooked breakfast if people wanted it. The menu for lunch and dinner included a starter, main meal and pudding with three choices for the main meal. Biscuits and fruit are provided during the morning and afternoon with a drink. Supper included a choice of sandwiches, cakes, jelly or mousse. People were observed having breakfast as they wanted it, which had the choices as stated on the menu. Some people eat their meals in the dining room, others eat their meals in their bedroom. Menus showed that a varied and nutritious diet is offered that reflects the cultural background of the people who live there. Water and fruit juice machines are provided around the home. A hot drinks machine is provided in the foyer with a wide variety of teas and coffees. The people who live there were observed to use this with staff Care Homes for Older People Page 18 of 31 Evidence: support. A wide variety of fresh fruits and home made biscuits were offered for the mid morning snack. Staff were observed to offer people choices as to what they wanted to eat and drink. The manager said that formal meetings with the people who live there do not often happen as people often do not say anything in a group meeting. Individual meetings with the people who live there take place so that people can have a choice in what they do. Records sampled showed that people are involved in their care plans as are their relatives if they want them to be. Care Homes for Older People Page 19 of 31 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. Arrangements ensure that the views of the people living there are listened to and they are safeguarded from abuse. Evidence: The complaints procedure is displayed in the home. This explains who to complain to, how the complaint will be investigated and how long this will take. It included our contact details so people know how to contact us if they need to. Since our last visit the home has received two complaints about the care provided there. The manager said that these had been investigated and were resolved. It had not been found during the investigations that Regulations were not met. Since our last visit there had been five safeguarding referrals made following incidents at the home that raised concern about the safety of the people living there. The issues arising from these had been investigated by appropriate agencies. Where appropriate an agency nurse was referred to the Nursing and Midwifery Council (NMC) and the agency they were from is no longer used by the home. There were no outstanding issues from the safeguarding referrals made. Following the death of one person at the home a Coroners inquest is to be held later this year. The manager said that since these issues had been raised some improvements that were needed had been made. This indicates that the manager is responsive to Care Homes for Older People Page 20 of 31 Evidence: complaints made and ensures positive changes are made to ensure the safety and well being of the people who live there. Several compliments had been made about the home since we last visited and these were recorded. They included, Thank you for your care and attention of looking after our relative. I have only praise and heartfelt thanks for the way in which all the staff cared for my relative. The nursing staff were excellent. We can never thank you and your staff enough for the care you all gave to our relative and also for the way you looked after us. Training records sampled showed that staff have training in the Protection of Vulnerable Adults and how to safeguard them from abuse. For one member of staff who had recently started working there this was included early on in their induction training. Training records sampled showed and the manager said that staff have received training in the Mental Capacity Act. This Act came into force in April 2007. It requires an assessment of a persons capacity where there is any doubt that they lack the capacity to make decisions about their health and welfare. If they do lack capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with decisions. The manager said that in addition to the training, information and the training pack is available in the home for staff to refer to. This ensures that staff know the implications of this legislation for the people who live there. As part of this legislation there are the Deprivation of Liberty Safeguards (DOLS). This requires that where a person lacks capacity staff should ensure that the care they receive does not take away their liberty and any care they receive is in their best interests. For example, a person may be denied the freedom to enter the kitchen as it may be thought this is an area where they may be at risk of harm. If this is so it must be considered whether this is in their best interests or they are being deprived of their liberty, in which case their care could be given differently to manage this risk. The manager said that a DOLS assessment had been completed for two people who live there, one of which was requested by the manager. Staff are booked to attend this training before the end of this month. Nurses have already been made aware of this legislation and how it may affect the people living there. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable, homely, clean, safe and well maintained so it is pleasant for people to live in. Evidence: The home was well decorated and maintained. In the dining room there were several small tables so that people could sit in smaller groups making it more homely. Tables were well laid with cloths and serviettes so it was a pleasant place for people to eat their meals. There is a lounge downstairs, a smaller lounge upstairs and downstairs there is also a separate activity room. Throughout the home there were several memorabilia pictures to remind people of the things that may have been familiar to them in their past. There were pictures of local scenes so that people who had lived locally could talk about their memories. There were several wall hangings and pictures that had a lot of texture on them, which people could feel to stimulate their senses. In some areas walls had been painted to make the rooms homely but stimulating. There were themed areas of items of memborabilia such as sports, music or weddings. The manager said that many of things had been donated to them. One relative brought in some more items during the afternoon to add to the display. All toilets and bathrooms had picture signs on them so that people would know where Care Homes for Older People Page 22 of 31 Evidence: these were. Bathrooms had assisted bathing facilities so that people with mobility difficulties would be able to use these. Some people spend all their time in bed because of their illness. Inflatable basins are provided so that staff can assist them to wash their hair so maintaining their personal appearance, ensuring their well being. Bedrooms seen were very personalised. Some people had many personal possessions reflecting their tastes and interests and other people only had a few items as they did not wish to have many things around them. On each persons bedroom door was a brass door knocker that staff were observed using before entering. These were different depending on which the person had chosen, some were horses, other dogs and several other birds or animals. The doors were painted different colours depending on individual choices. Some people share a bedroom and curtains were provided in the shared bedroom seen so that people had their own part of the room and some privacy. Through the activity room there is a sensory garden. This provides seating areas, raised beds, a water fountain and herbs and flowers making it a peaceful but stimulating space to spend time in. In the garden there is a memory wall with brass plaques of the names of people who have lived there in the past. The manager said that a relative of one of these people still maintains part of the garden. The garden won the Best Barchester Sensory Garden Award in 2008. Through the lounge downstairs there is a walled garden. This is also a pleasant place to sit and several chairs and tables are provided. Separate staff are employed to claen the home. The home was clean and there were no offensive odours making it hygienic for people to live in. There is a laundry