Care Home: Leopold Nursing Home

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What the care home does well The interaction between staff and people that lived at the home was respectful and professional. People`s care plans showed the support that people required and preferred to meet their assessed needs. People told us that they were happy at the home and that their needs were met. The service user survey asked what the service did well and comments included `staff are always attentive`, `caring for the different needs of each individual resident`, `responds to medical needs, treats me as an individual, acts promptly and professionally in the event of an accident or emergency` and `they look after me and make sure that I am clean and well fed`. What has improved since the last inspection? The needs assessments and care plans had been improved to include increased detail about how people`s needs and preferences were met. The curtains and carpets had been replaced in the communal and private areas of the home and the seating in the lounge area had been rearranged to provide increased access for staff and comfort for the people who lived at the home. The nursing staff numbers had been increased from one to two in the mornings, which enabled the morning medication administration to be completed in a timely manner. What the care home could do better: The complaints procedure needed to be updated to show the current contact details of CQC (Care Quality Commission), should people wish to contact us. People needed to be advised of the complaints procedure to ensure that they were aware of actions to take if they wished to make a formal complaint. The training and induction arrangements for staff needed to be reviewed to ensure that they were provided with the skills to meet the needs of people in the home, such as with feeding techniques and communication. Staff who do not hold appropriate qualification must be provided with an induction within six months of starting to work at the home, which incorporates the Skills for Care Common Induction Standards to ensure that people`s needs are appropriately met by newly recruited staff. There needed to be increased attention paid to the monitoring and management of the cleanliness of the home, in areas such as offensive odours, cleaning of woodwork and cleaning of privacy screens. The majority of the areas that were identified that needed attention were addressed immediately during the inspection and the manager assured us that the remaining issues would be addressed. Key inspection report Care homes for older people Name: Address: Leopold Nursing Home 17 Leopold Road Felixstowe Suffolk IP11 7NP     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: 1 2 1 0 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: Leopold Nursing Home 17 Leopold Road Felixstowe Suffolk IP11 7NP 01394670196 01394279059 leopoldnursinghome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rema Jayarajan care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Up to a maximum of 5 places may be used to provide respite care to persons aged between 55 and 65 years of age. Date of last inspection Brief description of the care home Leopold Nursing Home offers accommodation for a total of thirty-six older people. The home is in the coastal town of Felixstowe, close to local shops, amenities and the beach. There are frequent bus and train links to nearby Ipswich. The house is large and has been adapted to offer the accommodation over three of the four floors. There are 18 single rooms and nine double bedrooms each with a washbasin in the room. Each floor has toilets and assisted bathrooms. There is a passenger lift to all floors. There is a large communal lounge and dining area on the ground floor that has a conservatory at one end. Externally there is a small seating area and off road parking but no garden. The manager told us that at the time of the key inspection the home fees ranged from £480 to £650 per week. 0 Over 65 36 Care Homes for Older People Page 4 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 unannounced inspection took place Monday 12th October 2009 from 09:15 to 18:35. 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 manager was present during the inspection. The manager and the staff that were spoken with provided the requested information promptly and in an open manner. During the inspection the care records of four people were tracked, which included their care plans and medication records. Four staff recruitment records, staff training records and health and safety records were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and seven people that lived at the home, five staff members and three visitors were spoken with. Care Homes for Older People Page 5 of 35 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to us within the required timescale. Staff, health professional and service user surveys were sent to the home. Ten staff, fifteen service user and three health professional surveys were returned to us. Care Homes for Older People Page 6 of 35 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. Care Homes for Older People Page 7 of 35 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 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 9 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 who use this service can expect to have their needs assessed prior to moving into the home, to be assured that their needs will be met and to be provided with the opportunity to visit the home before they make decisions about if it is the right place for them. Evidence: The care records of four people were viewed and each held a needs assessment, which identified the support that they needed and preferred, in areas such as with their mobility, personal care and health. There were local authority needs assessments in place for local authority customers. The AQAA stated prior to admission the