Care Home: Melford Court Nursing Home

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What the care home does well Potential residents are having their needs assessed, are being given information on the home and invited to visit, or stay for a short period of time to `test drive` the service(respite care). This supports people in identifying if the home will be able to provide what they are looking for. Residents, relatives, along with Health and Social care professionals who visit the home regularly, describe (through either survey feedback, on in person during the inspection) the management and staff as being "approachable", `friendly and very helpful`, staff carry out `any instructions efficiently` and "very kind". Residents we met during the inspection spoke positively on the home cooked meals provided. Comments included "all very good", "bring me regular meals anything I want", "standard generally very good", and "choice of three meals - excellent". The home is being well-maintained, providing a clean, safe environment, situated within the local community and amenities. A range of activities and `themed` days are organised which residents can join in with if they wish to. Staff are receiving training and support to ensure that they have the skills and knowledge to undertake their role. What has improved since the last inspection? The management has addressed the two requirements we made following the last inspection, by ensuring medication stored in the fridges is being maintained at the correct temperature, and mobile medication trolleys are being locked, when out of view of staff. The AQAA provides information on different aspects of the service they have improved in during the last twelve months. This includes producing a new brochure which includes pictures and information on their new dementia care unit and purchasing specialist fire safety equipment, which supports staff to be able to evacuate residents during a fire. What the care home could do better: Although the home tells us in their AQAA that they `audit medications` monthly, and staff also record any shortfalls they find, our inspection identified that this is not sufficient. This is because during our inspection of medication paperwork, we identified that a resident on one day, had not been given their tea-time medication, and no action had been taken by the on-coming nurse to investigate, and see what action they could take. We also identified that staff are not always completing the medication records to confirm that medication has been given. Systems need to be in place to ensure medications are being checked prior to the nurse going off duty, to ensure appropriate action can be taken if any medications have been missed, or records not completed. Resident`s personal (care) plans show that people`s nursing and physical care needs are being monitored, however to make them more `person centred` further work needs to be undertaken. This is because currently there is very little information on what brings well-being to a person`s day, and information on how staff are meeting this need. Survey feedback, both ours and the home`s, and discussions with people living and working in the home, identifies that the current staffing levels are not always ensuring call-bells are always being answered and acted upon when rung, and people do not feel that their care is being rushed. The home needs to review their staffing levels, looking at assessed needs, to ensure they can staff the home in a flexible way, based on resident`s current dependency needs, not just occupancy levels. Key inspection report Care homes for older people Name: Address: Melford Court Nursing Home Hall Street Long Melford Sudbury Suffolk CO10 9JA     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: Jill Clarke     Date: 2 6 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 34 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 34 Information about the care home Name of care home: Address: Melford Court Nursing Home Hall Street Long Melford Sudbury Suffolk CO10 9JA 01787880545 01787881845 WHITNEYS@BUPA.com www.bupa.com BUPA Care Homes (BNH) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan H Whitney Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home is registered to provide care for two (2) service users with physical disability (PD) aged from 45-64 Date of last inspection Brief description of the care home Melford Court is situated in the town of Long Melford and is registered to provide care with Nursing for up to 52 people Older People, 8 of whom have a primary diagnosis of dementia. The home can also within thier 52 places, provide care for 2 people with a Physical Disability. At the current time they would not be able to accommodate 52 residents, unless they change the use of one of their lounges and dining rooms, back into bedrooms, ensuring they meet required standards. Care Homes for Older People Page 4 of 34 0 0 2 Over 65 8 44 0 Brief description of the care home The frontage of the Grade II listed building forms part of the main street giving residents easy access to the local shops, library, church, restaurants and public houses. There is limited parking to both the front and side of the home. The enclosed courtyard and garden run along the side and back of the home. Melford Court was purchased by BUPA from the Community Hospitals Limited in 1997, and has undergone extensive refurbishment. The accommodation is situated on two floors and consists of 43 en-suite bedrooms, 37 of which are singles and 6 doubles. Although the home has double rooms the AQAA informs us these are used as extra large single rooms, which enables residents if they wish, to bring in more of their own furniture and belongings. However, they could easily be altered to provide a shared room, if people require this. The home now offers a dedicated dementia care unit for up to eight residents, which has its own lounge and dining room, and access to secure gardens. The home provides assisted bath and shower facilities, extra communal toilets, a dining room, three lounge/activity rooms and a hairdressing room. Access to the first floor is via stairs or passenger lift. The fees for the home for private paying clients ranges from £840.00 to £1,100 per week, depending on the size of room, and level of nursing care required. These fees do not cover the cost of hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 34 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 (The Commission) visited the home unannounced, to carry out a key inspection over one and a half days. During the inspection we focused on assessing the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us gain an idea, from a residents view point, of what it is like living at the home, and gain feedback on the level of care they receive. The report has been written using accumulated evidence gathered since their last key Inspection (17th July 2007), and during this inspection. Earlier in the year we sent surveys to the home to give out. