Care Home: Parkland House

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What the care home does well Before deciding whether to offer prospective residents a place at the home, the home assesses their needs well, which promotes the success of any subsequent admissions to the home. Staff respect the privacy and dignity of the people they care for and support. The home`s involvement of community-based health professionals ensures people`s health care needs are met. And they benefit from a clean, well-maintained and homely place to live, which is improved and adapted in line with their needs. There are various opportunities for fulfilment and for people to exercise choice or control of their lives, reflecting individuals` interests, preferences and capacities. Links are maintained with peoples` families, friends and the community around the home, helping to ensure they benefit from supportive and enriching relationships. The home is run in the best interests of people who live there, with action taken to promote the health and safety of everyone at the home. It`s policies and practises ensure complaints, concerns and opinions are heard and acted upon. Development of the staffing arrangements ensures that people are looked after safely and well. What has improved since the last inspection? Action has been taken to improve care plans by including people`s recreational needs, so that their individual social needs will be met. The home`s recruitment procedures are more robust, offering people living at the home better protection from unsuitable staff. Refurbishment of the home has been ongoing, in areas used by people who live at the home as well as in areas such as the kitchen. What the care home could do better: Only one requirement was made following this inspection, in relation to medication. Otherwise, `good practise` recommendations have been made: Greater detail is necessary in some care plans, especially regarding current care needs, care required and medication, to ensure that individuals` needs are met safely, and in a personalised and consistent way. The home offers an appetising, nutritious and varied diet, although people should have equal opportunities to enjoy mealtimes by providing the same level of choice and quality of dining experience to everyone at the home. The home has invested greatly in the provision of activities for people who live at the home. Developing further the skills of the care staff team so that people are offered every opportunity for fulfilment through leisure, recreation or meaningful activities, would add to the quality of individuals` lives. It was good to find that staff understood about abuse, and that matters are reported in accordance with local policies, but all staff need to be fully aware of external procedures also, to further safeguard people living at the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parkland House Parkland House Barley Lane Exeter Devon EX4 1TA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 2 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Parkland House Parkland House Barley Lane Exeter Devon EX4 1TA 01392251144 01392252774 parklandhouseex4@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Peninsula Care Homes Limited care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 52. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years of age (Code DE(E)) Mental disorder, excluding learning disability or dementia - over 65 years of age (Code MD(E)) Old age, not falling within any other category (Code OP) Physical disability - over 65 years of age (Code PD(E)) Date of last inspection Care Homes for Older People Page 4 of 35 Over 65 52 52 52 52 0 0 0 0 Brief description of the care home Parkland House is a care home for up to 52 people above retirement age, who need help with personal care, and who may also have dementia, a mental disorder, or a physical disability. Nursing care is not provided, apart from that which the local district nursing service can provide. A detached and extended period house with large gardens, the home is in a residential area on the western outskirts of Exeter. It is not too far from some local shops and a bus route to the city centre, with St Thomas shopping centre less than a mile away. Accommodation is on two floors. The property has been extensively refurbished, including The Coach House where accommodation is provided for more independent people. There is a passenger lift between the ground and first floors in the main building; a platform lift and a stairlift are installed in the Coach House. The home has two lounges, a sun lounge, a lounge/dining room, a large dining room, and a kitchenette/dining room. Most bedrooms are for single occupancy, with one double room available. Half of the bedrooms have en suite toilet facilities. There are baths adapted for people with mobility problems, and level-access showers. The gardens are well kept, with good wheelchair access to covered sitting areas, and walkways. A courtyard garden gives an improved view from rooms overlooking it. There is a car-parking area at the front of the home. Weekly fees at the time of the inspection were 520-670 pounds per week. Fee levels depend on individuals needs and the particular room. Fees do not include the cost of hairdressing, private chiropody, staff escort duties (charged at the hourly pay rate for care staff), entry fees or tickets on outings, dry cleaning, newspapers (which are charged at cost price) and toiletries. Our last inspection report about Parkland House is filed with other information about the home, in the homes entrance hall. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: This inspection took place as part of our usual inspection programme. The homes last key inspection was on 7 September 2007. We completed an Annual Service Review (ASR) on 8 September 2008, concluding the home was still providing a good service and that they knew what further improvements they needed to make. We carried out an unannounced visit to the home, as part of this inspection, which lasted 9.5 hours on a week day. This included time spent with the registered manager, Sue Gooding, when we discussed our findings at the end of the day. She and her staff assisted us fully throughout the day. Prior to this visit, the home had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service they offered and any plans for the future. This gave general information about the people living at the home and the staff, Care Homes for Older People Page 6 of 35 some assessment of what the home does well, and any plans for improving the service. Before our visit, we sent 12 surveys to the home for people who lived there, with 10 staff surveys. Five surveys for people living at the home were returned, 4 of who were helped by their families to complete them; 5 staff surveys were returned. Surveys were positive about the home, and no-one indicated on them that they wished to speak to us. There were 48 people living at the home at the time of our visit, 43 of who had mental health needs. We spoke individually and in some depth with 11 people, and chatted with at least 12 others, around the home. To help us focus on the views and experiences of people who live at the home we were accompanied by an expert by experience. The term expert by experience describes here people whose knowledge about social care services comes directly from using them. The Care Quality Commission is trying to improve the way we engage with people who use services. So we introduced this method of working, with experts by experience being an important part of the inspection team in helping inspectors get a picture of what it is like to live in or use a social care service. The expert spoke to people about their experiences of life at the home, as well as making some general observations. Some people could not give us their views because of communication difficulties caused by dementia. Because of this, we sat for a while in lounge and dining areas, and used a particular method for observing activity that helps us get a sense of peoples well-being, how they are able to use their environment, and how staff support them. We case-tracked 4 people living at the home. They included people who had no relatives or other advocate, privately funded people and those funded by Social Services, people new to the home, and people with greater needs than most people at the home. Case-tracking involved looking into these peoples care in more detail by meeting them, checking their care records and related documentation, talking with staff about their care, and observation of care or support these people received. We spoke with 6 care and ancillary staff and looked at various records, including those relating to staff, health and safety, and quality assurance. Our tour of the building included the kitchen and laundry, as well as peoples bedrooms and shared areas. Information from these sources, and from communication with or about the service since the ASR, is included in this report. The expert wrote: I would like to say thank you to those people who live at Parkland House who gave their time to talk to me and share information about their life at the home, it was a privilege to meet them. I would also wish to thank the staff for making me so welcome and for their help and support during the time I was there. At the end of my visit I was able to meet with the Inspector and the Manager of the home to give feedback. With the exception of the one or two areas of concern (- discussed later in this report), it was a positive visit with some good examples of quality care at the home. What the care home does well: What has improved since the last inspection? What they could do better: Only one requirement was made following this inspection, in relation to medication. Otherwise, good practise recommendations have been made: Greater detail is necessary in some care plans, especially regarding current care needs, care required and medication, to ensure that individuals needs are met safely, and in a personalised and consistent way. The home offers an appetising, nutritious and varied diet, although people should have equal opportunities to enjoy mealtimes by providing the same level of choice and quality of dining experience to everyone at the home. The home has invested greatly in the provision of activities for people who live at the home. Developing further the skills of the care staff team so that people are offered every opportunity for fulfilment through leisure, recreation or meaningful activities, would add to the quality of individuals lives. It was good to find that staff understood about abuse, and that matters are reported in accordance with local policies, but all staff need to be fully aware of external Care Homes for Older People Page 8 of 35 procedures also, to further safeguard people living at the home. 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 set out 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 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before deciding whether to offer prospective residents a place at the home, the home assesses their needs well, which promotes the success of any subsequent admissions to the home. The home does not offer intermediate care. Evidence: We saw an assessment of someones needs completed by the manager shortly before the person moved into the home. It included what they preferred to be called, and an assessment template covering a broad range of potential needs - such as those relating to daily activities of life, pressure areas, wound dressings, medications, individual preferences and restrictions on personal choice. These last two topics had no further information in this case, however, so it was not clear if they had been looked into. Care Homes for Older People Page 11 of 35 Evidence: A more recent assessment for someone else had greater personalised detail, including their capacity to make decisions for themself and how their dementia affected them, personal risks such as their risk of falling and malnutrition, and their night-time routine. The information gained was used to provide a dependency score, which the manager told us was then used in planning the required staffing levels at the home. The manager said this was the new needs assessment for prospective residents. Information was also available from hospital staff who had been the persons previous carers. In other cases, care plans had been obtained from individuals care managers. Of the 5 surveys that were returned to us on behalf of people who lived at the home, 3 confirmed people had been given enough information about the home before they moved in, to decide whether it would be suitable for them. Two people did not answer the question. Staff told us they were informed well about any new admissions to the home at staff hand-overs between shifts, and that they could also read the persons needs assessment and subsequent care plan. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support people in a caring manner, with respect for their privacy and dignity, although a lack of detail in some care plans creates a risk that individuals needs may not be met safely, or in a personalised and consistent way. Their health care needs are met through the homes involvement of community-based health professionals. Evidence: Of surveys for people who lived at the home, 3 said they always got the care and support they needed and 1 said they usually got the care and support they needed (1 person didnt respond). All 4 said they always got the medical care they needed. We saw that there was a plan of care for each individual living at the home. These care plans were mostly based on a tick box format, with very brief descriptions under different headings. This limited the degree to which individuals care plans could be personalised, or updated. For example, where it was identified that an individual could be aggressive, there was no guidance as to how staff should respond if they were. It was positive to see that causes or triggers for aggressive behaviour were included in some care plans. Although most staff we asked seemed unfamiliar with this aspect of Care Homes for Older People Page 13 of 35 Evidence: supporting people, a senior carer spoke about keeping behaviour charts to help to identify such triggers. It was also very positive to see activities plans and evaluations that reflected peoples identified interests, if or how they had enjoyed an activity or event, etc. One persons Activities care plan reflected their short concentration span, but without going on to suggest suitable activities or positive ways this person could spend their time. Monthly evaluations of the care planned for one person showed a wrist injury had reduced their independence in washing, feeding themselves, etc., and that they were thus receiving help from staff. However, the care plan still indicated they were independent in eating and drinking, for example. The care plan for another person with a history of falls indicated they needed help from one person when mobilising, but during our visit we saw them walking unaided. An initial assessment for one person included that the person had no capacity, suggesting they couldnt make decisions for themselves. It was very positive, therefore to read later entries in care records that included what the person actually could indicate, and preferences they had expressed in some way. This showed that staff were mindful of the whole matter of decision-making, and observant of how people made choices or demonstrated their decision - important when people might be unable to express a choice clearly, verbally. However, where there were several evaluation entries over time, it was difficult to identify the care or support an individual currently needed, with some care plans not updated in the light of what were mostly informative, useful evaluations. It created a risk that people would receive inconsistent care or support. Some evaluations simply stated No change to plan. Another - where, under Continence, this was assessed as Occasional accidents, evaluations gave no indication of what this meant in practical terms for this person. Lack of such detail makes it difficult to know if the care planned was appropriate, or how it could be changed in order to meet the persons needs. Community Psychiatric Nurses that we spoke with said staff had asked for their input, regarding peoples care, in a timely way. One person we case-tracked had had an eye test, had chiropody, and been referred to a physiotherapist about mobility aids and to a continence adviser, in the last year. Each persons risk of falling had been assessed, with evidence that GPs were informed of any falls. Monthly evaluations of someones care plan showed staff were monitoring changes in their weight. Care Homes for Older People Page 14 of 35 Evidence: The AQAA told us that smoothies were provided as well as supplement drinks for people needing extra nourishment, with extra tea and coffee rounds. There was information in the kitchen area on which people needed particular encouragement to drink, and we saw staff encouraging people to drink plenty through regular but very pleasantly done prompting. We saw staff offer one person a doll to hold, which they looked glad to do. The manager said a specific type of doll had been obtained after discussion with a community psychiatric nurse, for the benefit of certain people at the home. Information for relatives or other visitors, on doll therapy, was available on a notice board. We looked at medication in relation to the people we case-tracked. Three of the four were on relatively little medication. The manager confirmed that GPs were now carrying out reviews of peoples medication at regular intervals. Records were kept of medications received into the home and returned to the pharmacy for disposal. Someone was prescribed medication with a variable dose, but the dose given by staff had not been recorded. We saw two carers carried out medication rounds together on the ground floor. We were told that this was so that people were given their medication on time. We were also told that only the senior carers dealt with medication. There were minimal stocks of controlled drugs and refrigerated medication. Generally records we saw for these were completed as required. The records of daily temperature readings indicated the refrigerated medicines were stored at appropriate temperatures. The home has appointed a staff member as a Privacy & Dignity champion, and they were meeting with the domestic staff team to discuss this shortly. Care staff told us that dignity had been discussed at a staff meeting the previous week. The expert by experience made the following observations: When I was shown around, staff knocked on room doors before entering and knocked on bathroom and shower room doors before showing me in. When I visited people in their rooms, again I observed the care staff and housekeeping staff to knock on doors before entering, and to show respect for privacy by closing doors, not interrupting conversation and leaving quietly. All the people I visited in their own rooms had the doors held open by a fire safety door closure device; they all said that they preferred the door to be open, Care Homes for Older People Page 15 of 35 Evidence: but doors were closed when needed for privacy. People told us they were consulted about the care they received, and said it was very good. When I asked people about personal care they received, they were satisfied with the way that the care was provided, including the opportunities that they had for baths and showers. All the people I saw at the home looked cared for; they were appropriately dressed, with good footwear and hair well groomed. Some people were wearing jewellery and make-up, which they had chosen and this seemed very important to them, even the more frail people at the home. One person I visited had a notice on their door asking people to knock, and they didnt wish to talk to us. But their room was well set out, and they looked very comfortable and cared for. When the expert asked some ladies how they felt about being given personal care by the male care staff in the home, the following were representative comments: The male staff are very good on the whole and I am used to the male care staff and I am happy for them to care for me. Asked generally what the home does well, one person living there said Care with kindness. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are various opportunities for fulfilment and for people to exercise choice or control of their lives, in line with individuals interests, preferences and capacities, although opportunities are not always used by staff, so people may miss out on positive experiences that enhance their wellbeing. Links are maintained with peoples families, friends and the community around the home, helping them to benefit from therapeutic relationships. The home provides an appetising and nutritious diet, although dining experiences are not the same for everyone, which means people do not have equal opportunities to enjoy and benefit from mealtimes. Evidence: The expert by experience told us the following: I spent most of my time at the home on the upper floor where those people who have more severe memory problems spend the day. Activities are provided for people with dementia and the activity I observed was appropriate for the group, who were treated with respect and dignity at all times. Information I was given about other activities showed there was variety and some work to try to help with memory loss. Staff took time to sit and talk to people appropriately as needed and as time allowed. I joined a hand massage session, where the people in the group all appeared to have Care Homes for Older People Page 17 of 35 Evidence: quite advanced memory problems. They all seemed settled within the group, and comfortable within the environment. The group was being run by the activity coordinator; she told me that she was qualified in aromatherapy and regularly offered hand massage and aromatherapy sessions to the people at the home. Relaxing music and restful pictures were being shown through the television as a background to the session. One lady came into the room, upset and crying. Someone came to sit with her and tried to find out what was wrong, offering support in a sensitive way. More staff joined the group to help serve drinks, with everyone asked what they would like to drink. Those who needed help were given help, and those who were likely to spill their drink were given tabards to protect their clothes, which were removed afterwards. People were offered a second drink and these were given, with biscuits of their choice. Those people that were involved with the hand massage appeared to be enjoying it; they also appeared to enjoy and were participating in the general conversation that ran alongside the session. People I visited in their rooms were all engaged in some form of individual activity such as watching TV, reading the newspaper, listening to classical music, reading a book. Everyone was quite happy with how their morning had gone. A small group of more able people were taken shopping (to get the flowers for a flower arranging session that day). Items made by people during art, craft and pottery groups were on display around the home. I was shown a scrap book and items used for reminiscence work. I was told by people that the Donkey Sanctuary visited the home quite regularly and this was always very enjoyable. Other comments made about activities at the home included: I really like the quizzes that we have; they help to keep my mind active, The art and Tai Chi groups are very good and also the singers, The pianist who comes in is very good, I choose to spend time in my room I like listening to classical music and reading the paper, I have only been here a short time, I like to be in my room and enjoy my TV programmes. Minutes of the last residents meeting included discussion of activities arranged for September. These included belly dancing, a visit by staff from the local museum, and poetry reading. The home has invested greatly in provision of activities, and is particularly pleased with a large electronic digital photo frame sited in the entrance hall. Throughout the day, this showed photos of various recent events at the home, which staff told us people enjoyed looking at. Care Homes for Older People Page 18 of 35 Evidence: We saw care staff spending time with people later in the day in the upper lounge, giving them colourful sensory items with unusual textures, or encouraging them to catch and throw a ball. The television was on, showing a film, but with no one watching it. A carer stopped one person handling spoons left on a table, but did not offer something else for them to handle or do. Someone twice got up and walked from their armchair, but staff returned them to their chair each time without offering to help them have a walk, though walked with them to the toilet later. On other occasions, when people were restless, another staff member got a book - of several made by staff from pictures of interest - which the person was happy to accept after the carer showed them its contents; another person was pleased when given magazines by the same carer. At one point during our observation time, music was playing in the conservatory. A carer entered the adjoining lounge and put on music there. People sitting near the door from one area to another were thus particularly having to listen to both Vera Lynn and ragtime music at the same time. We also noted that people were given biscuits, when drinks were given out mid-morning, rather than being offered the opportunity to choose their own. Someone later pointed out that they didnt like the particular biscuits they had been given so had left them. The expert commented: There were notice boards in the large dining room giving details of the menu for the day, details of planned activities, and photographs of events that had taken place