Care Home: Hutton Village Nursing Home

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What the care home does well Residents and visitors spoken with had only good things to say about the staff who work at Hutton Village, with comments such as "they are very understanding" and "they are very good". Residents spoken with and those who provided information on surveys told us that they were satisfied with the care provided to them at Hutton Village. A survey from a health professional said "the carers excel at meeting the needs of the residents". Hutton Village offers people a pleasant living environment that is well maintained. One relative survey said "the place is clean and does not smell. They welcome visitors at all times". Residents are offered a wide range of foods of their choice. The chef works with residents` individual needs and preferences and the care planning and risk assessment tools to support good nutrition. While one relative did not feel that the meals or quantities were suitable, all residents and other relatives who commented were satisfied. One person said "the meals really are quite good" and another commented positively about the food and choices available, particularly enjoying the cooked breakfast option. People`s right to retain independence and make decisions is respected, for example some people manage their own medication or their finances and residents who are able told us that they decide how to spend their day. There is also a good range of social activities available. The manager asks residents to complete surveys regularly and BUPA also undertakes a number of other routine checks and audits to assess and monitor the quality of the service. The current management team, both of whom took up role in the past few months, communicated well together and demonstrated clear planning for future improvements, for example in relation to staff training. A survey from a health professional said "this home is extremely well-run". What has improved since the last inspection? Since the last inspection, a number of local staff have been recruited. The manager explained that this provided staff that residents found easier to understand and communicate with. They have also been contracted to work shorter hours and shorter shifts making it easier to obtain cover when necessary, possibly from within the permanent care team, supporting better consistency of care for people. Care plans had been routinely reviewed at least monthly, this ensures that the care plan is monitored, kept up-to-date and accurately reflects the care needs of the person. Photographs of residents on care plans and medication administration records were dated. This helps with accurate identification and would support their being updated ifthere were any significant changes to the person`s appearance. The information front page of the controlled drugs register was completed, making it easier for staff to find the appropriate place within the log for the individual person. What the care home could do better: Care plans should be in place for each person on admission so that, from day one, there are clear instructions for staff on how they are to provide consistent care in the way the person prefers. Peoples views and preferences for end of life care should be included in the care plan so that their wishes are clearly known and can be met. Protocols should be in place for medication that is given on an `as required` basis, to give guidance to staff so that this medication is administered consistently and can be monitored for effectiveness. Staff files need to contain a current photograph. Records of induction training should be available to show that staff have been given training about the job and the needs of the people they asked to support. Staff training also needs to continue to develop, including in relation to basic issues such as safeguarding as well as NVQ training. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hutton Village Nursing Home Hutton Village Brentwood Essex CM13 1RX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Hutton Village Nursing Home Hutton Village Brentwood Essex CM13 1RX 01277261929 01277233955 wattsma@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Post Vacant Type of registration: Number of places registered: BUPA Care Homes (BNH) Ltd care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum numbers of service users who can be accommodated is 43. The registered person may provide the following categories of service only. Care home with Nursing - Code N; whose primary needs on admission to the home are in the following categories: Old Age, not falling within any other category - Code OP, Dementia - Code DE or Physical Disability - Code PD. Date of last inspection Brief description of the care home BUPA Hutton Village Nursing Home provides care with nursing for 48 older people incorporating some categories of dementia and terminal illness. The home is situated in a semi rural location, approximately four miles from the centre of Brentwood. It is easily reached from junction 28 of the M25 and from the A12. Shenfield main line railway station is one mile from the home. Some local shops are within easy walking Care Homes for Older People Page 4 of 31 10 0 2 Over 65 0 43 0 Brief description of the care home distance. Shenfield shopping centre offers a wide variety of facilities including the post office, several banks, library and many specialised shops. Apart from the main dining room, which is housed in a converted Victorian schoolroom, the home is purpose built. It is surrounded by its own well maintained gardens. There is ample parking both at the front and at the rear of the Building. The home has thirty single bedrooms and nine double bedrooms, all with en suite facilities. All the downstairs rooms have floor to ceiling windows overlooking the gardens or fields. Public areas of the home include three residents lounges and two dining rooms. A statement of purpose and service user guide is available from the manager. In January 2009, the manager advised that minimum fees were £650 a week ranging to a maximum of £990 per week. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of the service was completed on the 31st of January 2007. An annual review of the service was undertaken in February 2008. This site visit was undertaken over an eight-hour period on one day as part of the routine key inspection of Hutton Village nursing home. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices that the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has improved and what they plan to do better. This information was considered as part of the inspection process. Care Homes for Older People Page 6 of 31 Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff, care managers and health professionals. Completed surveys were received from four residents who were supported to complete them by relatives, one relative, one staff and one health professional. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back in detail and discussed with the manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? Since the last inspection, a number of local staff have been recruited. The manager explained that this provided staff that residents found easier to understand and communicate with. They have also been contracted to work shorter hours and shorter shifts making it easier to obtain cover when necessary, possibly from within the permanent care team, supporting better consistency of care for people. Care plans had been routinely reviewed at least monthly, this ensures that the care plan is monitored, kept up-to-date and accurately reflects the care needs of the person. Photographs of residents on care plans and medication administration records were dated. This helps with accurate identification and would support their being updated if Care Homes for Older People Page 8 of 31 there were any significant changes to the persons appearance. The information front page of the controlled drugs register was completed, making it easier for staff to find the appropriate place within the log for the individual person. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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. Residents can be assured that they will have sufficient information about the home prior to admission and that they will be appropriately assessed to ensure that the team at the home can meet their needs. Evidence: A copy of the statement of purpose and the service user guide were provided. These documents contain information about the service, its aims and objectives and the facilities provided. Both had been updated to reflect the new manager in post. Neither document was dated to support regular review. Additional information was provided welcoming people to Hutton Village. The print was large and easy to read and told residents about mealtimes and menus, access to healthcare professionals, hairdressing and manicure services, activities available including access to religious services, and arrangements for shopping, fire procedures, Care Homes for Older People Page 11 of 31 Evidence: having alcoholic drinks, smoking and visitors. The manager advised that as far as possible they try to provide a weekend receptionist to assist enquiries and a Handling Enquiries module has been included in their induction training for staff. Residents spoken with and comments from surveys told us that people felt they had had enough information about the home before they moved in so they could decide if it was the right place for them. In their AQAA, the manager said that all prospective residents undergo a preadmission assessment to ensure that the home is able to meet any identified needs and that the placement will be appropriate. This is followed up with an acceptance letter. Assessment documentation was reviewed for two more recently admitted residents. These demonstrated that an assessment of the peoples needs was undertaken prior to their admission to Hutton Village. The format for the pre-admission assessments was detailed covering a wide range of needs, allowing the assessor to choose from multiple choices of responses and to add additional comments and information relevant to the individual persons needs. Intermediate care is not offered at Hutton Village. 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. Overall, residents can expect their care and health needs to be met and their privacy and dignity to be respected. Evidence: Surveys received from residents of Hutton Village indicated that they felt they received the care and support they needed and that staff listened to and acted on what they said. A survey from a relative thought that this sometimes was achieved but that staff do not always listen to the resident and that the person is treated as if they have no ability to make informed choices. A survey from a health professional indicated that the home did meets the needs of the residents in their view. Discussions with residents at the site visit indicated that they were satisfied with the care they received and that staff did listen to them and treat them with respect. The manager has a care planning system in place. One care plan was not complete for a person admitted the previous day, but this had been achieved by the end of the site visit. The manager stated a BUPA policy of having up to seven days to write the care Care Homes for Older People Page 13 of 31 Evidence: plan after admission, however this does not comply with regulation. Care plans reviewed showed that residents needs had been identified well and that detailed information was in place to guide staff as to what support was needed, with the exception of end of life wishes. Care plans were signed either by the resident or their representative to confirm inclusion. The manager advised that BUPA procedures require that all care plans are reviewed either by them or the deputy manager within five days of the persons admission to Hutton Village. Basic assessments relating to, for example moving and handling, nutrition, falls and tissue viability are completed within a specified number of hours from admission to note any specific needs to inform the care plan and the care outcomes for that person. Photographs on resident files were dated, as recommended at the last inspection. The managers AQAA states that self-care is encouraged. This was confirmed in discussion with residents as well as in care plans sampled. Care plans instructed staff on the persons preferences, the parts of the individual tasks that they could achieve for themselves and what support was needed. The care plans were supported by risk assessment and they cross-referenced and supported each other in providing safe working practice instructions for staff. Care notes were detailed and written regularly and provided a good source of information for monitoring the effectiveness of the care plan. Care plans were reviewed at least monthly or as required, as recommended at the last inspection. The information received in resident surveys, as well as records sampled and discussion with staff indicated that residents health care needs were being met. Records showed that residents see their GP in a timely manner and have access to other health professionals such as chiropodist and optician