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they thought the home is run. At the time of writing this report we had received completed surveys back from five residents, two Health Care Professionals (Physiotherapist and Nutrition Nurse Specialist), and one Social Care Professional (Social Worker). Comments from which have been included in this report. Care Homes for Older People Page 6 of 34 We also looked at the homes Annual Quality Assurance Assessment (AQAA) sent to us in June 2009. This provides the Care Quality Commission with information on how the home is meeting or exceeding the National Minimum Standards, and any planned work for the next twelve months. Comments from which have also been included in this report. The Registered Manager was available during the inspection, to answer any questions and provide records to support work undertaken at the home. During our visit, we spent time talking to five residents in the privacy of their bedrooms, and a visiting relative, to gain their views on the home. We also spent time with members of the care, nursing, catering, housekeeping, laundry and maintenance staff. This supports us in identifying how well the home is being managed, and if staff are being supported, and receiving the training to be able to fulfill their role. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, minutes of meetings, Resident Customer Satisfaction Survey 2009, Statement of Purpose, Service Users Guide and medication records. This further evidenced the on going work being undertaken at the home. People living at Melford Court Nursing Home prefer to be described as residents; therefore this report reflects their wishes. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Although the home tells us in their AQAA that they audit medications monthly, and staff also record any shortfalls they find, our inspection identified that this is not sufficient. This is because during our inspection of medication paperwork, we identified that a resident on one day, had not been given their tea-time medication, and no action had been taken by the on-coming nurse to investigate, and see what action they could take. We also identified that staff are not always completing the medication records to confirm that medication has been given. Systems need to be in place to ensure medications are being checked prior to the nurse going off duty, to ensure appropriate action can be taken if any medications have been missed, or records not completed. Residents personal (care) plans show that peoples nursing and physical care needs Care Homes for Older People Page 8 of 34 are being monitored, however to make them more person centred further work needs to be undertaken. This is because currently there is very little information on what brings well-being to a persons day, and information on how staff are meeting this need. Survey feedback, both ours and the homes, and discussions with people living and working in the home, identifies that the current staffing levels are not always ensuring call-bells are always being answered and acted upon when rung, and people do not feel that their care is being rushed. The home needs to review their staffing levels, looking at assessed needs, to ensure they can staff the home in a flexible way, based on residents current dependency needs, not just occupancy levels. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. Prospective residents are given a good level of information to support them in identifying if the home will be able to offer the level of service and environment they are looking for. Evidence: The AQAA informs us that Bupa undertake regular mystery shops to ensure the home is providing the correct information to enquirers. During the inspection we were given a copy of the homes new Service Users Guide, which comes as part of an information pack, which includes photographs taken around the home and grounds. The pack provides a good level of information on what the home is able to offer, including a sample menu to give people an idea of the meals being provided. There is also information on chiropodist, hairdressing and BT line rental and call costs, which are not included in the fees. We were also given a copy of the homes latest (July 2009) Statement of Purpose Care Homes for Older People Page 11 of 34 Evidence: which again is informative. We noted where the Statement of Purpose, and Service Users Guide makes reference to having a total of forty-five bedrooms, which comply with the National Minimum Standards. Due to two bedrooms currently being out of commission, as they have been converted into a lounge and a dining room for people living in the dementia unit, this section now needs to be updated. Residents completing our survey, in response to being asked if they are being given enough information on the home to help them to decide before they moved in, if it will suit their needs, three people answered yes, one no and one resident said that they didnt know. The homes Terms and Conditions of Residence sets out conditions of staying at Melford Court, and both the homes and the persons obligations. The Service Users Guide informs a potential resident that the homes criteria for admission, which includes a member of the senior nursing staff, visiting them to undertake a pre-admission assessment. The two residents whose care we tracked (see next section of this report) care plan folders held completed pre-admission assessments, undertaken before they moved in. Whilst a prospective resident is having their pre-assessment carried out, it also gives them a chance to ask staff any questions they, or their family may have, and also enables staff to discover whether Melford Court will be able to meet their particular needs, or not. Health and Social care professionals completing our survey, in response to be asked Do the care services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people, One person replied always,and two people answered usually. People thinking of moving into the home are, where at all possible, encouraged to view the Home for themselves and are welcome to stay for a meal or the day, if they would like to. People are also able to test drive the home, and form their own view on the level of service being provided, and if it meets their individual preferences, by attending Day Care or