that is for both homes. Separate laundry staff are employed. Soiled laundry does not need to be carried through areas where food is prepared, stored or eaten so reducing the risk of cross infection. Care Homes for Older People Page 23 of 31 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. The arrangements for staffing, their recruitment, support and development ensure that the needs of the people living there are met and they are protected from harm. Evidence: The manager said that staffing had been affected by the incidents in the home over recent months. Some staff had left but she felt that staff that had stayed, now worked together more as a team and that this benefitted the people living there. The manager said that they had recently recruited to staff vacancies. A nurse was starting the next day so there would then be no nurse vacancies. Staff rotas for the week before the visit showed that on most days there were two nurses on duty. In addition to this there were seven or eight care staff in the morning and six care staff on the late shift. There is also an activity worker that works during the day. The manager said that this was more reflective of the occupancy of the home as there were vacancies for nine people. The manager also said that when a nurse was suspended following an incident the second nurse on duty would often be an agency nurse. The manager said that this resulted in people being cared for by nurses they did not know so impacting on the consistency of their care. Another nurse was starting working at the home the next day and this would address this issue. At night, rotas showed that there is one nurse and three care staff on duty. In addition to the care staff there are also kitchen, domestic and laundry staff so that care staff do not have Care Homes for Older People Page 24 of 31 Evidence: to do these tasks. The AQAA stated and the manager confirmed that 55 per cent of care staff have National Vocational Qualification (NVQ) level 2 or above in Care. This exceeds the standard and should ensure that staff have the skills and knowledge to meet the needs of the people living there. Staff records were available on the computer and as a hard copy. The manager said that the computer records are audited by the organisation. The records alert the manager when Criminal Records Bureau (CRB) checks are due to ensure that these are up to date. All staff have a Protection of Vulnerable Adults (POVA) check before they start working there to make sure they are suitable. Some staff start working there before their CRB record is received but they are supervised to ensure that the people living there are not at risk. Staff training records sampled showed that staff receive the training they need so that they can meet the needs of the people living there. This included dementia awareness training for all staff. The manager is a Memory Lane Regional Trainer so delivers this to staff working at the home. All staff receive first aid training and this is regularly updated so that there are always staff on duty who can administer first aid if needed. When staff start working there they receive a comprehensive induction that includes working alongside other staff to develop their skills and knowledge in working with the people living there. Care Homes for Older People Page 25 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the people living there can be confident their views are listened to and their health and welfare is considered so ensuring their well being. Evidence: The manager has managed the home for several years, she is registered with us for this home. The manager had recently applied to also be the Registered Manager of the other home owned by Barchester next door and is currently going through our registration process. In each home there is also a Head of Care who is responsible for ensuring that people are given the care they need. The manager has the qualifications and experience to manage this home. Throughout the day the manager demonstrated how well she knew the individuals that live there. It was clear that they knew her and were able to talk to her if they needed to. As stated earlier in this report since our last visit there have been some incidents relating to safeguarding. The manager has analysed each of these and Care Homes for Older People Page 26 of 31 Evidence: examined how things could have been done differently. Where action was needed this had been taken to ensure the safety and well being of the people living there. The manager does a weekly audit of two care plans and the medication to assess how these are ensuring the needs of the people living there can be met. A report of this is written and shared with the nursing staff so they can take steps to make improvements where needed. The manager also completes a full audit annually of the home that takes about three days to complete. This covers all the areas of how the home is meeting the standards and regulations to ensure the needs of the people living there are met. Monthly audits are done by senior managers that focus on different areas. The outcome of these are put onto the organisations computer system. Where required the manager has to submit an action plan to show how improvements are to be made to ensure the well being of the people living there. Recently a customer satisfaction survey was sent to relatives and friends of the people living there. The manager said that only 9 people responded to this. The results of this were looked at and a report written. This included an action plan showing how suggestions made were going to be put into practice to improve the home as people wanted it. One suggestion was that there should be more choices on the menu. It was observed that these had increased as a result. The overall satisfaction score for the home was outstanding. The manager said that they are not responsible for the money of any of the people who live there. The home pays for things like hairdressing and chiropody and then give a bill to the individual or the person who is responsible for looking after their money. Staff records sampled showed that staff have regular supervision so they are supported in their role. The computer system automatically tells managers when staff supervision is due so to ensure this is done. Records sampled showed that all the equipment in the home is tested and serviced regularly to ensure it is well maintained and works when needed. Fire records showed that regular fire drills had taken place during the day to ensure that staff and the people living there would know what to do if there was a fire. A fire drill had been held during the night last July. This was the first fire drill to be held at this time. As the night is a high risk time, as it is more difficult to evacuate the home when people are sleeping, it is recommended that another fire drill be held. However, it is also important that peoples sleep is not disturbed too often. The manager said she would ensure that this was done, whilst respecting peoples need to have rest. Care Homes for Older People Page 27 of 31 Evidence: An inspector from the Health and Safety Executive had recently visited the home. We spoke to them after our visit. They confirmed what the manager had told us in that there were no issues arising from their visit. They said that they were very satisfied with the health and safety procedures in the home and the way the manager addresses these. Care Homes for Older People Page 28 of 31 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 29 of 31 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 1 8 Individuals bowel movements should be recorded appropriately so it can be easily monitored if they are at risk of constipation which could affect their well being. For people who are prescribed as required medication a clear protocol should be in place for each medication. This should state when, why and how often the medication should be given to ensure the well being of the individual. Another fire drill should be held at night, when appropriate, to ensure that staff and the people living there can practice what to do if there is a fire. 2 9 3 38 Care Homes for Older People Page 30 of 31 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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