Care Home: James Hirons Home

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What the care home does well People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. One person asked about how they made their decision to stay at the home said "this home seemed very pleasant, its got a garden and people are very nice". Staff were observed to be kind, caring and attentive towards people living in the home. People spoken to were positive about the staff. We were told "staff are very nice, very kind and helpful". People living in the home were positive about the care they receive. People told us, "it has a very friendly and democratic atmosphere and makes me feel safe without having lost my independence", "excellent staff and care", "they are very caring". The `expert by experience` stated "All residents observed today seemed appropriately dressed, clean with tidy hair and nails. I observed positive care and consideration towards residents at all times". A good range of social activities are provided for people to enjoy. We were told, "yes there is a good range of social activities but I dont want to do something all of the time". The `expert by experience` stated "I saw a programme of activities for this week which seemed varied". "Outings take place occasionally using the homes own vehicle or by hiring a larger one". People are provided with, attractively furnished and comfortable surroundings to live in and enjoy. People told us, the home is "always" fresh and clean and people said they had everything that they needed. What has improved since the last inspection? Since the last inspection three years ago a number of improvements have been made to the environment. This includes improvements to the decor of the home such as new curtains, carpets, lighting in the lounge, corridor and dining room areas. Some of the beds, chairs and curtains in bedrooms have also been replaced. New bedroom door closures have been fitted so that if people wish to keep their doors open they can do so safely knowing they will close automatically in the event of a fire. Care plans have been extended to include a series of new forms to help provide improved care. These include nutritional screening forms and life histories. A second Activity Organiser is now in post so the frequency of social activities has been increased to improve the daily lifestyle of people in the home. Televisions have been upgraded to larger screens with built in `freeview` channels to extend the viewing choices for people living in the home. What the care home could do better: The service must ensure that medication records are clear in relation to the amount of medication available at the beginning of each medicine cycle. This is so the records can be audited to confirm people have received their medicines as prescribed. A `Service User Guide` should be available to people prior to them staying in the home so that they have all the information they need to make a decision on whether to stay. Staff should ensure the privacy and dignity of people is not compromised by bedroom doors being left open at all times. Menus need to be more detailed so that people are clear what choices are available to them. The complaints procedure should be more detailed so that people are clear who to contact should they wish to raise a concern. All staff need to be clear on the reporting processes for abuse so that any allegations of concern can be referred to the right person in the event of the manager`s absence. Some action is needed to attend to protruding tree roots on the garden walkways to help prevent people from tripping over them. Staff should wear protective clothing when dealing with soiled laundry to help prevent the spread of infection to people in the home. Staff duty rotas need to include all staff working in the home and their designations so that it is clear there are sufficient staff to meet the needs of people consistently. Staff induction training should be based on the `Skills for Care Common Induction Standards` to help ensure staff reach suitable levels of competency in order to meet the needs of people safely and appropriately. Each person should have their own records of money expenditure including receipts so that these can be made available to them should they request them. Accident records should clearly show any actions taken following injuries to people so that it is clear appropriate actions have been taken by the home to address them. Key inspection report Care homes for older people Name: Address: James Hirons Home 53 Lillington Road Leamington Spa Warwickshire CV32 6LD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: James Hirons Home 53 Lillington Road Leamington Spa Warwickshire CV32 6LD 01926422425 01926883332 james.hirons@lycos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Clerk To The Trustees James Hirons Home Name of registered manager (if applicable) Ms Elizabeth Tucker McColl Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated are 23. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission are within the following categories:- old age not falling within any other category, OP, 23. Date of last inspection Brief description of the care home James Hirons is a period building which offers personal care and accommodation for 23 older people aged 65 and over. The home is located in Leamington Spa and is close to shops, the post office and other amenities. The home consists of a three storey building which has two conservatories, three Care Homes for Older People Page 4 of 35 Over 65 23 0 Brief description of the care home communal lounges and a separate dining room. Accommodation for people is spread over three floors and there is a passenger lift to accommodate wheelchairs and those people with mobility difficulties to access these floors. There are also two stair lifts and a platform lift to allow for easy access to all other areas of the home. There are 23 bedrooms and 21 of these have an ensuite toilet although there are also three communal bathrooms and a shower room. There are call bells in each of the bedrooms so that people can alert staff if they need assistance and each room also has a Television point. The home has extensive and attractive gardens which have patio areas and walkways so that people can access them. Car parking is available to the front of the home. The fees for the home are published in the Service User Guide which is made available to people upon admission. At the time of this inspection the fees ranged from £505 up to £690 per week. These are subject to change and persons may wish to obtain more up-to-date information from the service. Extra charges are made for dry cleaning, chiropody, hairdressing, telephone calls, personal newspapers/magazines, taxis to and from appointments, postal services and any other items that are not set out in the homes Service User Guide section headed What is included in the fees. Care Homes for Older People Page 5 of 35 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 focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.25am and 7.40pm. We asked an expert by experience to accompany the inspector for a period of time during the day. An expert by experience is a person who, because of their shared experience of using services, and or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where Care Homes for Older People Page 6 of 35 possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this document has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, accident records, complaint records, maintenance records and medication records. We spent a period of time in the lounges to observe what it may be like for people living in the home. Both breakfast and lunchtimes were also observed with the expert by experience also joining people for lunch to sample the meals provided. A tour of the home was undertaken to view specific areas and establish the layout and decor of the building. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The service must ensure that medication records are clear in relation to the amount of medication available at the beginning of each medicine cycle. This is so the records can Care Homes for Older People Page 8 of 35 be audited to confirm people have received their medicines as prescribed. A Service User Guide should be available to people prior to them staying in the home so that they have all the information they need to make a decision on whether to stay. Staff should ensure the privacy and dignity of people is not compromised by bedroom doors being left open at all times. Menus need to be more detailed so that people are clear what choices are available to them. The complaints procedure should be more detailed so that people are clear who to contact should they wish to raise a concern. All staff need to be clear on the reporting processes for abuse so that any allegations of concern can be referred to the right person in the event of the managers absence. Some action is needed to attend to protruding tree roots on the garden walkways to help prevent people from tripping over them. Staff should wear protective clothing when dealing with soiled laundry to help prevent the spread of infection to people in the home. Staff duty rotas need to include all staff working in the home and their designations so that it is clear there are sufficient staff to meet the needs of people consistently. Staff induction training should be based on the Skills for Care Common Induction Standards to help ensure staff reach suitable levels of competency in order to meet the needs of people safely and appropriately. Each person should have their own records of money expenditure including receipts so that these can be made available to them should they request them. Accident records should clearly show any actions taken following injuries to people so that it is clear appropriate actions have been taken by the home to address them. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to some information about the home to help them make a decision to stay. Peoples needs are assessed prior to them coming to stay to ensure these needs can be met effectively by the home. Evidence: The manager explained that people who may be interested in staying at James Hirons are given a booklet which contains some information about the home including the fees. The booklet viewed did not contain a Statement of Terms and Conditions for the home or a summary of our inspection report. This information should be made available to people in a Service User Guide so that they have all the information they need to make an informed decision on whether to stay. The manager explained that a Service User Guide with a contract is issued to people once they have made a decision to stay. She also explained that a welcome pack is made available to people giving information about the home which is for them to keep Care Homes for Older People Page 11 of 35 Evidence: in their room. Both of these documents were found to be available and were informative although the Service User Guide did not contain all of the required information such as our summary inspection report. One person spoken to said they had received help from their family to find the home they stated this home seemed very pleasant , its got a garden and people are very nice. They confirmed they had been given a booklet with the times of lunch in it. The AQAA completed by the manager states The Home Manager always completes a home visit prior to admission to assess prospective residents to ensure the Home can meet the full needs of the resident. Prospective residents and relatives and friends are given every opportunity to visit the Home in order for them to check out our facilities and suitability. Residents are also invited to have a temporary stay with us to try us out. The manager said it was usual practice for her to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. The expert by experience spoke to people about their admission and stated residents and relatives spoken to said they had enough information to make a choice about the home. Assessments were carried out before residents moved in, including one person on respite care. Records viewed confirmed that people had received an assessment of their needs before coming to stay. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are treated respectfully and each person has a care plan in place detailing their needs to help ensure these are met by staff. Evidence: People living in the home looked well cared for. People were wearing clean clothes, their hair was combed and their nails were trimmed and clean. Those people spoken to were positive in their comments about the home. The expert by experience who spent time with people in the home stated All residents observed today seemed appropriately dressed, clean with tidy hair and nails. I observed positive care and consideration towards residents at all times. Staff seemed attentive and addressed residents by their Christian name. There was an atmosphere of calm throughout the whole Home. One person said staff are very kind and helpful, another said they were able to do most things for themselves but it was a very good home. Care Homes for Older People Page 13 of 35 Evidence: Completed comment cards received from seven people show that five people feel they always receive the care and support they need and two people feel they usually do. People told us it has a very friendly and democratic atmosphere and makes me feel safe without having lost my independence, excellent staff and care, they are very caring. The AQAA completed by the manager states We have a comprehensive care plan system to ensure that staff are able to meet the residents assessed needs. Our well established medication policy ensure medication is managed safely. We looked at the care files of people identified for case tracking. Each person had a care plan as well as daily records and monitoring records. Care plans were based on information secured during the pre admission assessment of people. Care files were standardised and well organised making it easy to identify the needs of people and how these were to be met by staff. One person had come into the home with a broken arm and limited mobility. Staff had recorded this in the assessment information and also in the care plan. There were clear instructions to staff when the arm sling should be used and when the follow-up hospital appointments were. Care plans in place detailed how the person was to be assisted at all times by one member of staff when mobilising and how they were to be assisted with personal care. There were also instructions for the persons food to be cut up to help them eat more easily. A risk assessment had been completing identifying all risks to the person due to their limited movement and health conditions. There were clear staff actions indicated on how to manage these risks to maintain the persons health and wellbeing. Records confirmed that the person received support from the Occupational Therapist when the plaster was removed from their arm to help them regain full movement. This person said that their arm was now a lot better and they had got back practically all use now. This person was complimentary of the care they receive and stated everything goes very smoothly. Another person was identified to have a bowel problem and an allergy to medication which was not discovered until after they had come to stay at the home. There were clear instructions on the care plans how the bowel problem was to be Care Homes for Older People Page 14 of 35 Evidence: managed and staff were monitoring the persons skin condition to make sure this did not deteriorate. Care records said that the person could suffer from low mood, as a result of this, a psychological assessment had been completed. This included actions for the person to have more involvement with other people in the home and join in social activities. Records showed these actions were being carried out. The person had fainted after taking medication to manage their low mood. This was followed up with the doctor to identify the cause but this was not clear. A second incident occurred also after taking this medication which again was appropriately followed up with the doctor and the medication was stopped. Records clearly indicated these two incidents and the actions taken by staff. Care records also highlighted that the person was allergic to this medication to prevent this being given again. Staff spoken to had a good knowledge of the people they care for and were able to identify individual needs and give details on how these were being met. We looked at the systems for management of medicines. A medication trolley was available for the storage of these and this was being kept in a locked room within the home. A monitored dosage system is used where tablets and capsules are pushed out of sealed pockets on a card known as a blister pack. The facility for storing controlled drugs (CD) was satisfactory and a suitable controlled drugs register was in place to record how this medicine was being managed. Controlled drugs for two people were checked and medicines in the controlled drug cabinet corresponded with the quantities recorded in the