service user will have a detailed preadmission assessment done by the social worker and the homes manager or appointed person to ensure that the home can meet their needs. Care Homes for Older People Page 10 of 35 Evidence: The manager informed us that there had been recent improvements in the needs assessments and showed us the updated template. The assessments had been updated to include how people made decisions in their lives incorporating the Mental Capacity Act and had included increased writing space to allow detailed information regarding peoples condition, well being and health. The AQAA told us that they had improved in the last twelve months by we have modified previous pre-admission and ongoing assessment to a single standardised detailed assessment record form. Peoples care records that were viewed included a care plans which identified how their assessed needs and preferences were met. The AQAA stated individual holistic care is planned and implemented for each service user which includes discussion and agreement with their relative or appointed person. The health professional survey asked if the services assessment arrangements ensured that accurate information was gathered and that the right service was planned for people, one answered always and two answered usually. Two people that lived at the home who were spoken with told us that they visited the home before they decided that they wanted to move into the home. They said that they looked around and met the staff that worked at the home. Another person told us that their relative had visited the home to ensure that it could meet their needs. The service user survey asked if they were provided with enough information to help them to decide if the home was the right place for them before they moved in, twelve answered yes, one answered no and two did not answer. The AQAA stated each service user and/or their relatives are given the opportunity to visit the home and spend time in the home prior to making any decisions and the home offers a month settling period and then both parties are able to re-assess arrangements and the environment. Care Homes for Older People Page 11 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 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 have their privacy respected and to be protected by the homes medication procedures. Evidence: The care records of four people that lived at the home were viewed and each held a care plan which identified how their assessed needs and preferences were met. The care plans included details of the support that people required and preferred in areas such as personal care, mobility, communication and eating. Risk assessments were present which identified the methods of minimising risks in areas such as skin tissue, manual handling, nutrition, falls and pressure sores. The care plans and risk assessments were updated regularly to reflect peoples changing needs and preferences. Daily care records were routinely completed, which showed the support that people had been provided with, their wellbeing and choices that they had made. The AQAA stated each service user is supported where possible to make their own decisions in line with the Mental Capacity Act, we use a person centred care planning Care Homes for Older People Page 12 of 35 Evidence: approach (Orems) and evaluate this at regular intervals. The AQAA said that they had improved in the last twelve months by we have upgraded the dependency profile to incorporate the following: falls risk assessment, our own malnutrition risk assessment which supports the MUST nutritional screening tool. The manager was spoken with and told us that they had attended training in the Mental Capacity Act and Deprivation of Liberty. They had a good understanding of how areas of peoples capacity to make decisions should be incorporated into care planning. Three staff members were spoken with and told us that the care plans included the information that they needed to meet peoples needs. They told us that they were updated regularly and changes in peoples care were communicated to them in the care plans, communication book and verbally from the homes management team. They told us that they felt that the needs of people at the home were met and that they provided a good quality care. Ten staff surveys said that they were always provided with up to date information about the needs of people and that the ways that they passed information about people between staff always worked well. Comments included the care is very good in this home, caring is doing well - total holistic care and in the care and everything else that we do. Two relatives that were spoken with told us that their relatives needs were met, this was confirmed by discussions with people who lived at the home. People told us that they were well cared for and that the staff catered to their needs. The service user survey asked if they were provided with the care and support that they needed, eight answered always and seven answered usually. Comments included I am happy being here as I think that I am well looked after and cared for, I am quite happy here, they look after me and make sure that I am kept clean and well fed, staff are always attentive and caring for the different needs of each individual resident. Three health professional surveys said that the service always sought advice and acted upon it to meet peoples social and health care needs and that peoples social and health care needs were always properly monitored, reviewed and met. Comments included staff always appear to be friendly, caring and attentive to the residents and in my observations patient care and contact is good. Peoples care records that were viewed showed the health care needs that people had been provided with and the outcomes for health care appointments that they had been provided with, such as with their doctor. During the inspection we observed a