Care Home: Loganberry Lodge

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What the care home does well The residents are happy living at Loganberry Lodge. Comments included `I feel safe and contented here`, `they are very good with your medical care` and ` the staff are terrific and all in all I am very satisfied. The residents spoke highly of the staff team and confirmed that they had choice in their day to day lives. Medication is administered properly and residents health care is looked after proactively. The food provided at the home is good and varied. The manager deals with any concerns or complaints well and keeps good records. The home is clean, safe and well maintained. The staff team at the home is stable, they know the residents well and they have access to a good training programme. The management at the home is sound and backed up by a robust quality assurance system. What has improved since the last inspection? The home has steadily improved since our last visit. The staff team has stabilised and the standard of induction and training has improved. More staff are now trained in the care of people living with dementia. The routines of the day are now more resident led and residents are experiencing more choice regarding the care the receive. The administration of medication has improved along with the management of residents health care and their care management overall. What the care home could do better: Whilst the home has improved, there are still areas for work and the manager is aware of this. Primarily the activities and social care in the home need work. At the moment residents social care needs are not properly assessed and the programme is limited and not person centred. Care staff, despite training, have not taken this role, as part of their work to heart and the team at the home need to look at this. There are minor shortfalls noted in the body of the report and recommendations have been made in respect of care planning and risk assessments and the mealtime experience for residents. Key inspection report Care homes for older people Name: Address: Loganberry Lodge 79-81 New Farm Road Stanway Colchester Essex CO3 0PG     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: Diane Roberts     Date: 3 1 0 3 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Loganberry Lodge 79-81 New Farm Road Stanway Colchester Essex CO3 0PG 01206563791 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.loganberry@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Name of registered manager (if applicable) Ethna Harbrow Type of registration: Number of places registered: care home 108 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 108. The registered person may provide the followting category of service only: Care Home only - Code PC 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 Loganberry Lodge is a new purpose built home on the outskirts of Colchester in Stanway. The home has 108 beds, split into four units and care is provided to older people and older people with dementia. Care Homes for Older People Page 4 of 30 Over 65 0 108 108 0 1 5 0 5 2 0 0 9 Brief description of the care home There are five lounges and two quiet rooms, one of which is used as a relaxation room, with specilaist equipment, for residents with sensory impairments or advanced dementia. All bedrooms are ensuite and some downstairs rooms have french doors leading onto patio areas. Other secure areas of garden are available. The home is near to bus routes and local shops and amenities. There is ample parking at the home. The home has a statement of pupose which outlines arrangements and services offered and a service users guide for residents giving day to day information on the home. The current fees range from £383.00 to £700.00. Additional charges are made foritems such as newspapers, chiropody and hairdressing. Care Homes for Older People Page 5 of 30 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: We visited the home for a day and a half met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. The AQAA contained minimal information and was therefore of limited use in this report. This was discussed with the manager. Over the course of the inspection we spoke to 5 residents, 3 relatives and 3 staff at the home. We also sent out surveys to residents and staff to complete prior to the inspection and their views and comments are reflected in the report. Whilst at the home we also reviewed records, observed practice and undertook a tour of the home. Care Homes for Older People Page 6 of 30 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 7 of 30 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 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs would be properly assessed prior to admission and they would generally have the information that they needed about the home. Evidence: The statement of purpose and service users guide was seen to be available in the main reception area. Since the last inspection, the service users guide has been updated and it has a more pictorial content. However this is minimal and the guide, for people living with dementia, may still be of a limited value. The pictures used need to actually relate to the home itself and the content was also seen to be wordy. The manager agreed that this document could be developed further and consideration would be given to producing two guides. The manager in her AQAA saids that she plans to develop the homes brochure more to incorporate residents views on what it is like to live at Loganberry Lodge. Care Homes for Older People Page 9 of 30 Evidence: The manager primarily undertakes the pre-admission assessments and a comprehensive form is completed. We reviewed two recent assessments and these were found to be completed well and contained sufficient detail to enable the team at the home to decided whether they would be able to meet that persons needs. The assessments contained, wherever possible, person centred information such as preferences regarding care staff providing personal care etc. but unfortunately this key information was not always evident in the subsequent care plans. Residents we spoke to said I have settled here and I am much better than I was. Customer satisfaction surveys are available in reception for visitors to the home to complete if they wish. It was possible to see recent feedback from people who had visited the home to see what it was like. Comments included the advice