Respite (short break) care. A new permanent resident we spoke with, had used the homes respite service, which they said had supported them in choosing the home, when the time came for needing permanent care. Bupa as an organisation also encourages prospective residents to visit other homes in the area. To support them doing this they have produced Choosing a care home check list. The check list helps people compare up to three different homes and gives suggestions on what to look for and ask about. When the home asked in their own survey, how do you rate how well do staff know you and your needs, out of the seventeen people answering 6 rated it as excellent, 88 as good and 6 rated it as neither being good or poor Care Homes for Older People Page 12 of 34 Evidence: When we asked a resident if they would recommend the home to others, they replied would if they can afford it telling us they felt very well looked after - mind, body and soul. People we spoke with felt that the staff, and home were able to meet their physical and nursing needs. This reflected our survey feedback from people living at the home, who replied either always or usually when we asked if they felt they are getting the care and support they need. The manager confirmed that they do not currently provide intermediate care, therefore we did not assess this key standard. Care Homes for Older People Page 13 of 34 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 can expect to have a plan of care, which sets out how staff are monitoring their physical health and nursing needs, which is being kept updated to reflect residents changing needs. Evidence: During our visit we spent time tracking two residents care, which involved looking at their personal plan, and meeting the people to hear (where able to) their views on their care. We also spent time talking with staff to identify their knowledge of the two residents physical, emotional and social needs. The AQAA informs us that all residents have comprehensive personal (care) plans produced with the help of the QUEST assessment tool, which are reviewed monthly and updated as necessary. well cared for and content. When the home asked in their own survey, how do you rate respectfulness of the staff towards you, out of the seventeen people answering, 35 rated it as excellent, 59 percent good, and 6 rated it as neither being good or poor. When we asked Health and Social care professionals who have regular contact with the home in our survey, if they feel the care service respects peoples Care Homes for Older People Page 14 of 34 Evidence: privacy and dignity, two people The personal plans we looked at, gave a good level of information about the residents medical and nursing needs, and how staff are ensuring they are being met, and monitored. There was also information to show when external health professionals had been contacted, to support peoples individual health needs. However, we did find that they way the information is being written focused more on what the person could not do, rather than what they could do. The daily life sheets written by staff, are often more a check list of tasks they had undertaken for example: assisted (persons name) with washing and dressing, pad changed, transferred (resident) into their wheelchair and bed made, no problem, hair brushed. More could have been written on how residents well-being was being met, and what had been undertaken to give quality to the persons day. The Health and Social Care Professionals completing our survey, when asked are individuals social and health care needs properly monitored, reviewed and met by the care service, One person answered always, and two usually. They also gave the same responses when asked does the care service seek advice and act on it to meet individuals social and health care needs and improve their well-being. Their comments included general care of patients is of a good standard and I call in on my way home, so my visits are un-announced and patients always appear replied always, and one usually. When we asked if the care service support individuals to administer their own medication, or manage it correctly where this is not possible, one person answered always and two usually. During the inspection we asked a resident, whose care we were tracking if they always received their medication on time, and they answered yes - always get it on time they also confirmed that staff had never run out of their medication. However discussion with a relative, who we asked the same question, identified that the home had run out of a pain killer (paracetamol). We looked at the MAR which confirmed that the home had run out of stock on two days, and was not given. We asked staff if the home kept paracetamol as part of their homely remedies, which the resident could have been given, until theirs arrived. We were told, they no longer did. However, further discussion with the Manager identified that they did, and the medication could have been given. The manager said they would confirm that staff are aware, of the medications that can be given out as homely remedies (set list of over the counter medications that can be given as per the homes policy). Although the home has auditing systems in place to ensure that nursing staff are completing the residents Medication Administration Records (MAR) charts, to confirm people have been given their prescribed medication, or if not the reason has been written down, we still found shortfalls. As we looked at the MAR chart we asked either Care Homes for Older People Page 15 of 34 Evidence: the nurse or manager to check our findings, which also enable them to give any explanations. On looking at the MAR we found five incidents where the monthly chart showed staff had not completed to say medication had been given. A check of the monitored dosage blister packs the medication is supplied in, identified that it was missing, indicating it had been given. However, we also identified that two lots of medication which had not been signed, or given. The manager showed us the record sheets nurses complete if they find a problem, and discussed ways that they would look to tighten up to monitor staff are following their policies and procedures. We then checked the system the home has in place for storing, giving out and disposing of controlled drugs, which showed that staff are following safe procedures. We then did a sample check of two peoples controlled medication against the drugs registry, which showed that the home had the right amount left, and residents are receiving their medication as prescribed. Since we last inspected, the home has purchased new fridges to store drugs in, as concerns