etc. residents spoken with confirmed this. One person said it is no problem, they will call the GP if you need them. Records sampled showed that residents were being weighed regularly and in accordance with their nutrition assessment and care plan. This allowed clear monitoring that would pick up weight changes early so they could be managed effectively. Medication systems at the home were sampled and found to be in good order, including in relation to controlled drugs. As recommended at the last inspection, the front pages of the controlled drugs book were completed to make the finding of the appropriate page easier for staff. Medication administration sheets were seen to be clearer and records were up to date. Medication was checked in correctly to the home. Protocols were not in place for medication prescribed on an as required basis to provide clear guidance to staff so these were administered consistently and Care Homes for Older People Page 14 of 31 Evidence: effectiveness could be monitored. It was positively noted that some residents are selfmedicating and risk assessments were in place. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents of Hutton Village can expect to experience a fulfilling lifestyle led by their preferences and choices, and to enjoy a varied and nutritious diet. Evidence: The AQAA tells us that each resident has a complete map of life and Lifestyle plan. This would provide detailed information for staff as to the persons interests etc and their preference for individual daily routines, to inform the activities provided. The senior activity coordinator confirmed they complete this with each person soon after they move in and have had time to settle. The home employs two dedicated activity coordinators, overall 40 hours per week. Additionally, a carer is routinely allocated to work with the activity staff so that they can get to know residents socially and in a different setting to that just of providing personal care and support. Various activities are provided to stimulate people living at the home, for example some people enjoy painting, quizzes and exercise club and those people that choose to remain in their own room can benefit from one-to-one time the chats, hand massage and nail care etc. A hairdresser, aromatherapist and manicurist visit the home routinely. Church services are available regularly. A shopping service is provided for Care Homes for Older People Page 16 of 31 Evidence: residents and retailers also visit the home so people unable to visit the shop themselves can choose and buy their own clothes etc. Resident surveys confirmed that there are activities available that they can take part in. Residents spoken with told us that there were activities available, some people participated and said they enjoyed them while other people said they preferred to stay in their own rooms and follow their own interest and this was respected. Residents and visitors spoken with confirmed that visitors are welcomed at Hutton Village. Residents spoken with told us that they have opportunities to make decisions and choices in everyday matters. These included times for going to bed or getting up, what to wear, whether to have a bath or shower, what to eat and where, where to spend their time and whether or not to join in activities. A resident spoken with confirmed the detail in their care plan that they are encouraged and supported to maintain their independence. The menu demonstrates a wide range of choices of meals and snacks, including a night bite menu, that were demonstrated in the record of food served. The chef demonstrated an excellent knowledge of effectively supporting nutrition for older people, was aware of their care plans and specific preferences for food and meal sizes, and routinely seeks their views at mealtimes as well as in an individual meeting soon after admission. The chef also provides training on presentation of meals etc to all staff as part of their induction. An additional member of staff has been introduced in the mornings to ensure residents are assisted in a timely way so that they can have their breakfast at a reasonable time. This helps to ensure residents have food offered at shorter and more appropriate intervals to support good nutrition. Observation of the lunchtime meal showed residents ate in pleasant surroundings. Those who needed it, were assisted in a respectful and patient way by staff who clearly knew the peoples needs. One staff member explained that it was important to give people time to eat as they may have swallowing difficulties or not be strong but to need their nutrition. They also advised that staff would only assist one resident to eat to show respect to them but that this level of assistance stretched staff as there were so many residents who needed support at mealtimes. Residents spoken with told us they were satisfied with the meals served, although one person was not happy that their preference for smaller meals had not quite been met in their view, but this was being addressed by the chef. One survey from a relative said they felt the meal portions were not big enough. Resident surveys indicated that people liked the meals at the home. In discussion, one resident said they really Care Homes for Older People Page 17 of 31 Evidence: enjoyed the cook breakfast option, another person said the meals are very good, plentiful and tasty. Care Homes for Older People Page 18 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. Residents can be assured that their concerns would be listened to and dealt with appropriately and that as far as possible they would be safeguarded at the home. Evidence: Information on the BUPA complaints procedure was clearly displayed in the entrance foyer. The procedure contained clear information on the timescales that people can expect responses by. Consideration should be given to the format and making the procedure more user-friendly for residents. A relative survey indicated that in their view, concerns raised do not always get the attention they deserve. All residents and visitors spoken with said that they would be able to raise any concerns or worry or make a complaint should they need to. This was also confirmed in the surveys received from residents. A log of complaints was clearly maintained. There was evidence of investigation and timely responses on those viewed. Full details of one logged complaint was not available as the documentation was at head office following review. A number of compliments were also available noting for example appreciation for the care and attention given, or the loving kindness given by all members of staff. The manager advised