health care professional visiting a person in the home. The manager was observed to inform Care Homes for Older People Page 13 of 35 Evidence: the health care professional of the persons well being. We asked if they were satisfied with the support that people were provided with and they said that they were, they told us that they had no concerns about the support provided to people. People that were spoken with told us that their health care needs were met and that the doctor would always be called in if they were unwell. The service user survey asked if they were provided with the medical support that they needed, twelve answered always, two answered usually and one answered sometimes. One survey commented responds to medical needs, treats me as an individual, acts promptly and professionally in the event of an accident or emergency. People were protected by the homes medication procedures and processes. The manager explained that there had been improvements in the morning medication administration which ensured that people were provided with their medication in a timely manner. Previously one nurse had undertook the morning medication round, which had been increased to two nurses. On arrival at the home it was noted that the medication round was complete. Medication was stored in MDS (monitored dosage system) blister packs in secure medication trolleys which were secured to the wall in the medication room when they were not in use. The MAR (medication administration records) charts were viewed and it was noted that medication was accounted for. Controlled medication was stored in a suitable controlled medication cupboard in the medication room and the records were maintained in a bound controlled medication book. The records were appropriately maintained, and included the time of the medication administration, a running total and the signatures of two staff members to show that the medication had been appropriately administered. A nurse was spoken with and they clearly explained the procedures for the storage and administration of controlled medication. Part of the lunch time medication round was viewed. The staff member who was administering the medication clearly explained the procedures for the safe handling, administration and storage of medication. They told us that they had been provided with medication training, which was confirmed in the training records that were viewed. The staff member washed their hands before they started administering the medication. They checked the MAR charts and MDS blister packs for the medication that needed to be administered. They provided people with their medication in a clean pot and signed the MAR chart when they had observed the person taking their medication. Care Homes for Older People Page 14 of 35 Evidence: The AQAA stated a clear audit trail regarding medication administration, a policy/procedure and ongoing training of registered staff backs this up. During the inspection staff were observed to respect the privacy of people that lived at the home. They knocked on peoples bedroom doors and bathroom doors before entering them. People who lived at the home that were spoken with confirmed that the staff always knocked on their bedroom door before entering. It was noted that shared rooms provided a privacy screen. Three health professional surveys said that peoples privacy and dignity was always respected. People that were spoken with told us that they were always treated with respect and that the staff were always polite. This was confirmed by observations of interaction between staff and people that lived at the home, which was friendly, respectful and professional. We noted a staff member whose interaction with a person with sight loss was very good, they approached the person several times throughout the inspection and each time they said hallo (the person), this is (the staff members name). We spoke with the person and they told us that they liked the staff to introduce themselves, so they knew who they were talking to. People were smart and clean and they told us that they were happy with the personal care support that they were provided to ensure that their appearance to maintained to a standard that they expected. The AQAA stated the home has a policy to ensure privacy, dignity and respect which involves things such as knocking on doors and waiting before entering service users rooms and staff training to ensure residents dignity, privacy and respect is always observed. Two people that lived at the home and a relative that were spoken with told us that there were times when they could not communicate their needs effectively with staff that worked at the home who used English as a second language. We spoke with five staff members during the inspection and it was noted that communication was good with four of the staff members and one staff member did not understand the questions that we asked about peoples choices of meals. One health professional survey commented in the section for what the service did well caring, listening to patients, quick response to their needs. Staff courteous and polite and do their best to communicate with local needs (most of the nursing staff Asian). The complaints records were viewed and it was noted that there had been a complaint regarding communication barriers, which was made by a persons relative June 2009. The Care Homes for Older People Page 15 of 35 Evidence: provider had responded and agreed that culture and languages required time to develop. We spoke with the manager about the need for staff that work at the home to be able to communicate effectively with people that lived at the home and that people needed to be provided with staff that could understand what they had told them about their needs and preferences. We told the manager that a person had told us that they felt isolated in the home and that they had difficulties understanding staff and making themselves understood. The manager said that there were times when the person shouted at the staff, which may have been because they could not make themselves understood. The manager told us that overseas staff were provided with support in English and the training book that was viewed showed that nine staff had attended English language training June 2009. The service user survey asked if the staff listened and acted on what they said, seven answered always, six answered usually and two answered sometimes. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with the opportunity to participate in activities that interest them, to be supported to maintain their chosen contacts and to be provided with a balanced diet. Evidence: The manager was spoken with and told us that a member of the care staff undertook the activity co-ordinator role and that activities were provided to people after 16:00 each day. The activities programme and an activities book were viewed, which identified the people who had chosen to participate in the activities. The activities that were provided included exercise and music, a picnic on the beach, watching a film, bowls, skittles, painting, reminiscence, bingo and quizzes. There were also a range of visiting entertainers and religious services and outings, such as to the Felixstowe Fort, pub lunches and Needham lakes. A person who lived at the home was spoken with and they told us that they enjoyed the outings that were arranged at the home, particularly the pub lunches. This was confirmed by their relative who was spoken with, they told us that there plenty activities that their relative could participate in. Two people that were spoken with told us that there were activities that they could participate in and that they enjoyed the Care Homes for Older People Page 17 of 35 Evidence: visiting entertainers. A person who was spoken with in their bedroom told us that they preferred their own company and liked to read and watch television in their bedroom, they told us that a library service visited the home and that they provided them with larger print books. Another person that was spoken with in their bedroom told us that the staff had encouraged them to go downstairs to meet other people, which they said they did and no one had spoken to them. During the inspection we observed a group of people in the lounge area watching television. However, in the open plan dining area the radio was playing loudly. We asked the manager about if the radio would disturb the people watching television. They told us that they thought that it had been put on by a staff member who was on their break and that they would turn it off. When we returned to the lounge later in the day people were observed to be enjoying listening to the music from 1950 - 1960 which was being played. We enjoyed a chat with a person about the music and we noted another person moving their arms around to the music. The service user survey asked if there were activities provided at the home which they could participate in, seven answered always, five answered usually, two answered sometimes and one did not answer. Comments made in the surveys included more outings to local shops, improve seating area, reduce height of hedge to allow better visibility to residents passing people and traffic. This would give residents a feeling of space and belonging to the wider community and they could help me with a bit more exercise out of your chair. The health professional survey asked how the home could improve and one stated probably to take out the people more often for social visiting and entertainment. The minutes of house meetings were viewed, which showed that people were provided with the opportunity to make choices about areas such as meals and activities. However, the last meeting was February 2009. The manager told us that peoples relatives were invited to the meetings to ensure that they were involved. The AQAA stated that they have regular service users meetings and discussions which include social activities and menus and that they had improved in the last twelve months by we have encouraged active participation from relatives and friends of service users in the homes activities and outings to voice their suggestions regarding any new ideas, enable the home to offer a wider range of activities. During the inspection we observed several people enjoying visits from their family and friends. One person told us that they were going out for lunch with a friend. Two peoples relatives were spoken with and they told us that they were always made welcome in the home and that they were kept informed of issues which affected their Care Homes for Older People Page 18 of 35 Evidence: relative. People who lived at the home that were spoken with told us that their visitors were always made welcome and they were offered a drink when they visited. The AQAA stated we have free open visiting arrangements. During the inspection we observed people being provided with the choice of hot drinks throughout the day and people were provided with jugs of squash, which they could help themselves to. People told us that they were provided with lots to drink and that they could ask for a drink when they wanted one. One person told us that their drink was too sweet and that they had told the staff several times that they liked half teaspoon of sugar in their tea. It was noted that when people were provided with hot drinks they were not asked if they wanted sugar in their drinks. Some people were provided with hot drinks in plastic feeder cups, we asked a person who was using a feeder cup what type of cup that they preferred and they told us that they liked to use the one they had so that they did not spill their drink. People that were spoken with told us that they enjoyed the food that was provided at the home, they got enough to eat and that they were always offered a choice of meals. A person told us that the