Care Home: Paddock House

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What the care home does well Discussions with residents, relatives and staff told us, "there is a very relaxed and friendly, atmosphere in the home and that staff put them selves out and are very caring". They also told us, "it is nice that my relative is supported by regular carers, they have lost their speech and mobility, but I know they are well and happy, as they always give the staff a smile and seems quite content" and "my relative was very particular about the appearance, the staff support them to maintain their self esteem, dignity and express their sexuality, by ensuring that they are always clean, wearing makeup and perfume". Comments received in residents `Have your Say` surveys, told us, what it is like for them living in the home, comments included, "the staff look after us well, we have very good meals, and we have transport arranged for us so that we can go to church" and "the atmosphere is friendly, kind and happy" and "I feel the home is run well, we get very good care, we have pleasant carers who look after us, however we could do with more outings and more staff at times". People also told us, they get good food, and usually have enough to eat. The manager is proactive and has demonstrated that they take prompt and appropriate action to address areas of concern, as soon as they are highlighted. Where concerns were identified about a safeguarding issue and missed staff signatures on residents Medication Administration Records (MAR) charts, they were able to provide detailed information and supporting paperwork of how they were addressing these issues What has improved since the last inspection? Since the last inspection the home has introduced an intermediate care service. Feedback obtained in discussion with people using the service, the Local Health Care Team (LHCT), staff and information received from in health care professional `Have Your Say` surveys reflects the service has made good progress. The LHCT advised us that 50 out of 75 who have used the service have been jointly supported by themselves and staff at The Paddocks to return to their own homes, following a period of rehabilitation. Time was spent talking with a temporary resident and their relative, who were very complimentary about the intermediate care service. They told us, "the staff are lovely here, they are very caring and welcoming, we have been very impressed" and "the service has been wonderful, with the OT support, staff have helped me to regain my mobility". In October the home are planning a celebration to acknowledge the first anniversary of the opening of the intermediate unit and its success. Previous intermediate care users have been invited, along with relatives and residents in the home. People using the service and their relatives, told us there have been improvements made to the provision of activities, which are now taking place on a daily basis, however to enhance the quality of life experienced by people using this service more could be done in this area to ensure people spend their day in a meaningful way.Care Homes for Older People What has improved since the last inspection? Since the last inspection the home has introduced an intermediate care service. Feedback obtained in discussion with people using the service, the Local Health Care Team (LHCT), staff and information received from in health care professional `Have Your Say` surveys reflects the service has made good progress. The LHCT advised us that 50 out of 75 who have used the service have been jointly supported by themselves and staff at The Paddocks to return to their own homes, following a period of rehabilitation. Time was spent talking with a temporary resident and their relative, who were very complimentary about the intermediate care service. They told us, "the staff are lovely here, they are very caring and welcoming, we have been very impressed" and "the service has been wonderful, with the OT support, staff have helped me to regain my mobility". In October the home are planning a celebration to acknowledge the first anniversary of the opening of the intermediate unit and its success. Previous intermediate care users have been invited, along with relatives and residents in the home. People using the service and their relatives, told us there have been improvements made to the provision of activities, which are now taking place on a daily basis, however to enhance the quality of life experienced by people using this service more could be done in this area to ensure people spend their day in a meaningful way.Care Homes for Older People What the care home could do better: Although, there has been improvements made to increase activities, feedback in residents surveys, and observations made through the SOFI reflects further improvements are needed, to ensure people are provided with support and activities so that their day is spent in a meaningful way and which enhances their well being. Development of needs assessments and life histories and additional staff training would help staff to understand feeling based person centered care, which would provide vital links to the persons past and provide staff with an understanding of the individual, which would form the basis of meaningful interaction and communication. The complaints log should only be used to record complaints and not used as a tool to record personal care information and staff grievances. More could be done to improve the environment in Bluebell (dementia care) unit, although nicely decorated, the unit lacks definition, objects of interest, memorabilia and signage could be better used to help guide and prompt people with a dementia to move around their environment and provide more stimulation. Paddock House Key inspection report Care homes for older people Name: Address: Paddock House Wellington Road Eye Suffolk IP23 7BE 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: Deborah Kerr Date: 1 6 0 9 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Paddock House Wellington Road Eye Suffolk IP23 7BE 01379870440 01379873332 Kym.Denny@socserv.suffolkcc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Suffolk County Council Vacant Care home 30 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia old age, not falling within any other category Additional conditions: Number of places (if applicable): Under 65 0 0 Over 65 10 20 Date of last inspection: Brief description of the care home: Paddock House is situated in the market town of Eye. The home is owned and administered by Suffolk County Council. It is situated close to all the local shops and other facilities in the town. The service offers accommodation and care for up to thirty older people across three units, Poppy Corner, Bluebell and Church View. Each unit has 10 single bedrooms with en-suite facilities. The accommodation is on two floors, access between floors is via a passenger lift. Each unit also has its own kitchen/dining area and separate lounge. There are assisted bathrooms and toilets in the communal areas of the building. Bluebell unit, on the ground floor, provides accommodation and support to people with dementia. Church View is dedicated to the provision of intermediate care, where short term rehabilitative care is provided to support people return to their own homes. Care Homes for Older People Page 4 of 33 Each of the people living at the home has a contract of terms and conditions; which reflect their fees and how much they are expected to pay per month. The cost to the individual person living in the home is £709 per week. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Their individual contributions are based on their level of income and / or capital; these are usually lower than the weekly fee. These charges cover all care, accommodation, meals, laundry and continence products. They do not cover additional services such as the hairdresser, personal items such as toiletries, clothing, dry cleaning, confectionary and tobacco or daily newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: two star good service Our judgement for each outcome: Choice of home Health and personal care Daily life and social activity Complaints and Protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted ten hours and included a one and a half hour Short Observational Framework for Inspection (SOFI). SOFI is a tool developed in conjunction with the University of Bradford, used to gain feedback from people, who due to their mental frailty may be unable to complete a Care Quality Commission (CQC) survey. During this time the inspector was able to look, Care Homes for Older People Page 6 of 33 and record how seven residents spent their time, how it affected their mood and well being, and how well staff engaged (interacted) with the residents. Observations made, are included in the relevant sections of this report. The report has been written using accumulated evidence gathered prior to and during the inspection, including information received in 9 service users, 18 staff and 4 health professionals Have Your Say surveys and the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We also assessed the outcomes for the people living in the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with the four people living in the home, three relatives and five staff. The manager was present throughout the day and fully contributed to the inspection process. Care Homes for Older People Page 7 of 33 What the care home does well: Discussions with residents, relatives and staff told us, there is a very relaxed and friendly, atmosphere in the home and that staff put them selves out and are very caring. They also told us, it is nice that my relative is supported by regular carers, they have lost their speech and mobility, but I know they are well and happy, as they always give the staff a smile and seems quite content and my relative was very particular about the appearance, the staff support them to maintain their self esteem, dignity and express their sexuality, by ensuring that they are always clean, wearing makeup and perfume. Comments received in residents Have your Say surveys, told us, what it is like for them living in the home, comments included, the staff look after us well, we have very good meals, and we have transport arranged for us so that we can go to church and the atmosphere is friendly, kind and happy and I feel the home is run well, we get very good care, we have pleasant carers who look after us, however we could do with more outings and more staff at times. People also told us, they get good food, and usually have enough to eat. The manager is proactive and has demonstrated that they take prompt and appropriate action to address areas of concern, as soon as they are highlighted. Where concerns were identified about a safeguarding issue and missed staff signatures on residents Medication Administration Records (MAR) charts, they were able to provide detailed information and supporting paperwork of how they were addressing these issues What has improved since the last inspection? Since the last inspection the home has introduced an intermediate care service. Feedback obtained in discussion with people using the service, the Local Health Care Team (LHCT), staff and information received from in health care professional Have Your Say surveys reflects the service has made good progress. The LHCT advised us that 50 out of 75 who have used the service have been jointly supported by themselves and staff at The Paddocks to return to their own homes, following a period of rehabilitation. Time was spent talking with a temporary resident and their relative, who were very complimentary about the intermediate care service. They told us, the staff are lovely here, they are very caring and welcoming, we have been very impressed and the service has been wonderful, with the OT support, staff have helped me to regain my mobility. In October the home are planning a celebration to acknowledge the first anniversary of the opening of the intermediate unit and its success. Previous intermediate care users have been invited, along with relatives and residents in the home. People using the service and their relatives, told us there have been improvements made to the provision of activities, which are now taking place on a daily basis, however to enhance the quality of life experienced by people using this service more could be done in this area to ensure people spend their day in a meaningful way. Care Homes for Older People Page 8 of 33 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 9 of 33 Details of our findings Contents Choice of home (standards 1-6) Health and personal care (standards 7-11) Daily life and social activities (standards 12-15) Complaints and protection (standards 16-18) Environment (standards 19-26) Staffing (standards 27-30) Management and administration (standards 31-38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service are provided with information they need to help them choose and know if this service will meet their needs, including people who are referred solely for intermediate care. Evidence: Information provided in the AQAA and verified at the inspection confirmed that the home has a Statement of Purpose, which provides details of what the home, can offer. Information about the home and what they offer is also available on the Suffolk County Council (SCC) web page relating to Paddock House. The service user guide was seen in resident’s rooms. This is a smaller document, which details information concerning the day to day living arrangements at the home, and is written in a user friendly way. A service user guide for the Intermediate Care unit reflects what people using this service will receive. This includes information about specialist facilities, equipment and staff. The aim is to provide the individual with short term intensive rehabilitation and to enable them to return to their own home. The home is made up of three different units. Bluebell is the special needs unit providing care and support to people who have dementia, Poppy Corner is for frail older people and Church View provides accommodation for people requiring intermediate care. The records and care pathways of one person from each unit was tracked, to ascertain how well the service is meeting their individual needs. These confirmed that a Care Homes for Older People Page 11 of 33 referral had been received, by the home, for a person requiring intermediate care and pre admission assessments had been completed for the people admitted to the other two units. The assessment covered all areas of the individual’s health, personal and social care needs. Where people had been referred through social services a copy of the social workers assessment had been obtained held on file and used to complete the individuals care support plan. Although, the pre admission assessments contained information