and information on admission was good, could do with a list of what people would need to bring in with them, I was just given basic information and the information was good. The manager, in her AQAA said that people are invited to visit at their convenience and no appointment is needed and that prospective residents can come for a day to see how they feel about the home. Care Homes for Older People Page 10 of 30 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. Residents care expect to have their care needs met in a proactive way. Evidence: The manager has a care planning system in place. Overall this has improved and developed since our last visit and residents had the care plans and risk assessments that they needed in place. An assessment of residents needs helps staff identify what care plans and risk assessments are needed. The care plans were sufficiently detailed in order to guide staff but in some areas they still did not always show residents preferences or a person centred approach. For those residents in rehabilitation beds the care plans should be more goal orientated to ensure that, if residents are able, they are optomised so that they get the best opportunity to go home. The daily notes should also reflect these care plans to enable an accurate review of the placement. More thought needs to be given to putting care plans in place that cover pain management as this can link to the residents mobility and general abilities and staff need to consider this when working with the residents. For example, one resident was suffering with osteoarthritis and arthritis and was Care Homes for Older People Page 11 of 30 Evidence: taking pain relief but this was not considered or referred to their care plans. More care plans were in place at this visit that covered residents needs in relation to their mental health, showing a more proactive approach to these matters. Night care plans were in place and these tended to contain more person centred information, identifying residents choices, for example if residents wished to be checked at night and how they liked their pillows etc. Residents who commented on the care they received said the staff are good with your dignity if they are helping you, if you need something from the staff, they do it straight away and they dont make me wait, They are very good here with your medical care, I complained of a pain, the GP was called, I saw a physio and now its been sorted and I only just mentioned it to a carer, I did loose some weight with a tummy bug but I am gaining again and having some supplement drinks, I have put on weight since being at the home, I prefer being cared for by female staff and that normally happens , they have looked after me well all the time I have been here and I am very well looked after. Comments from relatives included the care staff need to help and encourage residents to walk more. Residents who commented in our surveys said that they usually or sometimes got the the care and support that they needed. Comments included no regular baths, they look after me very well and everything leaves a lot to be desired. Residents had a range of risk assessments in place and these were up to date and nearly all linked into an appropriate detailed care plan. Nutritional risk assessments are completed and these along with a care plan showed that residents who are at risk are being appropriately monitored and referred on, where required. Some of the nutritional care plans lacked information on residents preferences and for example, what additional foods that the resident liked that could be offered to help them maintain or put on weight. On discussion, Care Team Managers spoken to were very knowledgeable about which residents were nutritionally at risk, they had up to date weights and knew what the current plan of care was. Some files contained information from the dietitian on foods that could be offered and evidence is needed that this advice is being taken into account. The manager confirmed that the chef does cater for residents that require extra food items and gave an example of the chef making smoothie drinks for one resident. Residents had risk assessments in place for the prevention of pressure sores and body maps are completed showing any areas of concern. However, not all those identified as at risk had a care plan in plan outlining what action, if any, the team were taken to reduce the risk. Some residents that are living with dementia can exhibit aggressive behavior and this was evident in the care records reviewed. From observation and the daily notes staff are aware that they need to diffuse the matter but no full risk assessment was seen to be in place and the care Care Homes for Older People Page 12 of 30 Evidence: plan stated staff should be aware how to handle x. Full guidance should be available to staff on the best approach to take. Risk assessments were also in place, for example, for falls, manual handling and the use of bed rails. The local community matron visits the home every week and there is a proactive approach to the health care of residents. Records show that staff actively refer residents to her for review and this has reduced the GP input into the home and increased the frequency of medication reviews. Records show that visiting doctors to the home confirm that they are responsible for keeping the residents medications under review and records show that reviews are done and that residents are not on excessive amounts of medication. Records show that staff referred residents to their doctors and that residents are seen promptly, as good records are maintained. Staff communication records also show a proactive approach to referring to residents doctors and other health care professionals such as opticians, who were visiting on the day of the inspection. Communication with relatives was also evident and proactive. Customer surveys from relatives said I feel that they know my relative and their requirements, Staff spoken to generally knew the residents well and from discussion had looked at the care plans. Customer surveys, completed by people visiting the home also said that the laundry service was generally good but occasionally poor. Comments included things do go missing and are never found, still finding other peoples laundry in my relative wardrobe, shirts are not hung up and its better than it was. The manager says that she has been working with staff since the last inspection to ensure