food was not too bad and they said that they were always provided with fresh vegetables. A relative of a person told us that their relative was provided with a balanced diet. The service user survey asked if they liked the meals at the home, four answered always, eight answered usually and three answered sometimes. The manager told us that the cook was on leave and were returning to work the day after the inspection. Lunch was cooked by a staff member who was usually a carer. Lunch looked and smelled appetising, which was a choice of vegetable and steak pie or fish, boiled parsnips, broccoli and mashed potatoes. People said that they enjoyed their meal, one person did not have broccoli on their plate and told us that they did not like it, which showed that their choices were listened to when serving their meals. The meal was served to people from a hostess trolley, which kept the food hot. People were provided with aprons, which the manager told us protected their clothing. They told us that they had ordered new aprons for peoples use, which were delivered during the inspection. We observed a staff member assisting a person with sensory loss to eat their meal. The staff member spoke to the person once and asked if they were enjoying their meal, they put the food onto the eating utensil, without asking the person what they wanted to eat next and they did not tell the person when the food was approaching their mouth. Whilst eating their desert the person sneezed, and the food sprayed out of their mouth, they apologised to the staff member who attempted to put more food Care Homes for Older People Page 19 of 35 Evidence: into their mouth, the person then asked if they could blow their nose before they carried on eating. When the person had finished eating we asked them if they were happy in the way that they were assisted to eat their meal and they said that they were. We told the manager about what we had observed during lunch and they told us that the staff had been told to ensure that they spoke with people when they were assisting them with their meals and that they would speak with the staff member about their practice. A comment made in a health professional survey was in my observations patient care and contact is good. Good practice in relation to the assistance provided to people during meal times was identified in a comment made in a health professional survey in my observations patient care and contact is good. Individual assistance on feeding care was excellent, clients were assisted if needed but not hurried. 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 who use this service can expect to be protected from abuse and to have their complaints listened to and acted upon. Evidence: The homes complaints procedure was displayed in the entrance hall to the home, which provided people who lived at the home and visitors with the information that they needed to enable them to raise concerns about the home. The procedure needed to be updated to show the current contact details of CQC, should people wish to contact us. The AQAA stated the home has a clear and accessible complaints procedure and all service users are informed about the complaints procedure and will be fully supported by staff in making their complaint. The service user survey asked if they knew who to speak to informally if they were not happy, thirteen answered yes and two did not answer. The survey asked if they knew how to make a formal complaint, eight answered yes, six answered no and one did not answer. The manager was told about responses in the service user surveys and they told us that they would include an update on the complaints procedure in the next house meeting to ensure that all people were aware of how to make a formal complaint. People that lived at the home and two relatives that were spoken with told us that they knew how to make a complaint if they were unhappy. A relative of a person told us that when they had raised concerns they were always listened to and their concerns were acted upon promptly. Care Homes for Older People Page 21 of 35 Evidence: Two health professional surveys said that the service always responded to concerns appropriately and one did not answer. Ten staff surveys said that they knew what actions to take if a person wanted to make a complaint about the service that they were provided with. Four staff that were spoken with told us that they were aware of the complaints procedure and what they should do if a person wanted to make a complaint. The staff training book was viewed and showed that they had been provided with training on the homes complaints procedure. The AQAA told us that they had improved in the last twelve months by commenced a suggestion box to allow for anonymous comments and complaints. It was noted that the suggestion box was in the entrance hall to the home. The records of complaints were viewed and it was noted that they were acted upon and the management team had responded to the complainants promptly. The AQAA said that there had been two complaints made in the last twelve months and that they were resolved within twenty eight days. During the inspection we observed an interaction which showed that concerns were acted upon promptly. A persons relative told the manager that their relative was using a wheelchair which did not belong to them. The manager told the person that they would find out the reasons for this, they immediately did this and explained to the person and their relative that their wheelchair was due to be repaired Wednesday and they apologised and said that they should have been told. The manager offered the person a cushion to ensure that they were comfortable until their wheel chair was returned to them. The AQAA said that there had been no safeguarding alerts made in the last twelve months and stated all staff have in house training on POVA (protection of vulnerable adults) and the requirements to work to these regulations. They are given a copy of the homes whistle blowing policy and awareness of how to respond to evidence or suspicion of abuse or neglect. Three staff members that were spoken with told us that they had been provided with safeguarding training and that they knew what actions to take if they had concerns about a persons wellbeing. The training book was viewed and it confirmed that staff were provided with safeguarding training. The homes safeguarding procedures and the local authority safeguarding guidelines were in the homes office for staff reference. 