Care Home: Leiston Old Abbey Residential Home

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What the care home does well The interaction between staff and people that lived at the home was observed to be friendly, respectful and professional. Staff had a good knowledge of people`s individual care needs. The care plans clearly identified the support that people required and preferred to meet their assessed needs. What has improved since the last inspection? There were new carpets in the halls and stairs of the home. The communal areas of the home had been redecorated. The home was clean and tidy at the time of the inspection. Regulation 26 visits were undertaken by the provider on a monthly basis and the reports were available in the home for inspection, which showed that the running of the home was monitored. What the care home could do better: The Statement of Purpose, Service User`s Guide, complaints procedure and safeguarding procedure needed to be updated to show the current CQC (Care Quality Commission) contact details, should people wish to contact us. The staffing rota and staff annual leave needed to be appropriately managed in the best interests of the people that lived at the home. Offensive odours in the home must be appropriately managed to ensure that people are provided with a pleasant environment to live in. It is recommended that consideration be made to how people`s dignity is respected for those who are reluctant to accept personal care support. Key inspection report Care homes for older people Name: Address: Leiston Old Abbey Residential Home Leiston Old Abbey Residential Home Leiston Saxmundham Suffolk IP16 4RF     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: Julie Small     Date: 0 7 0 9 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 33 Information about the care home Name of care home: Address: Leiston Old Abbey Residential Home Leiston Old Abbey Residential Home Leiston Saxmundham Suffolk IP16 4RF 01728830944 01728831263 leistonoldabbey@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Anil Kumar Agarwal care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 40 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia - Code DE Date of last inspection Brief description of the care home Leiston Old Abbey Residential Home is a country house set in extensive grounds just outside the main town of Leiston. A later extension comprising several small flats (with living room, bedroom and en-suite) and single rooms has been added to the main building. In this area the rooms are large enough to share if a couple wishes to reside here. En suites are provided with access to shared facilities, but there is no assisted Care Homes for Older People Page 4 of 33 Over 65 3 40 0 0 Brief description of the care home bathroom in the annex area. In the main home there are two communal bathrooms which staff can help residents access if needed. Accommodation in the main home is currently spread over two floors and a lift is available to reach the first floor only, however only the first floor is currently in use. There is a chair lift that provides access to the second floor. There are several large communal rooms including a dining room, lounge, reception and music room. The home is set off the main road against a wooded area. There is a large parking area to the front of the building, and fenced and walled gardens. Information provided in the Service User Guide at the time of this inspection states that charges for residents living at Leiston Old Abbey Residential Home range from £355 to £600 per week. The ownership of the home changed 3 March 2008. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place Monday 7th September 2009 from 09:05 to 18:40. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The provider was present during the afternoon of the inspection and the provider and staff that were met provided the requested information promptly and in an open manner. During the inspection health and safety records, staff training records and the recruitment records for three staff were viewed. The care records of four people that live at the home were tracked, which included care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and nine staff members, one visitor and six people who lived at the home were spoken with. Care Homes for Older People Page 6 of 33 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and it was returned to us in the required timescales. Twelve service user and six staff surveys was returned to us before the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with information about the home that they need to make decisions about if they want to move in, to be provided with a needs assessment and to have their needs met. The home does not provide an intermediate care service. Evidence: People were provided with information about the home that they needed to enable them to make decisions about the home and the services that it provided in the Statement of Purpose and the Service User Guide. The Statement of Purpose was viewed and included information about the service that was provided in the home. The document included information such as the homes philosophy of care, aims and objectives, management structure, staffing arrangements, how peoples needs were met and a summary of the complaints procedure, which needed to be updated to show the current CQC contact details, Care Homes for Older People Page 10 of 33 Evidence: should people wish to contact us. The Service User Guide was viewed and included information of how peoples needs were met at the home. The document included information such as the fees for the home, the terms and conditions of living at the home, service and facilities that were provided, the environment, the qualifications held by the homes manager and the staff that worked at the home and a summary of the complaints procedure, which also needed to be updated to show the current contact details of CQC. The AQAA stated that people were provided with a copy of the