were raised in our last report that the fridge, storing medication was not always being kept within the correct temperature range. Checks are also being undertaken to ensure that the fridge and room temperature are within the required ranges to store medication, and stop it deteriorating. Good practice was also seen with eye drops which have a limited shelf life once opened are being dated, so staff know when to stop using them. We also observed staff following safe practice by locking up the medication trolley if left unattended. One resident commented in their survey that I am a diabetic have insulin injections sometimes staff forget these. Further information supplied identified that the person would remind staff (see staffing section of this report). We looked at two residents care records, to check that nursing staff are monitoring blood sugars and giving insulin, we found the use of different recording sheets confusing, and had led to some staff writing in different areas, so the information was not always consistent. We showed the manager, who gave reassurances that they would look into it, and ensure staff are recording it the same way. Feedback given in the care plan, especially their physical states, showed no recording of ill health to indicate that insulin had not been given, therefore identifying inconsistency in the staffs record keeping. We also asked a resident if they were receiving their medication which included insulin and they confirmed they were. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to choose from a range of nutritious cooked meals, which meets their individual likes, dislikes and nutritional needs. Residents visitors are made to feel welcome, and invited to join in with the many themed social events held at the home. Evidence: When the home asked in their own survey, how do you rate the social and recreational activities and events at the care home overall (taking into account the choice and number of activities and events), out of the seventeen people answering 8 rated it as excellent, 75 good and 17 rated it poor. In our own survey when we asked does the home arrange activities that you can take part in if you want, two residents replied always, one usually and two sometimes. Whilst talking with a resident in their bedroom, they said they were happy to answer any questions, but could be whisked away at any time as they were waiting to be taken to the armchair movement to music exercise session, which they like to take part in. Before long, there was a knock on the door, and the activities organiser arrived to take the resident upstairs to take part. Care Homes for Older People Page 17 of 34 Evidence: Residents personal plans we looked at held a completed map of Life, which the Service Users Guide informs us so we can really get to know each resident and meet their emotional and social as well as physical needs. Time spent talking to a resident who spent a lot of their time in their bedroom, identified that there are no activities going on at the moment that interest me. They told us they would like the opportunity to go out and visit the local community more. Further discussions, identified that although staff come in and talk to them, it is normally to undertake a task, and would like staff to have the time just to come and have a chat, but felt staff were too busy. We looked at their map of Life, the front of which had been completed, but not the back of the form which sets out the residents preferences on what activities and outings they would like to join in with. When we looked at their social interaction page staff had written two comments about their physical and medical health, followed by enjoys watching films on TV. We looked at another map of Life, which had been completed for one of the residents whose care we were tracking who has dementia. The basic information given in their map of Life, was well supplemented by the families write up, which gave a good pen picture of the residents life, which included useful information on hobbies and interests. This included playing the piano, playing bowls and doing keep fit. However, having been provided with the information, we could see no evidence on how it was being used to provide stimulation and well-being into the residents day. The residents personal plan, under communication and lifestyle, staff had written to encourage (residents name) to participate in activities she enjoys, and to interact with others. We looked at their individual activities sheet, where the Activity organiser records what group, or one to social interaction the resident has had, and found one session of one to one in February and three for March, which included sessions looking at photographs and having a hand massage. We then looked at the daily write up sheet, which as we mentioned in the last section of this report was more reflective of which care tasks staff had undertaken, than what the state of their persons emotional well-being. We fed back to the manager, that although the home is arranging daily activities for people to join in with such as Bingo, cards, and art sessions, along with themed days such as the Burns day and Supper in January, and Cockney supper. However they still need to look on an individual basis, how much social stimulus people are having. They felt with the introduction of Bupas Dementia Champions, will support staff in developing their knowledge of person centered care. At the current time the home has not been given dates when the nominated staff will receive the training, however information contained in The February 2010 Bupa Care Homes newsletter, shows the companys commitment to ensure the training programme is rolled out to all their Care Homes for Older People Page 18 of 34 Evidence: homes providing dementia care. This is to ensure that staff provide truly personcentred care, and recognises the importance of every interaction with residents. People confirmed that their visitors are always made to feel welcome, and can receive visitors when they wish. In the sitting areas located around the home, we found information on past and future social events which residents families and friends are invited to join in with. To further update people on what is happening at the home, there is the Melford Court Newsletter. We were given a copy of their Autumn Edition, which describes Melford courts recent themed cruise activity, where they cruised around several countries including America, South Africa, India, Ireland and finally docking home in Southampton. They went on to thank the catering staff who provided menus from places they visited, saying that the cruise suppers were throughly enjoyed by all