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 adequate 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 a comfortable home to live in, they cannot be assured that the all areas of the home are clean, hygienic and free from odours. Evidence: The AQAA stated the home is well maintained and offers a homely place to live. A tour of the building was undertaken during the inspection. The open plan communal lounge, dining area and conservatory was noted to be clean, homely and tidy. There were sufficient tables and chairs for people to enjoy their meals and easy chairs for people to relax in. Since the last inspection the chairs in the lounge area had been rearranged as recommended, which provided staff with access and for the comfort of people. There were two hoists in the lounge area, which the manager told us were regularly used throughout each day. The AQAA stated that they had improved in the last twelve months and that they had replaced the carpet and curtains in the communal areas and private rooms. This was confirmed by the manager at the time of the inspection and people who lived at the home. People who lived at the home who were relaxing in the lounge and conservatory told us that they were comfortable. The service user survey asked if the home was fresh and clean, eleven answered always and four answered usually. Care Homes for Older People Page 23 of 35 Evidence: The AQAA stated the home is maintained appropriately to reduce the risk of infection and cross infection. However, our findings on the day of the inspection showed that attention needed to be given to some areas of hygiene of the home. The floor of a ground floor toilet was noted to be dirty, as was the floor and the toilet in a ground floor bathroom, we pointed this out to the manager who immediately asked a staff member to clean the areas, which was done promptly. It was also noted that a bath in another ground floor bathroom was dirty and in need of cleaning, this was also addressed during the inspection. There was hand wash liquid and disposable paper towels in the majority of the bathrooms, when we pointed out to the manager that two bathrooms did not have paper towels, they were provided immediately. The skirting boards and wood work in the ground floor hallways were chipped and dirty and in need of attention. The AQAA told us that their plans for in improvement in the last twelve months were ongoing refurbishment as and when necessary. The first floor bedrooms were viewed and it was noted that peoples bedrooms reflected their choices and individuality, each held items of peoples personal memorabilia and possessions. The manager showed us six new hospital beds that had been purchased. The AQAA stated that they had improved in the last twelve months we have purchased profiling hospital beds and more pressure relieving equipment in line with service users increased needs and frailty. It was noted that the skirting boards in a vacant bedroom were dirty, we pointed this out to the manager who told us that bedrooms were thoroughly cleaned before people moved in. An occupied bedroom was viewed and the skirting boards and windowsills were dirty and dusty, we showed this to the manager and they agreed that they would ensure that the cleaning would be done more thoroughly to ensure that people were provided with a hygienic place to live in. Shared bedrooms were provided with privacy screens and three that were looked at were dirty, one had splashes of a dark substance on them and the three were stained and dusty on the frames. The manager told us that they would ensure that cross infection was minimised by the regular cleaning of the privacy screens. They told us that they had a weekly cleaning schedule to clean wheelchairs and that they would include the cleaning of the privacy screens in the cleaning schedule. There was an offensive smell in two bedrooms in the home, when this was pointed out to the manager and they asked a staff member to clean the carpets, which they stated was a routine Monday job. However, the smells in one room were not improved when the carpet was cleaned and the smells in one room had reduced. The manager told us that they would take action to ensure that the smells were minimised. The care plan of Care Homes for Older People Page 24 of 35 Evidence: one of the occupants in one of the bedrooms were viewed and it was noted that there was reference to actions that were routinely taken to manage the issues of their continence. The homes training book was viewed and it was noted that staff were provided with training on infection control and health and hygiene. We observed staff undertake good infection control procedures by washing their hands and wearing protective clothing and gloves when supporting people in areas such as medication, personal care and with food. The homes laundry was viewed, which was clean and tidy. The laundry provided sufficient washing and drying machines for the people who lived at the home and hand washing facilities for staff use to minimise the risk of cross infection. Care Homes for Older People Page 25 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. People who use this service can expect to be protected by the homes recruitment procedures. They cannot be assured that staff are provided with an appropriate induction when they start the job and that care