controlled drug registers. However staff were also recording on the Medication Administration Records (MARs) the amount of controlled drugs received, given and remaining and this record was not accurate as the full amount available at the beginning of the prescribing period had not been documented accurately. On one MAR chart there was an entry 30 to follow for a controlled drug. There was no indication who had made this entry and it was not clear from the MAR that only half of the prescribed amount had been received. It was however evident that the controlled drug register was accurate. The manager advised that the handwritten entry on the MAR was not made by a member of staff in the home but by the pharmacy who had provided this medicine. We audited the medicines of two people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records MAR. We found that generally medication was managed well but in some cases there was Care Homes for Older People Page 15 of 35 Evidence: medication left over from the month before which had not been carried forward onto the new MAR chart. This meant it was difficult to check the correct amount of medicine had been given and was remaining. Sometimes there were capsules or tablets left in the blister packs that had been signed on the MAR as given. This could mean that staff are signing to say medicine has been given when it has not. Good systems were in place for the management of any homely remedies such as cough medicines that people may wish to use. These were clearly listed for each person and there records were kept with the MAR charts. People living in the home were observed to be treated with respect and their dignity maintained with the exception of one incident. We observed staff assisting people to the deliver personal care and asking people their wishes before assiting them to different lounges or the dining area. One incident was observed where a person was using the toilet in the ensuite and both the ensuite and bedroom door was left open. The expert by experience who spoke to a number of people in the home stated Residents felt that they were treated with respect at all times. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a planned programme of social activities led by dedicated staff so that people can maintain some of their interests and independence. It is not clear that a varied range of meals, snacks and drinks are always being made available to people at times suited to them to promote their health and wellbeing. Evidence: The AQAA completed by the manager states The Home now employs two Activities Organisers who co-ordinate a weekly programme of activities for all residents. Residents are encouraged to participate in as many of these as they wish. At least twice a year the Activities Organiser meets with as many residents as possible to review the activities making changes as required. Activities include bingo, crosswords, games, knitting, dvds, aromatherapy, nailcare, external entertainers and various outings. Religious needs are met through the provision of communion and other visits as requested by the residents. We found that two Activity Organisers are employed at the home and they split the working week between them to cover social activities. We observed the Activity Organiser compiling an activity schedule for the week and confirming with the manager that this was acceptable. This was then put onto the notice board in the Care Homes for Older People Page 17 of 35 Evidence: lounge for people to see. Activities included knitting club, firework display and celebrating a persons birthday. The expert by experience spoke with the Activities Co-ordinator to establish how activities are organised and stated Social activities take place twice daily during the week. Activities being led by the Activities Co-ordinator on the day of the inspection included an exercise class in the morning and Who wants to be a Millionaire by some of the residents after lunch. Residents were given the choice whether they wished to take part or not. I saw a programme of activities for this week which seemed varied. Outings take place occasionally using the homes own vehicle or by hiring a larger one. We were told by people using the service that they participated in the social activities provided. One person said yes there is a good range of social activities but I dont want to do something all of the time. Another person said there were a good range of activities provided and that they took place everyday. The expert by experience also commented All Residents spoken to said all their needs were catered for, including cultural and religious needs and that they have contact with their families. Comment cards received from people living in the home show that six out of seven people feel there are always activities they can take part in and one person feels there usually is. Comments included, welcomes visitors, the activities are good. In relation to what the home could do better comments included better arrangement of chairs in order to watch television and provide a little more musical entertainment and drama. The home is fortunate to have several communal lounge/seating areas so that if people do not want to participate in social activities or watch television they can go to another part of the home where it is quieter. The main lounge has a very large flat screen television as well as music systems and a DVD player. There are also faciliities for listening to music in other lounges. Large print books are available through the library exchange service to support those people with visual impairments but there was no hearing loop available in the home to assist people with hearing aids to hear more easily. This was discussed with the manager who