those that took part. The newsletter also gives information on the residents day trip to Felixstowe, and the summer fete which raised £550 for the Friends of Melford Court, which we are informed is a charity that raises money for the residents amenities fund. There was information on other community based projects, for MacMillan Cancer Nurses and Breast Cancer awareness, where staff had residents joined in with fund raising activities. This included a coffee afternoon, and staff and residents wearing pink wigs and clothes, and attending a pink themed supper with a raffle being drawn at the end of the evening. One relative said they would like to see the home put in facilities so relatives could make a drink for their next of kin when they visited, as they would if they visited in them in their own home. When the home asked in their own survey, how do you rate the food overall (taking into account, taste, variety, personal preferences catered for), out of the seventeen people answering 6 rated it as excellent, 88 good and 6 rated it as neither being good or poor. In our own survey when we asked people do you like the meals at the home, four people had answered with always or usually, and one person told us sometimes. One resident commented that they felt the home does breakfast well. They felt the home could improve their bacon sandwichs, as bacon cold and hard to cut. Another resident commented that they felt the supper choices are good, but for their individual preferences and needs, felt that more choice could be given when they have a trolley Tea. Feedback from residents we spoke with during the inspection was very positive over the quality and standard of meals being served. Comments included all very good bring me regular meals anything I want , standard generally very good, choice of three meals - excellent. residents we visited had access to cold drinks, and we observed hot drinks being served throughout the day. Care Homes for Older People Page 19 of 34 Evidence: We observed the end of lunchtime in the dementia units dining room, which was relaxed, with staff sitting next to residents requiring assistance. The first day of our inspection the lunch time menu was mushroom soup, followed by either breaded plaice and chips, or sausage and mash, served with mushy peas and tinned tomatoes, and for dessert apple crumble and custard. For supper chicken soup, cheese omelet or beef sandwichs, and raspberry cheesecake. The useful information file informs visitors that they are able to purchase a meal for £4.00, and gives information on meal times and when hot drinks are served throughout the day. the Information file also informs residents that there is a varied menu to choose from if, however you would prefer something different then the menu choices, we will happily find alternatives, we want you to enjoy your meals, and well do our best to provide you with what you like. Care Homes for Older People Page 20 of 34 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 can expect to have their concerns listened to, and appropriate action taken by staff to safeguard their well-being. Evidence: Survey feedback we received in 2009 from ten people living at the home, confirmed that they all knew who to talk to informally if they are not happy with the service being provided. However, when we asked if they knew how to make a formal complaint five people replied no. When we asked the same questions in this years survey, all five residents said they knew who to talk to informally, with only one person saying they did not know how to make a formally complaint. Discussions with residents and visitors we met during the inspection confirmed that they knew how to make a formal complaint if they needed to. When we asked Health and Social Care professionals surveyed, if the home responded appropriately if you, a person using the service, or another person have raised any concerns, two replied always and one said it was not applicable. Copies of the homes complaint procedure, as well as being displayed around the home, is included in the Service Users Guide information pack. The complaints policy informs the reader that At Bupa Care Homes we take every opportunity to improve the service that we provide and we encourage all those involved with our homes to share their suggestions and complaints with us. There is also information on who people can complain to, and when they should receive a response by. Care Homes for Older People Page 21 of 34 Evidence: The AQAA informs us at the time of completing (1st June 2009) they had received three formal complaints, two of which were upheld. Two safeguarding referrals were also made, which were both investigated by the social care vulnerable adult team. The home kept us updated on the outcomes of the two referrals, and where applicable, what actions were taken to address any concerns. Discussions with a relative confirmed that they were aware of the formal complaints procedure, however, they have not needed to use it, as any concerns they have raised with the manager has been looked into and dealt with. A relative surveyed also confirmed that they are aware of the homes complaints policy. Discussions with a new member of staff identified that as part of their induction they have received safeguarding training, which they felt had increased their knowledge of the different types of abuse which can occur, how to spot it, and what action they need to take. When we asked what action they would take they replied ensure the resident was safe and report it. The Manager confirmed that both they and another senior member of staff have completed the Safeguarding of Vulnerable Adults train the trainers courses, which gives them the skills and knowledge to train their staff group. Training records showed which staff had completed the safeguarding training, and if not, the manager gave us the reason why they had not done it (for example not currently covering shifts at the home). Whilst looking at some recruitment paperwork, we noted a comment about a potential member of staff trying a couple of hours shadowing. We raised concerns that they were inviting a person into the residents home, prior to them being in receipt of any checks to validate their identity, or previous employment. The manager confirmed that it was purely to spend time observing the role (only in communal areas) and giving a person, unsure if to pursue a career in care to discuss the role with staff. This led to discussions about the positive side of the person being able to talk to residents and staff (both of whom can also give their feedback and views on the applicants. However they need to ensure the potential applicant