Statement of Purpose when they visit the home and stated that they explain and go through the Service User Guide, including the philosophy of care and the aims and objectives of the home. The AQAA stated that they had improved in the last twelve months by the Service User Guide and Statement of Purpose have been converted into printed format, which allows the home to offer the documents in larger print and as an audio. The service user survey asked if they had been provided with enough information about the home before they moved in so that they could decide if it was the right place for them, nine answered yes and four did not answer. The care records of three people that lived at the home were viewed and each held a needs assessment, which had been undertaken by the homes management before they moved into the home. The needs assessments included details of the support that people needed and preferred, their abilities, their mobility, communication, medication and health. The records of social care customers also held a needs assessment which had been completed by their placing authority. There were detailed care plans in place which showed how peoples assessed needs and preferences were met. The AQAA stated all service users are assessed before admission to ensure that the home can cater for all the needs of prospective service user and the assessment is conducted by manager and a senior carer to ensure that there are two perspectives and thus a correct decisions is made. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their needs and preferences set out in an individual care plan, to have their health care needs met, to be protected by the homes medication procedures and to be treated with respect. Evidence: The care records of four people were viewed and each detailed how their assessed needs and preferences were met. They detailed the daily support that people required and preferred in areas such as their preferred form of address, communication, mobility, continence, personal care, appearance, eating and the areas of their care that they could undertake independently. The care plans were updated regularly to ensure that peoples changing needs and preferences were met. There was a section in the care plan, which identified the short term care needs that people had, such as for when they were unwell and how their needs were met during this time. The provider told us that the care plans had been further improved since the last key inspection, following advice from a consultant who assisted them in identifying methods of improving the care plans that clearly indicated how peoples needs were to Care Homes for Older People Page 12 of 33 Evidence: be met. A staff member that was spoken with said that the care plans were 100 better. The AQAA stated new care plan system has been introduced to ensure that they provide clear and concise information. The care records that were viewed included risk assessments that identified the methods of minimising the risks in peoples daily living in areas such as nutrition, mobility, skin viability, manual handling and wandering. The AQAA stated risk assessments are in place to minimise and reduce hazards. The service user survey asked if they were provided with the care and support that they needed, seven answered always and five answered usually. Comments included take care of my needs, good carers and look after residents. People that were spoken with told us that they felt that their needs were met at the home. Six staff surveys said that they were always provided with up to date information about the needs of people that lived at the home. The survey asked if the ways that they passed information about people between staff worked well, five answered always and one answered usually. Comments included gives good quality of care to the residents, providing exceptional care for the residents and ensuring individual residents care needs are met, ensuring a friendly relaxed environment, freedom of choice. Staff that were spoken with showed a good knowledge about the individual needs of people who lived at the home. Staff were observed to complete daily records throughout the inspection, which were viewed. The daily records identified peoples activities throughout the shift, their well being and the staff observations of the peoples well being. A shift plan was viewed, which had been completed by the senior staff member on duty, which identified the specific observations of people that required attention at the next care shift. We observed the morning staff hand over the events of the morning to the staff members who had arrived for the afternoon shift. It was noted that information was provided clearly and in sufficient detail for the afternoon staff to support people in a consistent manner. Peoples care records that were viewed clearly showed the health care support that they were provided with, such as from the district nurse, memory clinic, physiotherapist and chiropodist and the outcomes of the health care support that they were provided with. During the inspection we observed a visiting health care professional, who visited people in the privacy of their bedrooms. The AQAA stated keep records of all health care needs including dietary needs and outside agencies required in delivering the care needs. Care Homes for Older People Page 13 of 33 Evidence: Two people that were spoken with told us that the staff always called a doctor if they felt unwell and a person told us that they were getting ready for their chiropody appointment which was on the day of the inspection. Twelve service user surveys said that they were always provided with the medical support that they needed. Part of the morning and lunch time medication administration round was observed and it was noted that the staff member offered people their medication and signed the MAR (medication administration records) charts when they had seen the people take their medication. The MAR charts of four people that lived at the home were viewed and