about the peoples needs, discussion was held with the manager that these could be further developed to obtain more detailed information about prospective residents, including a more in depth life history and where an individual has a diagnosis of dementia, information about the affect this is having on their wellbeing, which would help to determine if and how they can meet this particular persons needs. The AQAA states that every resident is offered a Look See day, which offers them the opportunity to spend time at the home and ensure that they are happy to move in. Prospective residents can, if they wish stay overnight or for a week end to get a feel for what residential care would be like for them. Families are welcome to view the home and meet with the senior team to ensure they are happy with what is being offered. People spoken with confirmed they or their relative had had been provided with information and the opportunity to visit the home. This was also confirmed in Residents Have Your Say surveys, 7 out of 9 surveys returned said they had received enough information to help them decide if this was the right home for them, however 1 person said they had not received information and the other person did not know. In October 2008 the home diversified, offering a 10 bedded intermediate unit, offering a short term service providing support and encouragement to enable people to return to their own home. Time was spent talking with a nurse and Occupational Therapist (OT) from the National Health Service (NHS) Local Health Care Team (LHCT). The LHCT rents the 10 beds a year at Paddock House offering this service. Referrals come from local hospitals, such as the Ipswich, Norfolk and Norwich and West Suffolk, Papworth, or via GP, and other local care teams. Referrals are made through the LHCT. The nurse and OT commented they aim to be present at the home when the individual arrives to complete the individual care plan setting out the goals for rehabilitation, and completing the required assessments. The nurse and OT confirmed that the intermediate care service is working well and that the manager and staff at Paddock House are very keen to work with them. They told us, since the service was started in October last year, the LHCT and Paddock House have jointly made steady progress and have achieved a good success rate of supporting people to return home. They provided us with approximate figures, reflecting that 73 people have used this service, with 50 people being supported to return home, the remaining people had been supported to find alternative services to better meet their needs. The staffing ratio, provided by Paddock House for the intermediate care unit was discussed. Both the nurse and OT agreed this depends on the level of input required to assist with therapy and enablement, which is variable depending on the needs of the people using the service. They confirmed that the bed occupancy fluctuates, 1.5 staff was the set ratio agreed and established when service was set up, however both felt that if the 10 beds were consistently full and more dependent, staffing situation would need to be reviewed. They also told us, a nurse, OT and physiotherapist from the Care Homes for Older People Page 12 of 33 LHCT provided training to staff, which was very well received. They are considering providing further training to ensure other care staff are able to provide the right support to people using the intermediate service. Poppy Unit has two rooms allocated for short term stay, respite care. Time was spent talking with a person using this service, who confirmed that they are very happy with care they receive from lovely staff and that they get good food. The three peoples files seen confirmed an Adult and Community Care Home, Residential Contract and/or an Intermediate Care service user agreement had been issued signed and dated, setting out people’s fees, the roles and responsibilities of the provider and residents rights and obligations whilst living in the home. 7 out of 9 residents Have Your Say surveys, returned confirmed they had been issued with a copy of their contract, with their terms and conditions of residence. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service receive health and personal and medical care, based on their individual needs and wishes. Evidence: Information provided in the AQAA and verified at the inspection confirmed that each resident has a care plan, which identifies their health, personal and social care needs. The records and care pathways of three people living in the home were tracked to confirm this. The residential care plans follow the Suffolk County Council (SCC) model, which are set out in a way that can be easily used by people unfamiliar with the individual, to deliver a personalised and consistent service. The plans have photographs in place of the individual to identify and personalise their care plan. Care plans are built around the individual needs of residents, which have been discussed and written in conjunction with them, their key worker and family and include their preferences, choices and daily routines. Evidence was seen to confirm that care plans are being reviewed monthly to ensure that the information in them is current and accurate and that additional amendments are made, where peoples needs have changed. People using the service told us that they are receiving appropriate care, treatment and support. This was confirmed in residents Have Your Say surveys, 6 out of the 9 surveys returned told us they felt they always received the care and support they needed and 3 people told us they usually receive the care and support they needed. 8 out of the 9 surveys reflected people had access to the medical care they needed, with 1 person commenting that this is usually the case. This was also reflected in the care plan of a person who has recently moved to The Paddocks. Care Homes for Older People Page 14 of 33 Following a six week trial period, a review was held with the individual, their family, social worker and key staff from the home to ensure their needs were being meet. The review contained positive feedback about the service, staff and included comments made by the resident, they commented, they were happy and settled. This was confirmed in discussion with the individual who told us, I spend a lot of time outside gardening, as I used to live on a farm. I am happy here, I have moved here permanently now, and feel at home. Staff spoken with, had a good understanding of the people living in the home and were able to give a verbal account of individual residents needs and preferences. An example of this was seen during the SOFI observation and supported by information in an individuals daily notes, which reflects they do not like the hoover. A member of staff assisting the individual out of the dining area asked a domestic member of staff to switch off the hoover to enable the individual to pass. Conversation with people living in the home confirmed, that staff treat them with dignity and respect. They also told us, staff provide very good care, they are pleasant and they look after us well and staff are lovely, very caring, welcoming, we have been very impressed. Interactions between residents and staff, during the day were observed to be friendly and appropriate. Care plans contained supporting assessments, identifying the risks for activities of daily living. These collectively set out the actions required by care staff