systems improve and with relatives to improve the level of labeling of residents clothes. This work needs to continue. One relative commented that the beds could be changed more often. On checking, we did not see evidence of this and on talking to residents they were happy with the bed linen changes and were clear about changing routines. Staff also confirmed a bed changing rota that was in place. We reviewed the medication administration systems in the home. From observation, the medication rounds are better managed than before and finish in a timely way, allowing the care team managers to have input in other matters. Residents had photographs and helpful medication profiles in place. The administration charts were correctly signed and they tallied with the blister packs checked. The correct coding system was being used for residents, for example, refusing medication and where as and when medication is given. Overall the charts were neat and clear although staff could take more care when writing out hand written prescriptions, added on during the month. Controlled medication was correctly administered and recorded. The manager does have the Care Homes for Older People Page 13 of 30 Evidence: correct storage in place, but staff need to ensure that they lock the external cupboard. The manager has a weekly auditing system in place and records show that this is carried out and is reflected of the standards we found. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience choice in their day to day lives although their experience in relation to social activities and mealtimes may not always meet their needs. Evidence: From talking to residents, staff and reviewing records, the routine of the home is resident led as far as possible. Residents spoken to confirmed that they had choice in their day to day lives and that they could spend their time how they wished. Comments included I choose to stay in my room, thats what I like to do, I get up and go to bed when I want and I like to be up early and I buzz and they come and help me when I am ready and they get me an early breakfast. From observation and walking around the home, staff were seen and heard to give and offer residents choice and the approach was friendly. Residents that we met, who were living with dementia, although unable to give specific feedback, were happy in their demeanor and keen to interact and chat. The home has a new computer for residents to use and the screen savers show photos of residents enjoying days out, doing gardening and the new recent additions to the home, two rabbits, which staff can bring into the home for residents to hold. Notices around the home show that a confectioner with old fashion sweets comes to the Care Homes for Older People Page 15 of 30 Evidence: home, musicians visit and there are church services. The activities programme shows that on the first day of the inspection residents in all lounges were to have arts and crafts and exercise sessions available to them. We did not observe this happening. Whilst we appreciate that the part time activities officer was on a course, the care staff were seen to be available to spend time with residents but interaction was very limited, unstructured and consisted of offering a few residents colouring to do. Interaction and any explanation was seen to be poor and work is needed with the staff team so that they understand that social care is an integral part of their role and not just that of the activities officer. Whilst new bookshelves have been put in the corridors, in the main day rooms, there was a lack of stimulation apart from the television and there were no books, magazines or other items of interest. It was also noted that the activities programme was the same for all units despite the differing levels of need and this requires a review. The set programmer also shows that consultation in the development of the programme must also be limited. The deputy manager set up skittles in an empty lounge upstairs and put on a film and said that residents could wander in. We visited the lounge several times during the morning and it remained empty. A more proactive approach is needed and residents need to be consulted about what equipment they may want out. Social care planning in the home remains weak and still does not contain an assessment of residents social care needs. Staff need to identify what therapeutic social input would be of value to the person to ensure that, as far as possible, they retain independence, skills and that their self worth and confidence is promoted. Staff are more orientated towards providing entertainment, which is also important, rather than also focusing on what a resident may need. For example, care plans were seen to say encourage to join in activities and there was no guidance for staff as to what a resident may enjoy. Some residents had family trees in place, that aim to give staff an insight into the individual and their life and family history. The quality of these were variable with some only giving a good overall picture and some giving limited family information and nothing about the persons career or interests. These should be developed further so that they can feed into the social care plans. Activities records were limited and in some cases not completed and this reflects the lack of activities officer in post in recent past. This needs to improve to show the range of activities that residents are offered/take part in so that they can be properly evaluated etc. Residents who commented said there are not many activities at the moment as there is no activities officer, care staff will do something now and again, they do try and encourage people to do things, I like to do things like make my own bed and staff help me if I want them to, I dont take part in any of the activities, but they do tell me if something is going on, I like to spend time in my room rather than watching people sleep in the lounges, staff do come and chat to me and one residents son Care Homes for Older People Page 16 of 30 Evidence: does some singing sometimes, I would like to have more activities available. The manager, in her AQAA said, under What we could do better, expand on outside trips and provide effective social stimulation. Residents who commented in surveys said that sometimes there were activities they could take part in and comments included more activities in the summer, seaside etc and just to get out of the home sometimes, at