said this was something that was currently being considered. Care Homes for Older People Page 18 of 35 Evidence: At breakfast time we observed people in the dining room having cereals and toast. Some people had chosen to have a breakfast tray in their rooms which staff were delivering. No cooked breakfasts were seen and menus seen did not indicate these were available. Staff said that a cooked breakfast or cooked items could be provided upon request. We were told by people living in the home that at breakfast there are cornflakes, porridge, toast, tea, coffee and juice made available and there are no cooked items and no cooked breakfast is offered. However they stated they were happy with the choices that were made available to them. Another person said they dont make very good porridge but the food is satisfactory I have no complaints. Menus showed that at lunch time there is a choice of two main courses but it was not clear these were always being provided and it was also not clear if the second choice was a hot or cold option. Sometimes the same second choices were repeated which limits the variation of meals that can be provided. Menus stated snacks available at anytime day or night but there was no indication of the type of snacks that can be provided. It was also not evident that a snack meal is being offered to people in the evening with there being such a long period of time from 5.15pm to 9am the next morning. Staff said that they can provide snacks upon request and there are sandwiches kept in the fridge that they can give people if they request them. Menus stated that a hot drink is provided at 8.30pm althought the choices of milky drinks available were not detailed. On viewing these in the kitchen it was clear a range of hot drinks were available. The expert by experience who chose to eat with people at lunchtime commented Lunch was served between 12.30 and 1.10pm. I had a lunch consisting of main course and dessert with squash as a drink. The main course (gammon with potatoes) and vegetables lacked seasoning although it seemed wholesome. There was no choice of the main course, although one resident had fish, but there were several puddings. The meals were delivered from the kitchen and were well presented. Residents seemed to enjoy the meals. A soft food diet is given to two residents who require this type of meal, and some residents had meals in their rooms. I engaged in conversation with some of the residents over lunch and in their rooms. The following are some comments. The food is generally very good, It is a long time from 5pm till breakfast the next morning and I feel hungry sometimes as we only have tea/coffee and a biscuit in the evening. We determined from reviewing the care records for one person that they felt hungry in Care Homes for Older People Page 19 of 35 Evidence: the mornings and evenings. Records made it clear that staff were to provide a snack in the evening and in the morning when they woke up, it was not clear from speaking to the person and staff this was always happening. Comment cards received showed that two people always like the meals, three people usually do and one person sometimes does. One person has indicated they cannot answer the question. Care Homes for Older People Page 20 of 35 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. People living in the home can be confident that their concerns will be listened to and acted upon although written procedures are not sufficiently robust to ensure there is a clear and consistent approach taken by staff in managing concerns to safeguard people. Evidence: No complaints have been received by us for this home. A complaints policy and procedure is in place which directs people to make any comments, suggestions or complaints to the Manager or Deputy Manager in her absence. This procedure was not evidenced in the Service User Guide or Residents Information Booket which is kept in peoples rooms. Both documents made reference to the procedure being available, one stated the person should already have been given a copy and the other stated it is available on request. The full procedure seen on display in the home did not detail the names and telephone numbers of the people who should be contacted. The procedure suggests that if people remain unhappy after speaking to the manager they can see a member of the Board of Trustees but there are no names or contact numbers for people to contact them directly should they wish. Our details had been included in the procedure but contained the wrong address. There were no details of the local Social Services contacts if people should wish their complaints to be dealt with independently from the home. The homes procedure should allow anybody who wishes to raise a concern to do this is writing and therefore all contact details should be available to enable people to do this. The Service User Guide should also contain Care Homes for Older People Page 21 of 35 Evidence: details of the complaints procedure so this is readily available to people without them having to look for this on the notice board in the home. There were no complaints recorded in the complaints register for the home but on viewing staff records it was evident a complaint had been received that had been responded to by the manager but had not been recorded in the complaints book. The manager said it had been her intention to write this into the book and later confirmed this information had been transferred. People spoken to were very positive about the service and said they had no complaints. The expert by experience discussed complaints with one person who stated I would complain to the management if I was unhappy about anything. Comment cards received show that people know who to speak to if they should have a complaint and all felt there was someone they could talk to informally if they needed to. The home has an adult protection policy to give staff direction in how to respond to suspicion, allegations or incidents of abuse. Staff training records were seen to demonstrate that all staff had received training in recognising and responding to signs of abuse. No allegations of abuse have been received for this home. Staff spoken to knew they needed to report any allegations or observations of abuse to the person in charge but they were less clear on what happened to this information once reported. One senior member of staff was unable to confirm who they would report an allegation of abuse to other than the manager. Staff should know this information in case they are required to refer any allegations of abuse in the managers absence. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clean, attractive, well-furnished and comfortable accommodation to live in and enjoy. Infection control procedures are not always being followed to promote good hygiene to protect people. Evidence: The AQAA completed by the manager states All areas of the home are very well maintained and decorated to a very high standard. Several rooms have been updated to improve decor including new carpets, curtains and lighting. Lighting in all corridors has been upgraded to both improve the style of lighting and the level of lighting provided. The carpets to the main lounge, lower corridor and bottom conservatory have all been replaced. Door openers to resident rooms have been improved. The expert by experience who viewed the accommodation for people stated The Home consists of a three-storey Georgian building with ground floor extensions and two airy conservatories. There is an administration office, three lounge areas, a dining room, quiet area, main kitchen, laundry and a storage area. The Home is generally well presented in keeping with its type and age, is clean but showing some slight signs of wear. The furniture in the lounges/dining area and other common rooms was functional and appropriate. Care Homes for Older People Page 23 of 35 Evidence: Some of the 23 Bedrooms are personalised and residents are able to bring in their own possessions and small items of furniture if desired. All en-suites inspected were clean and seemed well stocked. We found the environment to be clean and decorated to a good standard. The bedrooms of those people case tracked had been personalised and were clean, warm and appropriately decorated. Call bells were to hand to enable people to alert staff if they needed assistance. The home has two bathrooms with assisted bathing facilities to support people with mobility difficulties. There is also a step up shower cubical which people can use if they wish. Comment cards received from people show that the home is always fresh and clean and people spoken to said they had everything that they needed. The home has attractive grounds which are well maintained with the exception of the issues highlighted by the expert by experience who stated The grounds, where there are some seating areas, are extensive and well laid out and are enclosed with safe boundaries. I discovered two trip areas caused by tree roots on one path, which was reported to the manager. One person said they liked to go out into the garden on most days weather permitting. The laundry area was viewed and was small but functional. The person who completed the laundry was sorting out items that had built up over the weekend. There was a large sink for staff to wash their hands to maintain hygiene which staff confirmed they used. It was established that the person who completes the laundry does not wear protective clothing such as a disposable apron when dealing with soiled items and then clean. This was discussed to ensure good hygiene practices are maintained. The expert by experience who visited the laundry stated: On a brief visit to the laundry, which is slightly confined, I observed the correct procedure for separating soiled clothing. The system seems well organised with instructions for use of the machines. Re-marking of clothing and minor repairs is carried out by the member of staff. There was no evidence of odours in any part of the home on the day of the inspection. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are subject to change although there are sufficient numbers of suitably trained staff to care for people effectively. Staff training is being addressed to demonstrate that staff employed are deemed competent to care for people safely Evidence: The AQAA states The home is staffed by skilled and knowledgeable staff who have been recruited appropriately. Copies of rotas are retained to evidence numbers and type of staff on all shifts. The manager reported that there were 23 people living in the home on the day of inspection. She advised that they aim to provide four carers on the early shift, three during the afternoon and evening shift and two care staff on night duty. We found that duty rotas are retained and these were viewed over a four week period. These did not show the designations of staff so it was clear in what capacity they were working in the home and also did not contain details of the shifts the manager had worked to show she is working in a supernumerary capacity. Duty rotas showed that on some days there were three care staff available in the mornings as opposed to the four the home aims to provide. Dedicated staff are employed to undertake cleaning and laundry services and there Care Homes for Older People Page 25 of 35 Evidence: are also two Activity Organisers who share the provision of social activities to people six days per week. Of the seven comment cards