is not left unsupervised at any time. The manager confirmed that the situation which rarely happens, however they would ensure the timing of the visits, meant that the applicant would have a member of staff with the whole time. The AQAA completed in June 2009, under what the home could do better, informs us Ensure all staff are trained in Mental Capacity and Deprivation of Liberty. Discussions during the inspection identified that they have started work on this, by having two staff trained, to enable them to then start training other staff. Care Homes for Older People Page 22 of 34 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 can expect a clean, odour free, safe, well maintained, homely environment, and be encourage/supported to personalise their bedrooms. Evidence: When the home asked in their own survey, how do you rate the cleanliness of the home, out of the seventeen people answering 12 rated it as excellent, 65 good and 24 rated it as neither being good or poor. When we asked residents during the inspection if staff kept their rooms fresh and clean, we were informed yes, with one resident telling us staff come in every day. In our own 2009 survey a resident commented that the home feels like a nice hotel - never smelly. In our 2010 survey when we asked is the home being kept fresh and clean, two residents answered always, two usually and one sometimes. When we arrived on the first day of our visit, except for a slight odour (which a visiting social care professional had also noted) as we came into the home, we found the areas we visited to be clean and odour free. Discussion with a Housekeeper, who confirmed that they have access to all the cleaning materials they need, identified that sometimes a smell wafts in from the street drain. We noted when we left, and also during our arrival on the second day, that the odour had gone. On the first day we visited the laundry area, and spoke to a member of staff, who Care Homes for Older People Page 23 of 34 Evidence: confirmed that staff are following safe handling of bodily fluids, as part of their infection control procedures. This reduces the risk of infections being passed around the home. Therefore, when there was an outbreak of diarrhea and sickness at the home, it was managed and contained. We noted housekeeping staff were ensuring that any cleaning chemicals they used, were being safely stored in lockable holders on their cleaning trolley, to ensure residents did not accidentally pick up any fluids which could cause them harm. Whilst walking around the new dementia care unit, we noted that some of the paintwork in the corridors showed signs of wear and tear. The maintenance person informed us that this would be addressed as part of their on-going decoration programme. The bedroom doors in the dementia unit had been painted in different colours, and to further support residents being able to locate their own room, memory boxes, filled with their personal items where located outside their bedroom door. We observed that the unit did not offer much space for those residents who like to spend a lot of their time walking around. When we fed this back to the Manager they agreed, and said as part of a resident with dementia pre assessment, they look at this, and if the person is known to need a lot of space to walk around, they would not be offered a place. We also noted although there was some colorful murals on the walls, there was a lack of tactile and objects to stimulate the senses whilst walking along the corridor. The staff had made the lounge look comfortable and welcoming, with the use of ordainments, board games, books and magazines lying around for people to pick up if they wished. Time spent talking with a Housekeeper, identified the arrangements they have in place to ensure any carpets which become soiled, are cleaned as soon as possible as part of keeping an odour free environment. A test of a baths hot water supply confirmed that the water was being supplied at a safe temperature, to prevent any scolding. The maintenance person informed us that two people cover the work between them, which includes maintaining the gardens and internal paint work. We were also told that one of the maintenance staff had undergone training to check equipment used to transfer residents, such as hoists, to ensure they are safe to use. They are supported by the external contractors who come in regularly to service the equipment, and carry out repairs as required. Care Homes for Older People Page 24 of 34 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. Residents can expect staff to have gone through recruitment checks, and received training to support them to undertake their role. However, residents cannot be assured that there are always sufficient staff on duty, to ensure call-bells are being answered, and acted on within a reasonable timescale. Evidence: The AQAA informs us that the home endeavour to maintain agreed staffing levels at all times. The Statement of Purpose and Service Users Guide also makes reference the minimum staffing levels and qualifications required are displayed in the reception area. Although we did not look at this notice during our inspection, it is more reflective of a time prior to the 2000 Care Standards Act when the previous regulator set out required staffing levels based on occupancy levels. This was superseded with the introduction of the National Minimum Standards (Care Homes for Older People). The regulations now state that the home needs to evidence that they have sufficient staff on duty during a twenty-four hour period, to ensure they can meet all the individual assessed needs of people living at the home. Comments from our 2010 surveys when we asked what the home could do better, included could answer call bells more rapidly at times. Short of staff at times (Healthcare professional), and from a person living at the home due to the lack of staff every procedure is rushed. I feel a little more time could be given to washing and Care Homes for Older People Page 25 of 34 Evidence: dressing. Residents and visitors we spoke with during the inspection felt the home does not always have sufficient staff on duty to ensure residents care is not being rushed, and to ensure call-bells are being answered within a reasonable timescale. One person told us that they were very concerned over the staffing levels. Feedback from staff also identified that they were very busy at times, but felt residents care needs were being met, but not always their social and emotional needs. We looked at a sample of the call-bell systems daily printouts, which shows the time somebody has rung their bell, which room it was, and when