that a referral had been made by staff at the home to the Care Homes for Older People Page 19 of 31 Evidence: safeguarding team to ensure that a resident had access to adequate of their funds to purchase items of their choice. The deputy manager confirmed abuse procedures were available to staff, with copies kept on all nursing stations around the home. All staff are provided with an individual copy of the whistleblowing procedure and attend video training on safeguarding as part of their induction. The whistleblowing procedure viewed contained relevant information and up-to-date contact details for social services and the Commission. The training matrix indicates that a number of staff are recorded as having received safeguarding training in the last three months and that a number of staff still require this training. The manager confirmed the information in the AQAA that this is being addressed by the allocation of one week in each month as a designated training week. The manager also advised that they are endeavouring to access additional training on safeguarding from the local authority. Surveys from staff indicate that they were aware of the appropriate actions to take in response to any concerns raised regarding Hutton Village. Records of monthly audits undertaken by a representative of the registered provider showed that staff are randomly selected for interview and their knowledge regarding effective safeguarding the whistleblowing assessed and recorded. Staff recruitment procedures generally safeguarded residents as do the systems in place to manage resident personal finances. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable environment for residents to live in that meets their needs. Evidence: There is a homely feel to Hutton Village that is relaxed and pleasant. Some decorating has been completed since the last inspection and there is a good standard of furniture and carpets. Most bedrooms a single, although the manager said that the home still has one double bedroom. It was noted that residents bedrooms were well decorated and personalised. All residents spoken with said that they were satisfied with their rooms and found them comfortable and appropriate to their needs. Many rooms had lovely views over the countryside which residents also said they appreciated. There are a number of lounges around the home for residents to use. There is also an attractive hair dressing room and a separate activity lounge. On viewing the home, it was clean, tidy and free from offensive odours. A random number of sinks were checked regarding water temperatures and all were found to be within the recommended safe temperature. The manager advised that Care Homes for Older People Page 21 of 31 Evidence: there were some problems with the ability of the hot water system to pump sufficient hot water to all residents bedrooms, although there were no problems relating to the bathrooms. A risk assessment was in place relating to the carrying of warm water in jugs to individual bedrooms affected and evidence was provided that work was planned to address the problem in the week following the site visit. The laundry was clean, appropriately equipped and were organised. Staff spoken with confirmed they were provided with protective clothing to support management of control of infection. Staff were observed using disposable gloves and aprons. Care Homes for Older People Page 22 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. People living at Hutton Village can expect to be cared for by friendly, helpful staff, that are generally suitably trained and safely recruited. Evidence: A survey received from a relative said that the home should have more staff working shorter hours and they should not employ untrained care assistants who cannot speak or understand English well. There has been a high turnover of staff in the past year as detailed in the AQAA. The manager stated that contracts came to an end for a number of staff and there has been successful recruitment of a number of local staff that should improve communication and understanding between staff and residents. The manager has employed staff on contracts of lesser hours and shorter shifts, so shifts are easier to cover when necessary supporting better continuity of care for residents. As transport links to the home are limited and may affect recruitment, an improved rate of pay has also been achieved in an effort to attract and retain staff to support consistency of care for residents. Rotas confirmed that some agency staff were still being used, particularly at night. The manager confirmed they are still actively recruiting. Staffing levels were confirmed as two qualified nurses throughout the 24-hour period, Care Homes for Older People Page 23 of 31 Evidence: additionally with eight or nine carers each morning, five carers in the afternoon and three carers at night for the current 36 residents, two of whom were in hospital. Following discussion with residents and staff and observations during the site visit, it is considered that this is currently adequate to meet the needs of residents, but should continue to be monitored regularly and increased as necessary as dependency levels of many residents was seen to be high. One of the surveys from residents indicated that staff were always available when needed, three others and one from staff indicated that they usually were. One resident spoken with said that staff do answer the call bell, but they can forget things and you have to wait because they are busy, but not too long. Two other people said that staff are busy but they do answer call bells promptly enough. Recruitment files were checked at random and found mainly to be in good order and containing the required checks and documentation, including criminal record bureau checks. However there were no current photographs on two files sampled and in one case, where one written reference was available, the manager had relied on a recorded telephone second reference. The manager advised that several attempts had been made to obtain a written response but these were not recorded and no additional referee had been sought. Profiles were in place for those agency staff randomly sampled from the rota, which is positive. However, one agency had not included confirmation and information on criminal record bureau checks. The manager agreed to address this directly with the agency without delay. A relatives survey commented that staff are lacking in skills relating to transfers and positioning. The deputy manager is a trained moving and handling trainer and confirmed that staff are fully trained on using the hoist and positioning of