staff are appropriately qualified to meet their needs. Evidence: The manager explained how the home was staffed twenty four hours each day to ensure that peoples needs were met. There was the manager, two nurses and seven carers on the day shift, one nurse and four carers in the evening and one nurse and three carers during the night. This was confirmed by the staff rota and observations of the staffing arrangements during the inspection. The manager told us that since last key inspection the nurse cover had been increased from one to two during the morning to ensure that the morning medication administration was completed in a timely manner. The service user survey asked if the staff were available when they needed them, six answered always, eight answered usually and one answered sometimes. People that were spoken with told us that the staff were attentive to their needs and that they answered call bells promptly when they needed assistance, this was confirmed in our observations during the inspection. The staff survey asked if there were enough staff to meet peoples needs, seven answered always and three answered usually. Staff Care Homes for Older People Page 26 of 35 Evidence: that were spoken with told us that there were enough staff on duty to meet peoples needs. A staff member told us that they were provided with enough time to chat with people and support them in their emotional needs, however, this was variable each day dependent on issues in the home. Two people told us that there were communication difficulties with the staff that worked at the home and this is discussed fully in the health and personal care section of this report. The recruitment records of four staff members were viewed and it was noted that the appropriate checks had been undertaken to ensure that people were safeguarded. The checks included POVAfirst (protection of vulnerable adults) checks, CRB (Criminal Records Bureau) checks, an application form that identified their work history, identification and two written references. Staff that were spoken with told us that they did not start working at the home until the appropriate checks were undertaken. Ten staff surveys said that their employer had carried out checks such as CRB and references before they started work. The AQAA stated we undertake a robust recruitment process and carry out various checks on possible employees, for example CRB, references and employment history. The manager told us that the majority of the nursing staff and carers at the home were recruited from India. The carers were qualified nurses in their country of origin and they were undertaking adaptation courses in UK to ensure that they were appropriately qualified. This was confirmed in discussion with three care staff during the inspection. The AQAA stated a high proportion of staff delivering personal care are qualified nurses (who qualified abroad) and some are registered with the NMC and the home has an appropriate qualified workforce with more than 40 of staff delivering personal care holding an NVQ (National Vocational Qualification) qualification or above. The home had not yet met the target of 50 care staff to have achieved a minimum of NVQ level 2 in care as identified in the National Minimum Standards relating to older people. The homes training book was viewed, which identified the dates of training that was provided at the home and the staff members who had attended the training. Four staff personnel records were viewed and they held some of the certificates for the training that they had attended. Training that was provided at the home included medication, safeguarding, manual handling, infection control, wound management, first aid, English language, fire safety and continence. It was noted, during the inspection, that there were some shortfalls in the service that was provided by the staff at the home in areas such as communicating effectively, ensuring that choices were listened to such as with the sugar that they liked in their drinks and with the assistance provided with eating, these are further discussed in the health and personal care and daily life and Care Homes for Older People Page 27 of 35 Evidence: social activities sections of this report. Ten staff surveys said that they were provided with training which was relevant to their role, provided them with enough information 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. Staff that were spoken with told us that they were provided with a good training programme, which enabled them to meet peoples needs. The AQAA stated all staff have induction training and regular updates and that twenty staff had completed the induction training expected by the NMS (National Minimum Standards) (described and recommended by the TOPSS England/Skills for Care). However, staff records that were viewed showed that they were provided with an induction course, which included reading of the homes policies and procedures, care plans, health and safety of the home and the in house processes of how people were supported. There was no evidence that showed that staff were provided with a Skills for Care Common Induction Standards induction within six months of starting working at the home. The manager told us that all staff were provided with an in house induction. The manager agreed that they would discuss the availability of the appropriate induction training for staff with Suffolk training brokerage, however they were not sure that free training was provided to the overseas staff. We explained to the manager that it was the registered persons responsibility to ensure that the staff at the home were appropriately trained and inducted. Staff that were spoken with told us that they had completed an induction course, which they completed when they started working at the home. They could not tell us if the induction incorporated the Common Induction Standards and they explained the in house