to ensure that people’s needs are met and describe the expected outcomes for the individual. These cover the risks associated with mobility, falls, use of wheelchairs, nutrition and personal hygiene and the action required by staff to minimise these, whilst enabling the individual to retain some independence and choice. The AQAA states residents can retain their choice of GP and can access NHS or private chiropody, optician and dental treatment. Information seen in care plans confirmed that people have access to health care services and social care professionals. The home has a positive relationship with the local General Practitioners (GPs) and district nurses, who make regular visits to the home. This was confirmed in feedback obtained in 4 health care professionals Have Your Say surveys, comments included, the staff liaise well with the community team regarding clients intermediate care and staff look after residents care needs well, they have close contact with us at the surgery and staff notify GPs and district nurses promptly and appropriately, if they have concerns about a residents health and the service provides a caring and supportive environment, with genuine concern for residents. Information in care plans and daily records reflected that on the whole peoples health needs are being monitored, however one persons notes recorded that tests had been carried out to establish if they had a Urinary Tract Infection (UTI). The notes also reflected the same individual had complained about pain in their left ear, on two occasions. Neither of these issues appeared to have been followed up on, there was no evidence to suggest the outcome of the tests and if the GP had been contacted or an appointment made. This information was provided to the manager who agreed to investigate the outcomes and ensure these were recorded in the individual’s notes. The care plan for the individual residing in the intermediate care unit had been completed by the LHCT, this included a STARS assessment, using a score rating system between 0 to 4, providing a full and comprehensive assessment of the individuals Care Homes for Older People Page 15 of 33 needs. This information was used to provide a plan of care incorporating the actions to be taken by the LHCT and staff at Paddock House to help the individual to regain their confidence and independence and enable them to return to their own home. The care plan was supported by communication sheets, which are being completed by LHCT and care staff. These provide a good overview of how the individual has progressed, rehabilitation treatment and hospital visits provided, outcomes of a home visit to assess their environment and the discharge date agreed for the individual to return home, with the appropriate adaptations made and equipment provided. Information provided in the AQAA states the home has robust medication polices and procedures in place. The medication policy confirmed people are supported to self medicate, if they wish. This is especially important on the intermediate care unit where residents need to be able to manage their medication before they return home. Time was spent with the team leader, observing the tea time medication round. They confirmed they are responsible for administering medication across all three units, although they are only required to prompt people residing in the intermediate unit, who have individual lockers in their rooms. For Bluebell and Poppy units, the Monitored Dosage System (MDS) is used, consisting of medication already dispensed by the pharmacy into blister packs. Photographs of residents had been attached to the Medication Administration Records (MAR) charts folder to avoid mistakes with the persons identity. The practice of administering medication is being generally well managed, however examination of the MAR charts reflected there were 18 missed signatures, on 5 peoples MAR charts in the week commencing 7th September 2009. The team leader was asked to check these against the corresponding blister packs, which confirmed the medication, had been administered, therefore people had received their correct medication, however it was discussed with them that the missed signatures could result in people receiving a double dose of their prescribed medication. These errors were discussed with manager, who confirmed they had already identified this as an issue through the medication audit process and provided us with an action plan of how they are to address the issues of recording. In addition to a monthly audit, they are implementing a team leader handover MAR and drug checking forms, to be used after each shift. Team leaders will have to check off MAR charts and make a record of gaps or problems, which will be reported to the manager. The AQAA reflects all senior staff are trained to National College of Further Education (NCFE) level 2, however to ensure the safe dispensing of medication within the home, the manager is arranging for further training for team leaders to refresh their knowledge and understanding of the importance of recording and administration of medication. Long term the manager is looking to train all staff, not just senior staff to administer medication and install medication cabinets in each person’s room, dispensing with the medication trolley. This will enable all staff to administer people’s medication in the privacy of their own room, reducing interruption from others and minimising the risk of errors. A check of the medication room reflects the controlled drugs cabinet meets with the required specifications as specified in the Misuse of Drugs (Safe Custody) Regulations 1973. There are currently four people prescribed controlled drugs, living in the home. A check of all four people’s medication against the controlled drugs register was made and found to be accurate. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of life experienced by people using this service could be further enhanced through staff training in delivering person centered care and activities, which will ensure their day is meaningful and their well being is enhanced. Evidence: A one and a half hour Short Observational Framework for Inspection (SOFI) was undertaken in the dinning area on Bluebell unit, to help us understand the experiences of people who are unable to tell us themselves and who are most likely to have the greatest care needs. The SOFI enabled us to get an insight into the general state of well being of people using the service. We observed five people sitting in the dining room, during which time we were able to look at, and record how the residents spent their time, how it affected their mood and well being, and how well staff interacted with the residents. Two staff were on duty during the observation and were present for the duration, with the exception of individual 30 minute breaks. The interaction between the staff and residents was mostly positive, with staff demonstrating warmth and affection in a relaxed and calming environment. Staff were quick to respond to peoples requests for drinks and actively tried to encourage conversation amongst the people in the room. Old catalogues were introduced to two residents promoting discussions about appearance, fashions and peoples shapes. Time was also spent talking with an Care Homes for Older People Page 17 of 33 individual who had attended a reminiscence session looking at old photographs. From the residents responses they had clearly enjoyed the