the alarm was switched off again. Looking at the printouts we looked at ones for the resident whose care we were tracking, whose health care needs requires closely monitoring. This enabled us to see how often they had rung, and how long staff had taken to answer. We identified that staffs response time varied between one to fourteen minutes. However, discussions with the resident identified that although the printout might show that staff were answering their call-bell quickly at times, it did not always indicate that staff were actually providing the care and support required at that time. Instead they were cancelling the call-bell informing the person they would be back in a couple of minutes as they were busy. When they did not return, the resident had to ring again, which sometimes resulted in being supported with their care, however, other times it resulted in staff cancelling the call-bell, and saying they would come back. When we arrived on the second day of our visit, we again checked the printouts for that persons bedroom and saw there had been a period where the call-bell had been rung and turned off, rung and turned off, and rung again. When we asked the resident about the calls, we identified that staff had again been cancelling the call-bell saying they would come back again, but as they had not it had led to the resident having to ring the bell again. With the residents permission we fed our findings back to the manager, who then spent time talking to the resident, giving reassurances that the situation would be investigated and monitored along with other residents call-bell printouts. This was to ensure they are being answered and dealt with at the time. When the home asked in their own survey, how do you rate the promptness of staff attending to your needs, out of the seventeen people answering 70 rated it as good, 24 as neither being good or poor and 6 poor. We noted, as the results were compared to their 2008 feedback, there had been some improvement, as in 2008, 25 had rated it as poor, and 6 as being totally unacceptable. Another question the home asked in their survey was how do you rate the number of staff in the home, 21 rated it as being good, 36 as neither being good or poor, 36 rated it as poor and 7 said it was totally unacceptable. When residents were asked how they think the home could improve, their comments included increase the Care Homes for Older People Page 26 of 34 Evidence: numbers of carers thus providing a little more time, and more staff in day time. To see if the home is following safe recruitment procedures we looked at the recruitment paperwork for two new care staff who had recently been taken on. The information was filed under different section headings which made looking through and checking the information easier. The staffs personnel files held information to show checks have been undertaken to validate their identity, and to confirm that they are able to work with vulnerable people, prior to them commencing their employment. Both staff had completed a medical questionnaire and application form giving their full employment history, and had also attended interviews at the home. However, when checking one of the applicants employment history, against the dates their previous employers said they had worked for them, we noted a three-month shortfall which we brought to the managers attention, so they could confirm with the person if they were employed or not during that time. The AQAA informs us that the home has a three day induction programme for care staff which is combined with supernumerary time to ensure they are fully supported as new members of staff. During our inspection we spent time talking to the new member of staff whose recruitment paperwork we had seen. They confirmed they had recently started their induction training, and were currently working shadow shifts so they could observe staff practice, and get to know the routines. They confirmed they were being supported on each shift by an experienced member of staff who acted as their mentor. When we asked how many shadow shifts they would be working, they told us all this week and most of next week. They were also, complimentary about the staff who were helping them, saying everyone is really friendly. They told us that they had also been going through the in-house training booklet, and watching videos on different aspects of health and safety and care which included falls and treating bedsores. The three staff returning our surveys in 2009, all confirmed that they are receiving training which is relevant to their work, keeps their knowledge updated, and helps them understand the individual, diverse needs of the people they care for. When we asked what they felt the home does well, one member of staff wrote provide training and study days and cover shifts to enable staff to attend. The AQAA informs us the senior sister has five hours per week as a training coordinator who provides an ongoing programme as well as arranging specific training requirements linked to staffs individual needs. The deputy matron also has supernumerary time to assist with training. When the home completed their AQAA in June 2009 they informed us that all staff have a development program that meets the national minimum standards for their service. They told us out of their 30 permanent care workers, nine held an National Care Homes for Older People Page 27 of 34 Evidence: Vocational Qualification (NVQ) level two or above in Care or Health and Social care. Under what they could do better they told us that they needed to increase the percentage of NVQ qualified carers in order to bring their percentage back up to over 50 . During this inspection the manager updated us on the statistics, saying they now had 10 out of their 23 care staff with a NVQ level two or above, and they currently have three members of staff undertaking the course. When they complete this training, the home will be achieving having over 50 qualified at this level. Whilst walking round the home we spoke with a member of staff who told us that they just started on their NVQ training, which they were enjoying. Survey feedback from Healthcare and Social Care professionals, when asked if they felt the manager and staff have the right skills and experience, to support residents social and health care needs, two replied always and one usually. Their comments included I have carried out many training sessions over the past seven years and the staff were always attentive and interested in carrying out any instructions efficiently and general care of patients is of a good standard, staff friendly and helpful. During our inspection, when we asked residents