induction that they had been provided with. Care Homes for Older People Page 28 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. People who use this service can expect for it to be managed in their best interests and to have their health, safety and welfare promoted and protected. Evidence: The homes manager was present during the inspection and it was noted that they were receptive to the inspection process and they provided us with the requested information promptly and in an open manner. They told us that they were previously the homes registered manager and that they had left the home February 2009. They had returned to work at the home as the homes manager the week before the inspection. They had achieved nursing and managerial qualifications and had been successful in their previous registration application with CSCI (Commission for Social Care Inspection). The AQAA stated the manager is well qualified in both management and nursing. She is resuming her duties as manager after returning after a short period of absence. The manager told us that there had been a deputy manager employed at the home Care Homes for Older People Page 29 of 35 Evidence: who would assist them in their duties, this was confirmed in the AQAA which stated that they had improved in the last twelve months by internal promotion of an experienced nurse to deputy manager (September 2009). There was an administrator who worked at the home to assist with the administration duties. The provider undertook monthly Regulation 26 visits to the home and the visit reports were available in the home for inspection. The AQAA stated in compliance with Regulation 26 the registered provider visits the home once a month and a written report is kept in the home. The home undertook various quality assurance activities, which ensured that people were provided with the opportunity to express their views about the service that they were provided with. The AQAA stated we ensure we meet the quality assurance requirements by the following; regular residents meetings, survey of residents satisfaction, customer satisfaction questionnaire, telephone quality assurance survey and one to one discussions with residents and relatives maintaining an open door policy. The minutes of residents meetings were viewed and it was noted that the last one was February 2009, which was when the registered manager left their post, the manager told us that they would commence with the meetings as soon as possible. The recent satisfaction questionnaires were viewed and the manager explained the actions that they would take to ensure that issues that had arisen from the questionnaires were addressed promptly. Peoples spending money was appropriately safeguarded in the home. We observed a relative of a person provide the manager, for safe keeping, with an amount of spending money for the person. The manager showed the relative the records and receipts of the persons spending and the balance of their remaining money. They checked the balance and the new amount of spending money was recorded and stored in a secure place in the office. The AQAA stated safeguards are in place to safeguard the interest of service users who are assisted in the use of their personal money. The fire safety records were viewed and it was noted that people were safeguarded in case of a fire. The fire safety procedure was displayed around the home for the attention of visitors and people who lived in the home. There was a fire risk assessment and the fire safety equipment was regularly checked. Three hoists were looked at and each held a sticker which showed that they had been serviced to ensure that they were safe to use. Care Homes for Older People Page 30 of 35 Evidence: Staff were provided training in areas of health and safety to ensure that people were safeguarded, training included first aid, manual handling, fire safety and infection control. There were shortfalls identified in the management and monitoring of the cleanliness of the home on the day of the inspection. Some of the issues were addressed immediately by the manager and they assured us that they would address the issues that we had identified. This is are further discussed in the environment section of this report. The AQAA stated the home adheres to and keeps records of health and safety requirements. Care Homes for Older People Page 31 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 32 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 26 13 The monitoring of the hygiene in the home must be effective to ensure that all equipment and areas of the home are routinely cleaned and offensive odours managed To minimise the risks of cross infection and provide people with a clean and pleasant environment to live in. 30/10/2009 2 30 18 Newly recruited staff, who 30/11/2009 do not hold appropriate qualifications, must be provided with an appropriate induction course within six months of working at the home, which meets with the Skills for Care Common Induction Standards To ensure that staff are provided with the information that they need to enable them to meet Care Homes for Older People Page 33 of 35 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 peoples needs in areas such as assistance with feeding, choice and effectively communicating with 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 30 It is recommended that a more effective way of recording staff training be considered, which would identify the training individual staff had been provided with and when they require updates. It is recommended that the training and induction provision of staff be reviewed to ensure that staff are provided with the skills that they need to ensure that peoples needs and preferences are effectively met, such as in areas of eating and effective communication with people. 2 30 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. 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