least once a month and more regular activities. The new activities officer has developed an excellent monthly newsletter which informs residents of up and coming events and any changes to the home. It is very well set out and includes a word search quiz. Residents should be consulted to see what they think about the size of the font used, as it was noted to be quite small and some may find it difficult to read. The home now has access to a large shared minibus, which should help with trips outside the home. Comments in customer satisfaction surveys said promising new chap now doing activities, not many outings are evident, the rabbits are good, day to day group stimulation is lacking and I visit daily and have never seen an activities officer. Mealtimes, both breakfast and lunch was observed in all four dining rooms. At breakfast, residents were seen to have choice with a range of options being provided and some residents were enjoying a cooked breakfast. At lunchtime, the overall experience looked much better and organised than the last time we visited. The food looked and smelt appitising. However there are still areas for work and increased monitoring at mealtimes may be of value. For example, no condiments were available in some dining rooms and where residents living with dementia are eating, staff could do more to promote independence. Some residents were noted to be eating their main meal out of a desert bowl, possibly reducing the amount eaten and the use of these needs to be reviewed. Despite the chef making pureed items of food, staff were again mixing this up together, therefore not giving residents the opportunity to experience different tastes and textures. The atmosphere in some dining rooms was better than others, for example in the morning, some dining rooms had breakfast radio on and other did not and the room was in silence. Residents could be consulted to see what they would like to do. Residents had access to fruit and although fruit bowls are available for the dining rooms, not all staff used this and just put the fruit on the table in the middle. Residents had access to jugs of juice etc. in their rooms and the night staff give this out. Residents had different drinks showing that they had been given a choice. Staff and residents confirmed that on occasions residents had access to items such as crisps and popcorn, if watching films etc and that often staff went out with residents to buy Care Homes for Older People Page 17 of 30 Evidence: these items. Wine and beer etc. are available for when the home has entertainers in or at other events. Customer satisfaction surveys, completed by people visiting the home said that overall the food was either very good or good and comments included they are adaptable to different clients needs, there is always a good selection to choose from and my relative says that the food is good. A detailed residents catering survey was completed in March 2010, where residents outlined their likes and dislikes and gave comments on the meals service. The chef discusses the results with the residents and if required changes to the menu are made. Comments from the residents included They do well with the food, The chef is good because he can cater for individual needs, the meals are very good, compliments to the chef and teatime is always the same. Residents we spoke to said the food and mealtimes are acceptable. If I dont like it, I tell the chef and he comes and asks me if I want something else, the cottage pie is good and the fish and chips are lovely, The chef is very good and helpful, on odd occasions the crockery and cutlery are short but its not a persistent thing, sometimes the food served to you in your room is cold and we are always served last, the food is often sloppy or old people !, loads of mash, they have wine at parties but not enough beer and last weekend it was my birthday and the chef came in to see me and asked me what I would like to eat all day, that was good, the agency chefs that sometimes cover are not as good at cooking. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their concerns and complaints listened to and acted upon. Evidence: The manager has a complaints procedure in place. She records the details of all complaints or concerns however minor and these were available for inspection. The records gave good accounts of any investigations made and subsequent actions taken, including letters to relatives. Overall the management of complaints at the home is good, the manager is proactive when dealing with any concerns and matters are accounted for. Recent complaints have related to the lack of activities, care management and staffing at the home. The manager in her AQAA said that she complete regular floor walks to engage with residents so that they can voice any concerns. Customer satisfaction surveys showed that people felt that overall, complaints management at the home was good and occasionally fair. Comments included If I have had any problem, they have always been resolved and they are reactive rather than proactive. Residents we spoke to said I would be quite comfortable in raising any concerns, but we dont have a lot of complaints overall, I feel safe and contented here, nothing to complain about, I get on well with the manager, I can talk to her and she will listen and sort out any concerns, I would be happy to raise any concerns and the manager often stops and asks if you are OK and I would be confident that Care Homes for Older People Page 19 of 30 Evidence: she would deal with anything that was troubling you. In our surveys, residents said that they all knew how to raise a complaint. The manager also keeps records of any compliments received and these included thank you for the patience and care you gave my relative, Thanks for arranging my relatives birthday celebrations and buffet, compliments to the chef, we were very impressed, thank you for all the hard work, my relative was looked after so well, my relative was happy and felt that everyone was kind, outstanding Christmas Party, good buffet, the premises is immaculate, spaciously generous and cleaned daily, we found that nothing was not too much trouble for your team and the food is of a good quality, fresh and well cooked, generous portions and cooked breakfasts. The manager has local adult safeguarding advice and polices available. Following recent potential adult protection matters at the home regarding one member of staff, advice was sort from a human resources adviser and local guidance was not followed. This should be reviewed and primary consideration should be given to the protection of the residents in the home. The matter was notified to us but not to the local safeguarding authority as we would have expected. Other than this matter the manager and team at the home are very proactive when dealing with adult safeguarding matters and referring them forward for consideration. From the staff training records at the home, nearly all the staff have up to date adult protection training in place, which is good. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is safe, clean and well maintained. Evidence: We toured the home, visiting all the communal areas, satellite kitchens, bathrooms and bedrooms. Since we last visited, there are now full bookshelves in both the upstairs and downstairs corridors and a new snooker table, which is positive. In the morning the satellite kitchens were seen to be clean and reasonably tidy considering they were in full use. Overall the home was very clean and we did not notice any unacceptable odours. Two of the lounges are very large and primarily contain chairs, footstools and some small side tables. Consideration should be given to providing other furniture and items to make these more homely. The manager in her AQAA identifies that we could work on making the units more homely and user friendly for residents living with dementia. Signage around the home, especially on the floor for people living with dementia has not developed. The manager told us that residents on the ground floor have chosen not to have specialist signage on their bedrooms doors and on the floor for people living with dementia some relatives have helped but this has been limited. This should be reviewed so that residents living with dementia or any form of confusion or memory loss are aided to maintain their independence by been able to find their own bedroom. Residents were seen to have personalised their bedrooms including bringing in double Care Homes for Older People Page 21 of 30 Evidence: beds to sleep in and other items of furniture. The size of the bedrooms helps to facilitate this. Residents we spoke to said the cleaning is good including the en-suite, its done daily and my room is hoovered at least 2-3 times a week and the accommodation here is very good. Residents who commented in the surveys said that the maintenance man in the home was very good and extremely helpful with anything they wanted done. One resident told us he is wonderful and helped me bring some of my garden things from home so I could have them outside my garden door. Customer satisfaction surveys completed by visitors to the home included responses that people felt the garden and outdoor areas were either good or very good and that the environment in general was either good or very good. One comment included some of the chairs are stained and need to be cleaned. On the day of the inspection we did not note that this was a widespread issue. Overall people felt that the cleanliness was either good or very good. Others asked for en-suite toilets to be checked for cleanliness more often. Records in relation to fire safety were reviewed and found to be in good order with fire drills taking place and a fire safety risk assessment in place. Care Homes for Older People Page 22 of 30 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. Residents benefit from a stable and generally very well trained staff team. Evidence: The staff team has stabilised since our last visit to the home and turnover has reduced as has the use of agency staff. There has been some agency use at the home but this is minimal and is being used to cover annual leave and some staff sickness. Staff had accrued leave previously when the home was experiencing staffing shortages. Staff vacancies are low. Staff meeting minutes show that the manager is trying to address the staff sickness levels at the home which, on occasions, may let the teams down, leaving them short of staff at the last minute. The manager provides one Care Team Manager and three care assistants for each unit. On the downstairs unit the dependency levels of residents is lower and after breakfast one carer goes upstairs as a floater between the two units. The rotas seen reflected these levels. The manager and the provider assure us that the staffing levels at the home are kept under review and relate to the dependency of the residents. Recent resident dependency statistics were available for review. In addition to this the deputy manager is on duty in a supernumerary capacity at least 2 days a week. The layout of the home is large and staff are not always visible. Concerns have been raised with the home and CQC regarding staffing at the home. We expect the team at the home to keep the levels regularly under review. Care Homes for Older People Page 23 of 30 Evidence: Residents and relatives who commented in our surveys said make sure the bells are answered straight away and not have to wait for up to half an hour, not enough staff on duty, when one is sick no one to replace them and the home is often short staffed. We arrived at the home quite early and residents were finishing breakfast, reading papers and the medication rounds were just being completed by senior staff. The atmosphere was was calm and staff were available to the residents. Residents we spoke to said the staff are fine, they really are, we have a laugh and a joke, I get on with the night and the day staff really well, they come quickly if you buzz for them, overall the staff are terrific, the staff team are pretty good at the moment, days and nights, the staff are all friendly, we have a laugh, Customer satisfaction surveys, completed by people visiting the home said that the staff at the home were good or very good and comments included, they are friendly, the majority are very caring, most of the staff are very pleasant and polite, on the whole staff are very professional in their attitude and nothing is too much trouble. One person felt that the units for people living with dementia required more supervision and an increase in staffing numbers as there is a lot of demand for individual attention. At the current time 36 out of the 58 care staff team have achieved an NVQ qualification and records show that other staff are also undertaken these courses. This has improved since our last visit to the home and takes them well over the