it was noted that all medication was accounted for. The shift plan included a section which asked if the MAR charts had been checked for gaps, which showed that they were routinely checked at each shift. The home used MDS (monitored dosage system) blister packs, which were stored in a secured medication trolley. Controlled medication was stored in a metal cabinet which was secured to the wall inside a wooden built in cupboard. It was not checked at the time of the inspection if the controlled medication met with current legislation. The controlled medication register was viewed and it was noted that the administration for controlled medication was appropriately recorded, which included a running total of the medication and the signatures of two staff members to show when the medication had been administered. A staff member was spoken with and they told us that they had been provided with medication training and that they had recently completed a distance learning course in the safe handling of medication. Staff training records that were viewed showed that the staff who were responsible for administering medication were trained to do so. The homes medication procedures were viewed and they clearly identified the methods of the safe handling, storage and administration of medication. The AQAA stated medication training, safe storage and disposal is tracked twice a month. Medication training is supplied to all senior staff. During a tour of the building it was noted that there was a pay telephone which was provided in a small private room in the home to ensure that people were provided with the opportunity to make private telephone calls if they chose to. The care records of a person that were viewed showed that they had a private telephone line in their bedroom, from where they made personal telephone calls. People that were spoken with told us that their privacy was respected at the home and that the staff always Care Homes for Older People Page 14 of 33 Evidence: knocked on their bedroom door before entering, this was confirmed in observations that we made during the inspection. The interaction between staff and people who lived at the home and their visitors was observed to be friendly, respectful and professional. People that were spoken with were complimentary about the approach of the care staff and they said that they were always treated with respect. Staff were observed to include people that lived at the home in their discussions. The majority of people that were met at the time of the inspection were clean and smartly dressed. However, a person was visited in their bedroom and it was noted that the hem had come down on both of the legs of their trousers and their fingernails were unclean and they were uneven and one was pointed. We told the provider about what we had observed and they told us that the person was sometimes unwilling to accept support and that they would look into the issues that we had told them about. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with the opportunity to participate in activities which are of interest to them, to maintain their chosen contacts and to be provided with a balanced diet. Evidence: The care records of three people that were viewed showed peoples interests and hobbies and the activities that they participated in that were provided at the home. Peoples care plans detailed peoples choices, such as it should be respected if they preferred to stay in their bedrooms and if they required encouragement to participate in activities. A concern was received by us which stated that a person left the home on a regular basis and got lost. Staff that were spoken with told us who the person was and we viewed their care records. There was a risk assessment in their care records which identified that they enjoyed going out for a walk in the area that surrounded the home, but due to a deterioration in their condition they were prone to wander. The methods of minimising the risks were identified and a staff member was to accompany the person on their daily walk. Staff that were spoken with were aware of the arrangements to ensure that the person was safeguarded and that they could continue Care Homes for Older People Page 16 of 33 Evidence: in their chosen activity. The AQAA stated hobbies and interests are recorded and service users encouraged to continue as part of their social life. There was an activities programme which was posted in the entrance hall in the home which showed that activities were provided each weekday, such as jigsaws, board games, quizzes, armchair exercises and bingo. There was a visiting entertainer each month and a notice on the notice board advertised the next date that they would be attending the home. Catholic Holy Communion was provided at the home on a weekly basis and Church of England worship was provided monthly. During the inspection a person was observed to go out for lunch with a friend. A visitor to the home provided some chocolates which they said were to be used for prizes for the bingo. A person was reading a book by a window and they said that there were lots of places in the home where they could read. A hairdresser was observed to visit the home and the staff told them which people had requested to have their hair styled. People that lived at the home who were spoken with told us that there was plenty to keep them occupied. The service user survey asked if there were activities arranged at the home that they could take part in, nine answered always, one answered usually, one answered sometimes and one answered never. The provider told us that there was an activities coordinator who worked at the home who had left and that the activities were currently facilitated by the care staff and the manager. Peoples care records that were viewed detailed the contacts that they chose to maintain and where people had expressed a wish for their relatives not to be contacted. During the inspection several people were observed to enjoy visits from their friends and family. The