occasion. A relative visited at 11.30am and was observed spending time with their parent, the visit was relaxed and clearly enjoyed by the parent and another resident sitting at the table who joined in the conversations with the relative and staff. This encouraged a lot of interaction between them and the other residents. However, some interactions were noted to be less positive and the effect of these was seen in the residents. One of the residents spent much of the time, in a withdrawn state, awake, but with their head down and appearing to be in their own inner world. At 10.50 a member of staff provided the resident with a cup of coffee, at 10.55 the resident was observed sleeping, staff woke them to assist them with their coffee, and asked if they wanted a biscuit at the same time as putting the cup of drink into their mouth. They were not provided with the opportunity to respond and the question was not offered again, for a further 15 minutes, when another carer asked if they could help them with their coffee, which had been sat on the table in front of them. One of the care staff noticed that these residents’ glasses were dirty and removed them commenting how dirty they were’; these were cleaned and put back on, but with no inclusion or interaction with the resident. Additionally, the two staff engaged in a conversation, noting the individual appeared very tired today and talked about the position of the individuals arm chair in their room, again at no point was the resident asked their opinion or included in the discussion. As well as observing the 5 people in the dining room, 2 people were seen sitting in the lounge at the start of the SOFI. Between 10.45 and 11.35 there was no interaction with these two people. At 11.25 one of the residents started to become vocal, making noises, which suggested they were in some kind of discomfort or distress. At 11.30 another member of staff entered the dining area via the lounge, walking straight passed the residents in the lounge, with no acknowledgement of them, in particular the resident who was continuing to make moaning type noises. At 11.35 a carer returned with a resident who had had a hospital appointment, having handed over information to the two carers on duty, they stopped to talk to the resident in distress, calling them by their name and sat with them for a while, whilst writing notes. The resident became visibly less anxious, however when the carer got up to leave, the resident spoke saying please dont go, at which point the carer did sit and talk with them about baking, making lots of nice contact, offering reassurance and comfort to the individual, who clearly responded well to this and was observed relaxing and laughing. It was 11.50 am before any engagement was made with the second resident sitting in the lounge, who had been sitting passively with no interaction for 1 hour and 5 minutes. The AQAA states that through assessment, care planning and review we can offer individual choice and provide social activities to meet individual needs and that routine within the home is flexible and tailored to meet the needs of the residents. Residents Have Your Say surveys, told us that the home does arrange activities, 4 out 9 people said this was always the case, 2 people told us activities, which meet their needs are usually provided, however 3 out of the 9 said this happened sometimes. Relatives commented, there has been an improvement in level of activities, these are happening daily and people are being encouraged to take part. Entertainers are being brought in to the home on a regular basis and an activities programme, has been developed which includes a variety of games, such as board games, bingo, carpet bowls, word search and crosswords, also reminiscence, knitting, coffee mornings, video shows, Care Homes for Older People Page 18 of 33 flower arranging, escorts to church and high tea and songs of praise on Sundays. Additionally, a Pat dog visits weekly and the church choir attends on a monthly basis to provided entertainment. Improvements have been made to the courtyard garden, incorporating raised flower beds, enabling a gardening club for residents to make better use of the garden. Although, there has been some improvements made to increase activities, feedback in residents surveys, and through the SOFI observation reflects further improvements are needed in this area to ensure people are provided with support and activities to ensure their day is spent in a meaningful way and which enhances their well being. The need for additional staff training to provide person centered care and the development of life histories was discussed with the manager, which would provide vital links to the persons past and provide staff with an understanding of the individual, which would form the basis of meaningful interaction and communication. Time was spent talking with a temporary resident and their relative. They were very complimentary about the intermediate care service, comments included, staff are lovely here, they are very caring and welcoming, we have been very impressed. They also told us, the service is wonderful, with the OT support, staff have helped me to regain my mobility. However, following a further assessment of need, both the individual and their relative have agreed with the outcome, that 24 hour nursing care would be more appropriate. They confirmed all the arrangements have been made for the individual to move into nursing home, to be nearer their relatives. A relative of an individual residing in Bluebell unit, told us, activities are provided for people living in the special needs unit, which has included trips out to the beach and other places of interest. They confirmed the new manager has introduced coffee mornings, for people from all units and relatives to intermingle and that there is a very relaxed and friendly, atmosphere in the home. They also told us, staff put them selves out and are very caring, it is nice that my relative is supported by regular carers, they have lost their speech and mobility, but I know they are well and happy, as they always give the staff a smile and seems quite content and my relative was very particular about the appearance, the staff support my relative to maintain their self esteem, dignity and express their sexuality, by ensuring that they are always clean, wearing makeup and perfume. Information provided in the AQAA states that the recruitment of an activities coordinator would enable an increase in group and one to one activities, for residents, however this currently relies on care staff to fit in alongside their care duties. Time spent with two staff who showed a particular interest in activities, who were creative with their suggestions for improving activities. One of the staff is to attend a local college to complete a music and movement course. The manager confirmed they are in the process of planning a resident meeting to discuss activities and is looking to use staff who have a flair for encouraging and facilitating activities to create an activity forum. The AQAA states a choice of meal is offered daily, menus are reviewed and adapted when feedback is received and there are celebratory meals for special occasions. The homes own quality assurance survey reflected people are provided with a choice of meal each day. 6 out of the 9 people that responded in our Have Your Say surveys told us, they liked the meals provided, 2 confirmed they usually liked the meals, with 1 who commented that they sometimes liked the meals. Care Homes for Older People Page 19 of 33 Comments received in residents surveys, told us, the staff look after us well, we have very good meals, and we have transport arranged for us so that we can go to church and the atmosphere is friendly, kind and happy and I feel the home is run well, we get very good care, we have pleasant carers who look after us, however we could do with more outings and more staff at times. People also told us, they get good food, and usually have enough to eat. A relative commented, the food is good, my relative has a normal diet and requires assistance to their eat meal, I know they are receiving this support as my relative is maintaining a healthy weight. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to robust complaints and safeguarding procedures, however additional training for senior staff will ensure the correct procedures are followed to ensure people are protected from abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were examined. These reflect the procedures in place, to protect people using the service and identifies the actions staff should take if they receive a complaint, or if an incident of abuse is discovered or reported to them. The safeguarding procedure includes the process of reporting allegations to internal personnel and the contact details for the local area safeguarding adult protection team. However, information obtained in the daily records of one of the people being tracked, highlighted an issue, which should have been referred as a financial safeguarding concern. The issues and reasons were discussed with a senior member of staff, who was not clear of the safeguarding referral process. They were advised, by us to make a safeguarding referral retrospectively, which was completed at the inspection. We have since been notified by the adult safeguarding team that a strategy decision was agreed that due to lateness of referral, (the incident happened 2 months ago) it was decided that the incident could not be investigated as a crime. The new manager has responded promptly to this incident and has instigated new procedures for handling resident’s monies, supported by risk management strategies to avoid this happening again in the future. The AQAA also identifies that refresher training for all staff on safeguarding adults is to be provided. The complaints log was seen which confirmed information provided in the AQAA that there have been no formal complaints received in last 12 months. However, the complaints log was inappropriately being used to record personal care information and staff grievances. Care Homes for Older People Page 21 of 33 People using the service and staff confirmed they were aware of the complaints procedures and told us the new manager, is very approachable and they feel able to discuss any concerns openly with them. They confirmed they felt confident that there concerns would be dealt with. This was also confirmed in residents Have Your Say surveys, 8 out of 9 people who responded to the surveys told us they did know who to speak to, if they were not happy and would know how to make a formal complaint, however one person told us they did not know this information. Staff files seen confirmed all staff and volunteers are subject to Criminal Records Bureau (CRB) checks prior to commencing employment and Safeguarding of Vulnerable Adults (SOVA) training is provided and guidance books are available to all. Two staff spoken with during the inspection demonstrated a good knowledge and understanding about protecting residents from harm, and were aware that they needed to be mindful of their actions and language, when supporting people to make choices and not to restrict them. They also provided a good explanation of what they would do if they observed poor practice, or suspected an individual was being abused. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Paddock House provides the people who live there with a safe, well maintained and homely environment. Evidence: Paddock House offers accommodation and care for up to thirty older people. The home is divided into 3 units, Poppy Corner, Bluebell and Church View, each consisting of 10 beds. Each unit has its own kitchen/dining area and separate lounge. All bedrooms are for single occupancy and have the benefit of en-suite facilities. There are also assisted bathrooms and toilets in the communal areas of the building. The home is nicely decorated throughout, with a lot of natural light. Communal areas are spacious and well furnished with domestic style and age appropriate furniture, lighting, carpets and curtains. People are able to move freely around the home, including people in the dementia unit by use of doors that stay open automatically. However, doors to the dementia unit are alarmed, which alert staff, if people leave the unit to ensure their safety. There is wheelchair access throughout the home. The special needs unit, Bluebell is on the ground floor. The unit is open plan to give residents space to walk about while remaining in view of the staff for their own safety. There is also an additional small quiet lounge for residents to use. Corridors are long and although painted in two colours lack definition, objects of interest, memorabilia and signage could be better used to help guide and prompt people with a dementia to move around their environment. The AQAA states that people living in the home are encouraged to personalise their rooms, and to add finishing touches of their own to make their living space more homely. Rooms seen were nicely decorated with peoples personal effects to reflect their individual personalities, hobbies and interests. Rooms had peoples names, and or a picture to help them identify their room. Care Homes for Older People Page 23 of 33 The home has sufficient bathrooms and toilets available to meet the needs of the people living there. These include toilets at frequent intervals in corridors, assisted baths and a wet room. There is a courtyard garden to the rear of the home with raised flowerbeds to give access to wheelchair users. This garden is also fully enclosed to enable residents with dementia to access the garden without restriction. Additionally, there is a paved area with flower beds leading out from the lounge and dining area in the dementia unit. This area is currently not secure. The manager advised there have been previous issues with securing the garden, due to a public right of way, however they have established this is not the case, and is looking to installing fencing and a gate, to open up the garden to the residents. The AQAA states that Suffolk County Council (SCC) has a rolling programme for maintenance and improvements to the home. Budget constraints have meant that not all work is carried out in a timely fashion. Of the 91 windows in the home, only 25 have been replaced with double glazed units. The replacement windows are all on the north side of the building; this has improved warmth and comfort for the residents, and reduced heating bills. Suffolk County Councils responsible individual for Paddock House has advised us that a contract is currently being negotiated and a phased plan to replace the windows is scheduled for the new financial year. Refurbishment of the intermediate unit has created a more modern environment, including upgrading the toilet facilities, and creation of a wet room. The manager confirmed there are further