we received from people, three felt there were always staff available when needed them and four people felt there usually were. Five people stated that staff usually act on what they say and two stated they always do. One person stated staff they are wonderful most of them another stated staff are very nice, very kind and helpful. Staff spoken to confirmed that sometimes there were three staff on duty in the mornings and sometimes four. A comment was made that there was not enough staff when the numbers were down to three in the mornings although they did acknowledge they had recently started to use agency staff and this had helped on some days by enabling four staff to be on duty in the mornings. The expert by experience stated There seemed to be enough care assistants attending to residents needs and there was one male care worker evident on the day of the visit. They also stated Residents spoke highly of the staff and felt the provision of facilities was good. They are all very kind many said. Staff confirmed they had attended statutory training including fire, moving and handling, first aid and health and safety. Some felt they were due to update their food hygiene training. Training records viewed confirmed that ongoing training is being provided and some staff were due to update training in food hygiene and manual handling. The manager acknowledged that some staff were due to update their training. All staff had attended training in the prevention of abuse and of the thirteen care staff employed, eight had achieved a National Vocational Qualification II in Care. This training enables staff to identify needs and respond appropriately to these needs. It was not clear from staff records that new care staff had completed full and detailed induction training to enable them to carry out their role safely and appropriately. Induction records seen were part completed. The manager was able to show us induction records they would complete for new staff. Induction training should incorporate the Skills for Care common induction standards as required. This training allows staff to build up their competences over a number of weeks to help ensure they can care for people safely and appropriately. The manager agreed to follow this up. Care Homes for Older People Page 26 of 35 Evidence: We looked at the personnel files of two recently recruited staff to confirm that recruitment practices are suitably robust to protect people living in the home. Each file contained evidence that satisfactory pre-employment checks had been carried out before people started to work in the home. This included a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults (POVA) check. Care Homes for Older People Page 27 of 35 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. Systems are in place to manage the health, safety and management of money for people living in the home although records are not always clear to demonstrate this is being done effectively. The quality of care and services is monitored to ensure people are happy with the support they receive. Evidence: The manager has been in post since May 2009 and prior to this was a deputy manager of a 40 bed nursing home. She is a qualified nurse and midwife ,has a Bsc in health sciences, Diploma in Management and had a City and Guilds 7302 teaching certificate. The manager has continued to update her skills since being in post and has undertaken training in areas including dementia, health and safety, adult protection, nutrition and optical awareness. It was evident during discussions with the manager that she is committed to providing high quality care to ensure the needs of people are met effectively. Several systems are in place for monitoring the quality of care and services provided. This includes the Care Homes for Older People Page 28 of 35 Evidence: use of quality satisfaction surveys, meetings and provider visits. Satisfaction surveys had been sent to eleven people. Eight responses had been received which contained both positive and negative comments. An outcome report had been completed but it was not clear from this report that actions had been taken to address the issues raised. The manager said that all areas for action had been addressed and the outcome report had been put on display at the time the surveys were undertaken. Staff had also been sent surveys for completion but these had not been annonymised to help prevent staff giving guarded answers. The home had received seven responses from the 26 surveys forwarded to staff. Questions included the care of people in the home as well as staff training. Visits by the provider (known as a Regulation 26 visits) had been undertaken regularly and reports had been completed for the manager to action as appropriate. These reports consisted of a inspection of the home and discussions with people to determine the quality of care and services being provided. A relatives meeting had taken place in October 2009 and notes of this meeting were seen which indicated a number of issues relating to the home had been discussed. The manager said any actions highlighted at the meeting had been addressed. People spoken to were positive in their comments about the service. Comments included: James Hiron Home is very good, they look after all the people in care very well I feel this is very comfortable and nice visitors are welcome at any time so I do not feel cut off from the outside world I have been here for X years and I am very happy. Comment cards received from people detailed very few comments in regards to what the home could do better. Comments received in this section included: more frequent baths, better arrangement of chairs in order to watch television and improve the variety of food. We looked