staff were observed to welcome visitors into the home and provided updates where requested regarding peoples well being. A visitor was spoken with and told us that they were always made welcome in the home. People that were spoken with confirmed that their visitors were made welcome. A service user surveys commented always give visitors a cup of tea and cake or biscuits. Staff are always cheerful and patient. Also they let visitors bring dogs in to see the residents which cheers them up. The AQAA stated families are encouraged to take service users on outings. Service users encouraged to maintain regular contact with family and friends by having flexible visiting times, private visiting areas, assistance with correspondence and access to telephones and e-mailing. Care Homes for Older People Page 17 of 33 Evidence: The choices that people made in their daily living were clearly recorded in the care records that were viewed. People that were spoken with told us that they made choices in their daily living. Twelve service user surveys said that the staff listened and acted upon what they said. The minutes of residents meetings were viewed and showed that people were consulted with regarding the activities and food that were provided at the home. The AQAA stated choices are given regarding meals, meal times, dining areas, participation in group or individual activities. Service users opinion on social activities and daily life are sought during service user meetings and one to one/group conversations. The menu was viewed and it was noted that it was nutritious and people were provided with a choice of meals. During the inspection, we observed people having breakfast, which was attractively provided on a tray for each person, which held a hot drink, a glass of orange juice, cereal, a rack of toast and a choice of spreads for their toast. Lunch was home made steak pie and fresh vegetables, people were observed to eat their meals with little being left on their plates. People who required support to eat their meal were supported by a staff member who remained with them until they had finished eating. People chose where to take their meals, either in their bedrooms or in the attractively decorated dining room. Tables in the dining room were laid with salt, pepper and paper napkins. There were jugs of cold drinks and glasses in the dining room, with a notice stating that people should help themselves to drinks when they wanted them. People were provided with a choice of hot and cold drinks throughout the day of the inspection. One person who was visited in their bedroom had a jug of water and a glass on their dresser, however, this was not within easy reach of the person. People that were spoken with told us that the food was always good at the home and that they were provided with a choice of meals. A person said that they would like more variety of fresh vegetables and said that cabbage was often provided, this was one of the fresh vegetables that were provided for lunch on the day of the inspection. One person who was going out for lunch told us that they were a little put out that I will be missing lunch, the food is very good, and plenty of it, they then showed us their stomach and laughed. The service user survey asked if they liked the meals at the home, seven answered always, five answered usually and comments made were good food and food could be better, cook does good but the quality of food is poor. A cook was spoken with and they had a good knowledge of the specific dietary Care Homes for Older People Page 18 of 33 Evidence: requirements of the people that lived at the home and they clearly explained how they met peoples dietary needs. Peoples care records that were viewed held a nutritional assessment and detailed their dietary needs. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their complaints listened to and acted upon and to be protected from abuse. Evidence: Several cards and letters which thanked the staff at the home for the service that they had provided were viewed and they were presented in a folder in the entrance hall in the home. The complaints procedure was viewed and it clearly identified the actions that would be taken upon receipt of a complaint. The procedure needed to be updated to show the current contact details of CQC, should people wish to contact us. The procedure was provided in the entrance hall of the home and included complaints forms, which people could complete if they had concerns. The complaints procedure was also summarised in the Statement of Purpose and Service Users Guide. The AQAA stated complaints procedure is explained to all service users, family and friends. The complaints book was viewed and showed that there had been no complaints received since the last key inspection, this was confirmed in the AQAA. A person told us that they had verbally raised informal concerns, which had been acted upon appropriately. Informal concerns were recorded peoples individual care records. Care Homes for Older People Page 20 of 33 Evidence: The AQAA stated all complaints/concerns recorded upon and acted upon to improve the service we provide to the service users. People that were spoken with said that they knew how to make a complaint about the service that was provided at the home. Twelve service user surveys said that they knew who to speak to if they were not happy and how to make a complaint. Six staff surveys said that they knew what actions to take if someone had concerns about the home. The AQAA told us that there had been no safeguarding alerts made in the last twelve months. Staff that were spoken with had a good understanding of the roles and responsibilities regarding safeguarding and said that they had been provided with safeguarding training. A maintenance worker was asked about the training that they had been provided with and they told us that they had been provided with safeguarding training and were aware of how they should report concerns. Staff training records that were viewed showed that all staff that worked at the home were provided with safeguarding training and updates. The AQAA stated that they provided staff training and active promotion of whistle blowing and protection of vulnerable adults. Staff were further provided with information about their roles and responsibilities in the whistle blowing and safeguarding procedures in the home. The safeguarding procedure needed to be updated to reflect the current contact details of CQC. The local authority safeguarding guidelines were provided in the staff office for their reference. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with a well maintained and clean environment to live in. They cannot be assured that unpleasant odours are managed appropriately. Evidence: A tour of the building was undertaken and it was noted that the home was clean and tidy. Eleven service user surveys said that the home was always fresh and clean and one said that it usually was. We noted that there were new carpets in the hallways and stairs of the home, which was confirmed by staff that were spoken with. A maintenance worker was observed to change two light bulbs in the home after being notified by a staff member that they needed replacing. The maintenance worker was spoken with and told us that there were two maintenance workers at the home and that they undertook jobs that were identified by care staff and recorded for their attention on a notice board in the staff office. They told us that they were responsible for the general maintenance of the home and garden and that they had recently repainted all the rooms in the home and they had started to repaint the external areas of the home. The AQAA stated that they had improved in the last twelve months by accelerated programme of rooms decorated, including soft furnishings, carpets and decor and redecoration and re-carpeting of the communal areas. Care Homes for Older People Page 22 of 33 Evidence: The communal areas of the home were clean and decorated and furnished in fitting with the homes period. There were no unpleasant odours in the communal areas of the home. There were machines in the communal areas which ensured that there were no flies. Bedrooms were provided with en suits facilities, consisting of a toilet, hand wash facilities and a bath and there were two supported bathrooms on the first floor for peoples use. All bathrooms provided hand wash gel, disposable paper towels and gloves and aprons to minimise the risks of cross infection. The laundry was clean and tidy and it provided a sink in which staff could wash their hands and hand wash liquid to minimise the risk of cross infection. It was noted that there were no paper towels in the laundry on the morning of the inspection, however, these were provided later in the day. Two domestics were working on the day of the inspection and both were spoken with. They told us that they were responsible for ensuring that one floor of the home was appropriately cleaned. They told us that cleaning materials were provided to them that was sufficient to enable them to do their job. We had received a letter of concern from an anonymous source, which stated that they had written in response to the surveys that we had sent to the home. The letter stated there are never enough gloves and aprons or wipes for the care staff to use, a few boxs are usually brought from the owners other care home. How can we protect ourselves and residents from cross contamination? The provider was spoken with and confirmed that they delivered the gloves, aprons and wipes to the home because the supplier that they used did not deliver in the Suffolk area. They said that there was one weekend when the gloves had run out. Staff that were spoken with said that there were sufficient gloves, aprons and wipes at the home at the time of the inspection. However, there had been times when they were waiting for a delivery from the providers, that they had run out. During the inspection staff were observed to undertake good infection control procedures, which included washing their hands and wearing aprons and gloves when working with food and personal care. We visited a person in their bedroom and it was noted that there was an offensive odour and several flies in their room. A visitor was spoken with and they said that they had purchased air freshener to attempt to eliminate the smell. The provider was spoken with and told us that they had a machine to clean carpets, that the person was reluctant to accept support and that that the person refused to have their bedroom windows open. We discussed this issue with the provider and explained that it was their responsibility to manage offensive odours appropriately to ensure that people were provided with a pleasant environment to live in. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be supported by a staff team that are trained to meet their needs. Evidence: During the inspection there were four care staff working on the morning shift and three on the afternoon shift. It was noted that call bells were answered and that the staff were busy attending to peoples needs throughout the day. Staff were attentive to peoples needs and their approach was friendly, respectful and professional. The staffing procedures that were viewed showed that a staff assessment had been undertaken and the usual staffing arrangements for each day was the numbers of staff on the day of the inspection. The AQAA stated that they had improved in the last twelve months by implemented methodology outlined by National Service Residential Forum, which takes into account, amongst other factors, the care needs of the service users. A staff member told us that there were twenty six people accommodated in the home at the time of the inspection. We viewed the staffing rota for the period of 18th August 2009 to 31st August 2009 and it was noted that the day shifts were covered by between three and four care staff. The rota from 1st September to the day of the inspection was viewed and it was noted that