desired 50 level. We reviewed staff files to check the robustness of the recruitment procedures at the home. Overall the files were in good order with all the required checks and documentation in place. There was also evidence that staff are being properly inducted to the home and going on to do the Common Induction Standards under Skills for Care. This has improved since our last inspection. From staff files and training records, the staff training programme at the home continues to progress well. Compliance levels are very good in relation to mandatory training such and safe manual handling, fire safety, first aid etc and in addition to this the number of staff undertaking training in the care of people living with dementia has increased. Staff are also undertaking more in depth training on caring for people living with dementia, which is very positive. The provider has invested in training for staff on activity based cared and a review is needed to see how the staff could put this into practice for the residents in the home. Consideration should be given to providing key staff in the home with training on conditions associated with old age as appropriate to the resident group in the home, for example, Parkinsons disease, diabetes etc. Care Homes for Older People Page 24 of 30 Evidence: Records also show that the ancillary teams, such as domestic staff and kitchen staff, supporting the home are as equally well trained. Staff spoken to said that the training here is fantastic, I am really pleased with the training we receive and we are reminded of any training we need to do and there are lots of opportunities for non-mandatory training as well. Care Homes for Older People Page 25 of 30 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. Residents benefit from a home that is well run and has their interests at heart. Evidence: The manager is in the process of applying for registration with CQC. The manager has previously run a large residential home and has been registered with the CQC. She has been in managerial posts for over 7 years. The manager has City and Guilds qualification and an NVQ level 4 in Management The manager has a very hands on approach and helps out if the staff team are busy and to ensure that she keeps aware of how the home is running for the residents and the staff. This is a positive approach in such a large home. Residents who commented on the manager and the home in general said she is very easy to get on with, the manager pops in and chats , she might make the bed and tidy up, she helps out if the staff are short, shes a sound person, the home has definitely improved since she has been in post, all in all I am very satisfied with the home and I am perfectly happy here. Customer satisfaction surveys included Care Homes for Older People Page 26 of 30 Evidence: comments such as I would have no worries recommending this home to others, Overall the conditions at the home have improved, Its much better now there are permanent staff, Its been a lot better lately and I have recommended it to several people and My relative is happy here and its a lovely place. The manager holds residents meetings and the minutes show that residents are consulted and informed about any changes within the home. She also meets regularly with the care team managers and the care staff and minutes show that a wide range of subjects are discussed and she is clear about the standards that she expects in the home for the residents. The manager undertakes a monthly audit at the home and actions any items raised. The company completes a yearly audit, which includes seeking feedback from residents and relatives and an action plan is also developed, where required. In addition to this the manager completes audits of accidents in the home and other key areas, such as pressure sores, weight loss etc and these are monitored by the companies quality monitoring team. A health and safety audit checklist is also completed on a regular basis and any items are actioned. The manager has a supervision records in place and this shows that the majority of staff are receiving regular supervision. This is also reflected in the individual records found in staff files and from discussion with the staff themselves. We reviewed the accident records for the home and staff complete these well. The manager has been analysis accidents, mainly falls, at the home to see if there are any patterns and she has also reviewed any falls prevention strategies that they have in place. Statistics are also fed through to the providers head office on falls etc. for review and to the local falls prevention team. There are no areas for concern at the current time. Records show that they are also monitoring the incidence of skin tears at the home and overall the current figure is low with most incidents being accounted for. This type of monitoring and review is good practice and should continue. One member of staff is currently undertaking a course so that they can become the falls prevention champion for the home. Care records showed evidence of the falls prevention team visiting residents at the home following referrals and one resident confirmed to us that they had seen someone from the falls prevention team. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16 Following further 31/01/2009 consultation, develop the activities programme to meet the diverse needs of a range of residents living in the home. To ensure that residents social care needs are met as far as possible. Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 7 8 Continue to work on developing user friendly information for resident groups in the home. Continue to develop a person centred approach to care planning. Ensure risk assessments are in place for those residents with challenging behavior, so that staff have the guidance that they need. The management/senior team need to keep the mealtime service for residents under review to ensure that standards are met and maintained and that the mealtime experience for residents continues to improve. More work should be done on developing a more stimulating and homely atmosphere on the units. Keep the staffing levels at the home under regular review. Give consideration to providing more training to staff on conditions associated with old age. 4 15 5 6 7 19 27 30 Care Homes for Older People Page 29 of 30 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. 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