at how peoples monies are managed by the home by viewing records and receipts obtained. Due to money being locked away at the time this was audited we could not check any monies available were correct in relation to the records seen. We found it difficult to audit records relating to individuals due to there being joint receipts and records in place. Hairdressing receipts contained no official name and address of the person providing this service and necessary to demonstrate this was an Care Homes for Older People Page 29 of 35 Evidence: official receipt. Newspaper receipts needed to be viewed with other records to identify who they were for. Although there are systems in place for the management of peoples money, the manager acknowledged that current systems could be improved so that there are clearer audit trails for each individual person. Accident and incident records were viewed and we found that it was not always clear what staff actions had been taken when people had sustained injuries. This is important so that the home can demonstrate appropriate actions have been taken to manage these. The AQAA states Health and safety records are properly maintained by the management team with all necessary certificates available on request these include maintenance and service details for all equipment such as lifts, gas appliances, electrical testing, legionella testing etc. We found this to be the case. Records viewed included gas, five year electrical wiring certificate, hoist and bath maintenance, electrical portable appliance testing records, lift maintenance and water temperatures records. All checks were in date to confirm equipment safety. The kitchen area was viewed by the expert by experience and comments received stated I visited the kitchen, which seemed clean and well organised, where two members of staff were preparing the lunch. I was not invited to wear any protective clothing. There are three fridges, two for storage of fresh foodstuffs and one for snacks and the evening meal preparation. There is a cool storeroom and fresh supplies of meat and vegetables are delivered twice a week. It seems to be safe and reasonably well maintained. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The quantity of all medicines 31/12/2009 received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. This is so that it is clear medicines have been managed as prescribed to maintain the health of people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 A Service User Guide should be made available to people prior to their admission which contains all of the required information such as a Statement of Terms and Conditions, Sample Contract and Summary inspection report. This is to help them make an informed decision on whether to stay. Any handwritten entries on medication records need to be signed and dated so that it is clear who initiated any Page 32 of 35 2 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations changes or requests. 3 10 Action should be taken to ensure the privacy and dignity of people is maintained. This in particular applies to those people who leave their bedroom doors open. Menus should be more detailed so that people know what food and drink is available to them. They should contain a good variation of choices to promote a wholesome and varied diet for people. Comments made by people living in the home in regards to the food should be considered to ensure people are happy with the quality and amount of food being provided. The complaints procedure should contain more detailed information on people to contact in the event of raising a concern or complaint to help people make contact with the person of their choice. This includes information on independent contacts so that people know who to contact if they do not wish to approach the home. All staff should be aware of the reporting process for safeguaring referrals (beyond the manager) so that they understand how allegations of abuse are managed to keep people safe. Attention to the tree roots on the garden pathway is needed to prevent people from tripping and falling over these and to help promote peoples safety when using the garden. Staff should wear protective clothing when dealing with soiled items to ensure there is no risk of spreading infection to people living in the home. Staff duty rotas should include all staff who work in the home as well as staff designations to show that there are both sufficient and suitable numbers of staff to support the needs of people. Staffing numbers for the home should continue to be monitored to ensure people continue to feel their needs are being met and staff feel they can meet the needs of people effectively consistently. Staff induction training should be based on the Skills for Care Common Induction Standards. This is to enable staff to build up their competencies to care for people safely and Page 33 of 35 4 14 5 15 6 16 7 18 8 19 9 26 10 27 11 27 12 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations effectively. 13 35 Each person should have a clear set of records relating to the management of their money as well as individual receipts relating to any transactions undertaken on their behalf. This is so these records can be viewed by the person at any time should they request them and there is a clear audit trail of how they money has been managed for them to see. Regulation 37 notices need to clearly show how any accidents resulting in injuries have been managed. This is so it is clear staff have taken appropriate action to address them. Any accidents which impact on the wellbeing of a person in the home should also be reported to us. 14 37 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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