there were two staff members on duty on the afternoon shift 5th Care Homes for Older People Page 24 of 33 Evidence: September 2009. A staff member was spoken with and said that the two staff that were on duty was a newly recruited person and a senior staff member. They said that the cook had agreed to come in to help with suppers. We asked if peoples needs were met during the shift, they told us that they were, however, they were very busy and struggled to ensure that people that were in their rooms were checked on an hourly basis. An agency had been called but there were not staff available to cover the shift. The rota showed that the manager was on call for this period, however, the provider and staff that were working at the home advised us that the manager was on leave. The provider also told us that two day staff members and one night staff member had recently left the home and that there were six staff on annual leave during this period. A staff member also told us that there were four or five staff on leave, two staff had left and one had called in sick. This meant that the staff had to cover the shifts between themselves. The provider told us that there were two staff members who regularly covered shifts, which was confirmed in the rota that was viewed. They told us that there were clear procedures in place to advise staff of actions to take to ensure that shifts were covered, when issues arose. However, they agreed that the numbers of staff on leave at the same time was not acceptable. The provider telephoned us following the inspection and told us that the manager had told them that they had ensured that the rota provided sufficient staffing cover when they were on leave and that the issue of two staff had arisen due to one staff member not turning up to work the shift which was on the staffing rota. Comments received from the homes manager 5th November 2009 said that all staff were aware that the provider was on call during the managers leave. A letter of concern was sent to us from an anonymous source, which stated that they it was sent in response to the surveys that we had sent to the home before the inspection. The letter stated that a name had been on the rota of a person who had never worked at the home. We asked staff about this and they said that the persons name had been on the rota, however, this was a rota from a couple of weeks ago and they did not know where the rota was. The provider was spoken with and confirmed that the person had been a newly recruited staff member who had not worked at the home, they had not turned up for the shifts that they had agreed to work. Comments received from the homes manager 5th November 2009 said that the staff had covered the shifts and the home was never short staffed. The provider said that they were advertising for staffing vacancies and they were in the process of changing the times of the day and night shifts to make the job more appealing. The provider told us that they had lost staff due to the afternoon staff ending late for people to travel home. Staff that were spoken with confirmed that the Care Homes for Older People Page 25 of 33 Evidence: provider had consulted with them about the hours of working. The service user survey asked if staff were available when they needed them, seven answered always and five answered usually. Comments made in the surveys included understaffed, maybe more staff at times and girls are overworked need more help. The staff survey asked if there were enough staff to meet the individual needs of people, four answered always and two answered usually. The home had met the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 in care as identified in the National Minimum Standards relating to older people. The AQAA stated 99 staff have gained NVQ qualification in care. Care staff that were spoken with told us that they had achieved an NVQ level 2 and one had achieved an NVQ level 3 in care. Staff were appropriately trained to meet the needs of people that lived in the home. The training records, which included a list of training achieved and training certificates were viewed and showed that they had been provided with training such as manual handling, medication, safeguarding, infection control, dementia, fire safety, food hygiene and an appropriate induction course. Staff that were spoken with confirmed that they were provided with a good training programme which enabled them to meet peoples needs. A newly recruited staff member was spoken with and they told us that they had undertaken an induction course in the home, were working on an induction work book and they shadowed staff. They said that they had not yet been provided with formal training courses and that they would be attending training courses when their probation period was completed. The AQAA stated induction is centred on the Skills for Care and training of all staff is given a priority. Six staff surveys said that their induction covered everything that they needed to know to do the job when they started and that they were provided with training which was relevant to their role, provided them with enough knowledge about health care and medication, that helped them to understand and meet peoples needs and that kept them up to date with new ways of working. The recruitment records of three staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that people were safeguarded. Checks included CRB (Criminal Records Bureau) checks, POVAfirst (protection of vulnerable adults) checks, identification and two written references. Six staff surveys said that their employer had carried out checks such as their CRB and references Care Homes for Older People Page 26 of 33 Evidence: before they started work. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their health and safety promoted and protected. Evidence: The Statement of Purpose which was viewed stated that the registered manager had achieved a nursing qualification and an NVQ level 4 in management. This was confirmed by the provider who was spoken with. The manager had been successful in the CSCI (Commission for Social Care Inspection) registered manager application process. The manager was on leave during the inspection. Staff that were spoken with told us that the manager was fair in their approach. We had received an anonymous letter which raised concerns about the management approach in the home, the contents of which were explained to the provider at the time of the inspection. It was noted during the inspection that the staffing in the home had not been appropriately managed with regards to staff leave, this is fully discussed in the staffing section of this report. Care Homes for Older People Page 28 of 33 Evidence: A requirement made at the last key inspection was that Regulation 26 visits must be undertaken on a monthly basis and copies of the reports must be kept in the home. During this inspection it was noted that the requirement had been met. The provider completed Regulation 26 visits on a monthly basis and the reports were available in the home for inspection. The reports were viewed and showed that the provider routinely sought the views of people that lived at the home and staff members. People were further provided with the opportunity to express their views about the service that they were provided with in regular residents meetings and satisfaction questionnaires. The results from satisfaction questionnaires which had been undertaken January 2007, were provided in the entrance hall to the home. They showed the issues that had arisen as a result of the questionnaires and how the issues would be addressed. The provider was spoken with and they told us that satisfaction questionnaires had recently been undertaken and that they had provided the results to the manager for distribution in the home. The minutes from a recent residents meeting were viewed and they showed that people were consulted with regarding the food and activities provided at the home and were updated with changes in the home. The Statement of Purpose, Service Users Guide and the procedures for safeguarding peoples finances were viewed and they stated that people were provided with a secure place in their bedroom to store their valuables and that spending in the home, such as hairdressing, would be billed to their representatives. This was confirmed by a visitor to the home, they told us that their friend kept their spending money in their bedroom and that they regularly received bills for spending in the home. They said that the bills previously did not provide the dates of the interactions, however, this had been addressed when queried by the person. A person was visited in their bedroom and it was noted that there was an offensive odour, this is further discussed in the environment section of this report. There was a heater in the persons bedroom and we noted that there was a sticker on the plug which showed that an electrical appliance check had been undertaken July 2009 which showed that the appliance was safe to use. The fire safety records were viewed and they showed that people were safeguarded in case of a fire. There was a fire risk assessment and fire safety checks were undertaken regularly. Staff training records that were viewed showed that they had been provided with fire safety training and regular updates. The homes fire procedures were displayed around the home to ensure that people were aware of actions that they needed to take in case of a fire. Care Homes for Older People Page 29 of 33 Evidence: The health and safety records were viewed in the kitchen that included daily water, refrigerator, freezer and food temperature checks. The provider showed us the monthly health and safety checks, which were undertaken by the homes manager which ensured that peoples health and safety was protected. The AQAA stated health and safety checks are made and recorded at least twice monthly by the manager. The checks include care, general, kitchen and domestic and the processes and procedures implemented in the past year has enabled us to comply with all the requirements outlined by Suffolk coastal districts environmental health, food safety agency and Suffolk fire departments. Staff were provided with information about how they should promote and protect the health and safety of people in the home in the homes health and safety procedures and in training such as safeguarding, health and safety, infection control, manual handling and food hygiene. The procedures that were viewed did not hold an emergency plan to show what actions they would take if staff or people living at the home contracted swine flu. The provider told us that they thought that the manager had completed one, but it may be stored on their computer, which was broken. This was confirmed in the telephone calls that we observed the provider making to attempt to get the computer repaired. The homes records that were viewed were up to date and it was noted that peoples care plans clearly detailed the support that people required to meet their needs and preferences. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 16 All areas of the home must be kept free of offensive odours. To ensure that people are provided with a hygienic and pleasant place to live in. 30/09/2009 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 10 It is recommended that methods of ensuring that peoples dignity is respected, even when people are reluctant to be supported with their personal care. It is recommended that there be sufficient gloves and aprons for the use of staff to minimise the risks of cross infection. It is recommended that the staffing rota accurately shows the staffing and on call arrangements, to ensure that peoples needs are met by sufficient staff numbers. It is recommended that a procedure be undertaken to ensure that people are appropriately supported in the event of people or staff contracting swine flu. 2 26 3 27 4 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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