individuals as part of their basic training. A survey from a health professional indicated that staff have the right skills and experience to look after people properly. Residents spoken with were satisfied with the support provided to them in relation to transfers. The managers AQAA states that special concession had been obtained from the registered provider to increase the number of staff making application for NVQ training from November 2008, to support additional training and in light of the high number of new staff. In discussion, the manager advised that six of the current care staff had achieved NVQ level 2 and an additional five are to commence this training in February 2009. The manager and deputy manager confirmed that they use induction to Skills for Care standards. Evidence of this was not available on the two files sampled. The management team advised that this is because staff retain the records and recognise Care Homes for Older People Page 24 of 31 Evidence: the need for them to obtain a copy from all staff to keep on file to evidence progress and completion. Evidence from files of longer serving staff sampled concurred with the up-to-date training matrix provided and showed that training had included issues such as medication, safeguarding, breast aid, moving and handling, dementia care, health and safety, fire awareness and food hygiene. Staff spoken with confirmed opportunities for access to training. The matrix identifies where staff need additional training or updates. The manager advised that this was being worked through in their newly introduced designated monthly training week. Interaction between staff and the residents was seen and heard to be appropriate, friendly and caring. One resident was heard to be asked if they would like to eat their meals in their chair or return to bed. Their choice was respected and implemented straight away. Staff addressed residents by name and individual residents spoken with confirmed that this was the way they like to be addressed. Residents spoke in complimentary terms about the staff with comments such as they are very good or they are lovely. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a safe, well managed home that is run in their best interests. Evidence: A new manager has been in post since June 2008. The manager confirmed the information in the statement of purpose that she is a qualified nurse, who also has a Masters diploma in human resource management and palliative care studies. She has five years experience in nursing older people. The manager confirmed that she has commenced arrangements to make an application to be registered and also to undertake the registered managers award. A new head of care/deputy manager has been appointed recently from within the staff group. Throughout the inspection, the new management team demonstrated good communication, clarity of their roles and responsibilities and clear objectives for managing the service. BUPA have a range of audits and monitoring systems in place, supported by an Care Homes for Older People Page 26 of 31 Evidence: experienced Quality and Compliance team, to review the quality of the service provided at Hutton Village. Aspects observed at the site visit include care management documentation, medication and health and safety. Regular monthly visits and report on the home are also undertaken as required by the registered person to reassure themselves that the home is running as it ought to. An annual survey of residents is undertaken. The outcome of the most recent survey of October 2008 is not yet available from independent analysts but will be sent to the Commission. The report of the previous years survey was available and indicated that people over all were satisfied with the services provided at Hutton Village. Residents meetings are held quarterly said that people using the service have opportunity to discuss their views. A newsletter is also provided to residents that keeps them up to date on changes and plans for the home. Some residents exercise control in managing their own finances. For other people, the administrator manages a separate bank account for residents of Hutton Village, that pays proportionate interest. Invoices are provided for newsagents, paid from each persons account by the administrator and receipts maintained. The cash float is available to residents at all times and signatures maintained for withdrawals. A number of records were reviewed as part of this inspection process and identified throughout this report. Accident records and notifications to the Commission were appropriately maintained. Records were well organised and securely maintained. Safety checks are completed to ensure there is a safe environment for residents and staff. The home also has a maintenance person who is employed at the home five days a week. Regular inspections were evidenced relating to the gas appliances, hoists, fire alarm systems, passenger lift, emergency lighting and nurse call system. The public liability insurance certificate was displayed and in order. Care Homes for Older People Page 27 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 28 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 7 Care plans, based on the pre-admission assessment, to be in place for each person on admission so that staff have clear guidance on how to meet their needs and preferences. Written protocols or guidance to be in place for resident each and for each medicine prescribed on an as required basis. This will show residents receive the medication prescribed for them in a consistent way. Peoples preferences for end of life care to be sought and included as part of their plan of care so their needs can be known and met. The level and deployment of staff to be kept under review to ensure that it remains sufficient to meet residents needed at all times. A minimum of 50 per cent of care staff to achieve NVQ level 2. A current photograph of staff to be available on their files. Records should be kept to identify efforts made to obtain a written reference from the most recent employer and consideration given to taking up another written reference where this cannot be obtained. 2 9 3 11 4 27 5 6 7 28 29 29 Care Homes for Older People Page 29 of 31 8 30 Records of induction training to be available to show that staff have been given training about the job they are to do and the needs of the people they are to support. Staff training and updates to continue and provided to all staff, including in relation to basic issues such as safeguarding. 9 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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