if they have confidence in the staffs abilities which we were told that they did. However, discussion with one resident identified that they felt the level of staffs knowledge about diabetes could be better (Care staff and Nurses). Following the inspection we received a survey from a resident who also commented that not all staff understood about their diabetes which results in them having to explain my condition including when they should eat. Duirng the inspection we looked at the staffs training records, and identified three nurses who had undertaken refresher training. The manager confirmed that they are trying to arrange more diabetic training and will be looking for courses to send staff on. Feedback in the homes own survey included staff are good, everyone is kind and caring, reflected comments gained from our own survey, and through talking with residents during the inspection. Comments included from surveys very friendly and experience staff, and from discussions staff are kind and staff are very nice. Care Homes for Older People Page 28 of 34 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. The Management and staff are committed to working in the best interests of the people they look after. Evidence: The homes Statement of Purpose and Service Users Guide gives information on the Registered Manager, Mrs Susan Whitneys qualifications and experience. Discussions with Mrs Whitney confirm that they are keeping their knowledge updated, and are aware of the forthcoming regulatory changes. Throughout the inspection Mrs Whitney demonstrated their commitment to working in the best interests of the people they care for. The manager also gave us their assurances that the shortfalls we identified during the inspection would be investigated, and action taken to address them straight away. Discussions with residents, relatives and staff during the inspection identified that they felt the manager is approachable and is seen regularly around the home. Whilst with the manager, two relatives of a recently deceased resident arrived bringing a thank you card and gift for the staff. Other thank you cards were seen around the home. Care Homes for Older People Page 29 of 34 Evidence: The home has a range of different quality assurance systems in place, to gain feedback on what residents and people associated with the home, feel about the level of service they are providing. The AQAA provides us with information on their quality assurances systems which includes audits undertaken by their team of Quality and Compliance Officers, resident and staff meetings, unannounced monthly audits undertaken by their regional manager, and annual internal and external customer satisfaction survey. We were given a copy of the analysis, following the homes 2009 Resident Customer Satisfaction Survey which showed that out of the nineteen questionnaires they sent out, seventeen were returned (89 ). Residents were asked to give a rating ranging from excellent to totally unacceptable, on different aspects of the service. This included giving feedback on the staff, food, being treated as an individual, activities, external and internal environment. When asked overall, how would you rate the quality of service from this care home, 12 rated it as excellent, 59 very good, 18 quite good and 12 quite poor. Comments ranged from staff are good to takes too long to get from one to another. The AQAA informs us that during the next twelve months they will continue to address issues raised in our surveys and audits to improve our practice. They also provided us with information on what changes they have already put in following feedback from residents. This included activities staff are offering more arts and crafts activities, as a result of our catering survey, we offer fresh fruit and homemade cakes at tea and supper time, and more themed suppers with English menus, and Resident and Relatives meetings were changed from evenings to afternoons after residents requested it. Records we looked at, with the exception of the medication records (see Health and Personal Care section of this report), were being completed and kept updated. The majority of the information which had been hand written in the personal care plans we could read, with one exception. This was where neither we nor the member of staff we asked, could make out a couple of the words in a sentence. We were informed that an Inspecting Officer from Barbergh District Council visited unannounced in July 2009 and carried out an unannounced inspection of the homes kitchen and food store. The copy of their report showed the premises scored 4 out of 5 stars. The following judgement was made by the Inspecting Officer Good food safety management. High standard of compliance with food safety legislation. The AQAA did not provide us with any information how service users financial Care Homes for Older People Page 30 of 34 Evidence: interests are safeguarded. However, discussions with the manager confirmed that they still have the same accounting procedures for looking after residents monies, which we have inspected as being met before. The manager said residents account sheets now show the amount of any interest that has occurred on the money held in safe keeping. The AQAA provides us with information on the policies and procedures the home has in place (and when they had been last updated). The policies and procedures give guidance to staff on safe ways of working to ensure the safety and welfare of the people they look after. Discussions with a new member of care staff, who was on their induction, confirmed that they had received training on fire safety. They told us the training included learning where all the fire points are located in the home, in case they needed to use them. At the time we spoke with them they had not undertaken their manual handling training, but had been told not to anything, involving assisting residents with their mobility, such as using a hoist, until they have undertaken the training. Care Homes for Older People Page 31 of 34 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 34 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 9 Systems should be in place to check residents have been given their prescribed medication and medication records have been fully completed before staff go off duty. Systems should be in place to check and monitor that residents call-bells are being answered and acted on within an acceptable time, to ensure residents are not kept waiting, or needing to call staff again. 2 27 Care Homes for Older People Page 33 of 34 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. 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