plans for improvement, including refurbishment of the kitchens and flooring on each unit. The home is generally equipped with aids and specialised equipment to promote mobility and maximise people’s independence. There are a range of hoists, grab rails and other aids, which are available in corridors, bathrooms, and toilets, and where required, and in residents own rooms. One resident raised concerns with us that they find it difficult to move around the dining room in Poppy unit at mealtimes, due to the number of mobility aids. This was observed at the evening mealtime, the dining area is relatively small, wheelchairs and walking frames made the room cramped and difficult to get passed to get in and out of the dining area. Beds in the home have been replaced with brake castor divans or profiling beds to meet the changing needs of the residents. A call system is provided throughout the home, including individual’s rooms and all communal areas, so that residents have access to staff when they need them. The environment is maintained by a team of domestic assistants, with additional assistance from carers on a day to day basis. The Home was found to be clean and tidy throughout with no odours. The laundry facilities contain the appropriate equipment to launder soiled linen, clothing and bedding. Red dissolvable bags are provided for dealing with soiled linen, soiled garments and bedding are placed directly into the bag and into the washing machine on a sluice cycle minimising staff contact and the risk of spreading infection. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in the laundry, all en-suite and toilet facilities, where staff may be required to provide assistance with personal care. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the 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 using this service are supported by a staff team that are available in sufficient numbers and who are trained, skilled and competent to do their jobs. Evidence: The duty rosta reflects the home is staffed 24 hours a day, 7 days a week. The normal staffing ratio is 1 senior or team leader each shift, plus 2 carers on Bluebell unit, and 1 carer on each on Church View intermediate unit and Poppy, OP unit supported. These numbers are supported by 2 floating staff who are allocated, depending on need, to help with meals, moving and handling and activities. Morning shifts start at 7am until 3pm, with afternoon shifts commencing at 2pm to 10pm. Nights are covered by a team leader and 2 care staff, one of whom is designated solely to the dementia unit. 10 staff Have Your Say surveys were sent to the home for distribution, 18 completed surveys were returned, which told us what staff thought the home did well, and where they could improve. Overall, staff told us the home provides a good service to the people who live there, comments included, Paddock House provides a good level of care for residents, on a personal level I would not hesitate to have my parents being cared for here, certainly a few things could improve, but on the whole I think we do a good job and the home enables people to live as independently as possible and maintains individuality at all times and we make sure everyone feels welcome and try to understand peoples fears. Other comments included, it is a very happy home management, careers and residents get on very well, we are happy in what we do and laugh together, there is a genuine care for residents, not a tick box culture and the home has a homely feel and a friendly atmosphere, it is a nice home to work in. However staff felt there could be better communication between the different departments, relief staff, team leaders and the manager. This was also identified in 3 of the 4 health professional Have Your Say’ surveys, which reflected that communication amongst staff could be improved, one commented, there are too many Care Homes for Older People Page 25 of 33 occasions of, I dont know, Ive just come on shift and been asked to ring you. Other comments made by staff where they though improvements could be made included, provision of more staff would improve the service, which is particularly necessary on the special needs unit, as peoples frailty and dependency are consistently increasing and provide more activities, although it can be difficult to get client participation and if we had more staff we would be able to offer more person centered care and activities. These concerns were discussed with 2 staff during the inspection, who told us that the new manager has implemented new systems, which have improved communication a lot throughout the home and that there is a more positive attitude to activities. Both staff felt the staffing levels were alright, and had been quite good, but confirmed they had used regular agency staff. The manager acknowledged that they currently have 3 staff vacancies, which they are trying to recruit to internally. The confirmed information provided in the AQAA that they have experienced problems recruiting due to changes in the recruitment process, which has meant there has been inevitable time delays from appointing staff to their start date. This has resulted in losing potentially good staff who get tired of waiting, which has in turn led to an increase in the use of agency staff. Staff confirmed that recruitment of new staff has reduced the need for agency staff, recruiting to the 3 vacancies will further reduce the need to use agency staff. The AQAA states the recruitment of new staff follows Suffolk County Councils (SCC) policy and before commencing employment all staff will have an enhanced Criminal Records Bureau (CRB) check, two written references and a health clearance check. Examination of three staff files confirmed this and that all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing work. Of the 18 Staff Have Your Say surveys returned, all 18 confirmed they had been given training relevant to the work they do, 17 staff told us, they received training to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. This was also confirmed in discussion with staff during the inspection. Most recent training has included risk assessment and a two day moving and handling for team leaders, Boots care of medicines, fire safety, Safeguarding Vulnerable Adults (SOVA), infection control, moving and handling, dementia, working with dementia, emergency first aid appointed persons, supporting individuals with dementia, falls and fractures and intermediate care. The AQAA states further training is being planned for staff relating to the Mental Capacity Act and the Deprivation of Liberty Safeguards and how they relate to delivery of care, within a residential setting. Information provided in the AQAA and verified at the inspection confirmed that all care staff receives induction training, which meet the Common Induction Standards (CIS) and can access additional training through SCC. The induction process consists of completion of the CIS Skills for Care workbook, relevant training and shadow shifts with an experienced member of staff. Staff confirmed that they had felt well supported during the induction process. Throughout their induction, staff files confirmed that new staff have interim meetings at 9, 18 and 26 weeks, to discuss their work performance, training and development needs and general conduct. Care Homes for Older People Page 26 of 33 Information provided in the AQAA states the staff group comprises of a team of 49 in total, as mix of managers, care staff and ancillary staff. There are a total of 39 care staff, 28 of whom have completed a National Vocational Qualification (NVQ) level 2, or above. These figures reflect the home has 50 percent of staff who hold a recognized qualification, which meets the National Minimum Standard (NMS). Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using the 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 administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. Evidence: Kym Denny was appointed as the manager of the home in August, this year. They are in the process of making an application to us to become the Registered Manager of the service. Kym has a wealth of knowledge and 20 years experience of working in the care sector. They have completed a National Vocational Qualification (NVQ) level 4 and has completed the NVQ Assessor Award D32/33, which means they are able to assess and support staff in the home to complete their own NVQ. They are in the process of completing the Leadership and Management qualification, formerly known as the Registered Managers Award (RMA). Records reflect they continue to access training to further enhance their knowledge and keep up to date with current legislation and new ways of working. Most recent training has included the Mental Capacity Act and Depravation of Liberty Safeguards. Care Homes for Older People Page 28 of 33 The manager confirmed they are aware of the work they need to do to improve the service and the outcomes for the people living in the home. They are in the process of sourcing training for staff to further develop principles of person centered care, including life history work and provision of activities. Discussion with staff confirmed The manager has a very positive attitude and is easily approachable and that they have already made positive changes, improving communication, activities and delegation of areas of responsibility to staff, providing an open, positive and inclusive atmosphere. Information provided in the AQAA and verified at the inspection confirmed that the home has quality assurance processes in place, to monitor how well the service is meeting people’s needs. An external member of Suffolk County Council (SCC) staff makes monthly visits to the service to monitor how the home is achieving the aims and objectives as set out in the statement of purpose and inline with SCC goals. They also speak with residents and staff to gain their views on the service provided. Additionally, people’s opinions are sought through the distribution of surveys. In recognition of the fact that 10 residents living at Paddock House have a dementia and are often unable to express their views, a questionnaire has been devised, which is distributed to friends and relatives, covering their welcome to the home, the environment for the resident, the communal areas, standard of care, staff attitude and how they feel about making a complaint. Since opening the intermediate care unit, which houses 10 people for up to six weeks at a time, a questionnaire has been devised to encompass their views on the service they receive. The results of these surveys were not yet available. A copy of the outcomes of the most recent quality monitoring survey was provided at the inspection. This reflects 12 residents were provided with a range of questions, which looked at how satisfied they were with the service in general, if they had a say in how the service is being run, health care, choice, activities, how to complain, environment and their key worker. Feedback from residents was mostly positive, however 6 people commented that they did not feel that they were provided with enough information about what is going on in the home, 4 people considered they would like to be given more choice over what they would like to eat each day and 6 people identified improvements could be made to their rooms. To get to know the people in the home the manager has had lunch and tea with the residents and told us they are in the process of arranging a date with the catering staff, to invite residents to have lunch with them and to incorporate a residents meeting. The AQAA states unit meetings are held, on a regular basis where residents can contribute their views on about the service, staff are also involved, acting as advocates for those residents who have communication difficulties. To ensure people are provided with information in the home, the manager has delegated responsibility to a team leader to put together a monthly newsletter for residents and relatives. People using the service are encouraged to maintain control over their finances where they are able to do so. As already mentioned in the complaints section of the report, there have been concerns about the handling of people’s personal monies. As a result of this, a safeguarding alert was made and new procedures for handling residents monies has been introduced to ensure that there is an audit trail in place, which are supported by risk management strategies. Care Homes for Older People Page 29 of 33 Discussion with staff and information held on their files confirmed that regular supervision is taking place. The documentation reflects that these sessions include discussion about performance, areas of development and training needs. Each member of staff has an annual performance development review, which looks at their performance and sets yearly objectives. Staff confirmed they felt supported in their role and have access to regular staff meetings, which are held bi monthly and keeps them informed about changes within the organisation and the service. To ensure the safety of people living in the home, an automatic fire system is in place which links to the fire service. All doors in the home have automatic closures which close when the alarm sounds to prevent the spread of fire. All radiators throughout the home guarded with radiator covers, which minimises the risk of people falling against them and sustaining burns. Regular hot water checks are made to ensure these are operating within the safe recommended temperatures. Records kept in the home confirmed all equipment is being regularly serviced as per the manufacturer’s recommendations. The most recent Gas, Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen. Certificates confirmed the passenger and moving and handling equipment is regular checked and serviced, including Lifting Operations and Lifting Equipment Regulations (LOLER) tests. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes 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 Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 12 16 More could be done to ensure people are provided with meaningful activities, which enhances their well being. The complaints log should only be used to record complaints and not used as a tool to record personal care information and staff grievances. More could be done to improve the environment in Bluebell unit although nicely decorated, the unit lacks definition, objects of interest, memorabilia and signage could be better used to help guide and prompt people with a dementia to move around their environment and provide more stimulation. Arrangements for mealtimes in the dining room in Poppy unit should be reviewed to ensure people have sufficient space to get in and out, without being restricted by mobility aids. 3 19 4 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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