in the home. I observed staff addressing people appropriately and by name, giving them information about what was happening and giving them an opportunity to make choices. The people that I visited in their rooms, all had small items of furniture, pictures and photographs which they had brought in with them. Everyone I visited was happy with their room and how it had been arranged, they were pleased to have familiar things around them. Staff told us activities were planned Monday-Friday, with people tending to have visitors at week-ends and the homes church service taking place then also. People told us that their visitors were made to feel welcome. The manager told us she is at the home some week-ends so that she can meet peoples relatives. People that the expert visited in their rooms did not know what was on the menu for lunch that day. Menus were displayed in 3 areas of the home, and we were told that staff asked people what they wanted. Staff had also made a book of pictures of food which they said was used to promote discussion around food and individuals food Care Homes for Older People Page 19 of 35 Evidence: choices. The expert ate lunch in the main dining room with some of the people who lived at the home. She observed the dining room was well set out, bright and cheerful, with cloths on the tables, cutlery, condiments, water and small flower arrangements created by people living at the home. She found the meal was appetising, nutritious and tasty. It appeared people were not given a choice for their main course, with plated meals given out, but a choice of pudding was offered, as well as cheese and biscuits, with tea or coffee. People she spoke with afterwards were all very complimentary both about the food and about the home in general. We also observed lunchtime in the dayroom upstairs, where there were people with greater needs. In both dining areas, staff were unhurried yet concerned for individuals. Both areas had a relaxed atmosphere, with socialising between residents during the meal. People who needed pureed meals were served the different pureed vegetables and meat separately on their plate, so they could enjoy the different colours and flavours in the meal. Staff upstairs patiently and repeatedly explained someones cutlery to them, which enabled the person to feed themselves independently given this support and time. Meals were plated in the upstairs dining room, but serving trolleys were very close to individuals - obscuring one persons view of the room, with plates scraped off in the proximity. Someone was fed by a carer using a relatively large spoon, with the next mouthful offered before the person had finished eating the last one. Staff simply said it was pudding when giving one person their dessert. Another person, who also was not offered a choice or told what pudding they had been given, asked staff what it was, and was then told. Someone we met, who had only been at the home a short time, had problems using their hands and was very pleased to have been given special crockery and cutlery. They said this helped them and prevented them from spilling food, which had worried them a lot. We asked staff about offering choices at mealtimes. One said they were supposed to ask people in advance, with a menu provided, except at lunchtime. At lunch, if people didnt like what they were offered, they could have an alternative like a salad or omelette. Peoples known preferences would have been taken into account ahead of the meal - staff cited examples of current residents who didnt like fish or pork, who would be offered an alternative dish anyway. We saw a list of peoples likes/dislikes in the kitchen. Care Homes for Older People Page 20 of 35 Evidence: People we spoke with liked the food, and people in both dining areas looked as though they were enjoying the lunch. One said they were not given a choice of food or drinks, but added that the staff were very nice and they felt sure they would bring an alternative if someone asked. The manager said that although there was no stated choice on the lunchtime menu, the seniors checked with individuals in the morning that they still wanted the meal of the day. The cook was also available during the serving of the meal, checking that no on wanted something different, and we saw her making someone a side salad during our visit. We also noted that some people seemed able enough to serve themselves - if dishes of vegetables, for example, were provided. The manager said that people in the third dining area helped themselves each meal, and teatimes were usually an opportunity for anyone to help themselves if they wished. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes policies and practises ensure complaints, concerns and opinions are heard and acted upon. Staff lack some knowledge about local safeguarding procedures, so people at the home may not be as fully protected from harm as possible. Evidence: People we asked said they would feel able to speak up if something was wrong or not as they wanted, but added the situation had not yet arisen. We saw some versions of the complaints procedure did not have any timescales included, or a phone number for making a complaint (although an address was given) for people who may not be able to make a written complaint. The manager said she would look into this. We have not received any complaints about the home since our last inspection, and there have not been any safeguarding investigations. The homes AQAA stated the home had received 1 complaint in that time, which we saw from the homes complaints records had been resolved. People said they felt safe with the staff. Staff were aware of what constitutes abusive practise and that they should report any such actions or behaviour if they witnessed it. They knew who in their organisation they could report concerns to, but were not entirely clear about organisations outside the home that they could contact if necessary. We noted that the workbook on safeguarding, used for induction of new staff, did not include local reporting procedures. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a clean, well-maintained and homely environment, which is improved and adapted in line with their needs. Evidence: The expert made the following observations: The home was very bright, clean and homely, with good carpets and soft furnishings. There were good signs on room doors, etc.; some rooms had photographs beside the door as well as a name. Bathrooms and toilets have been made more homely and welcoming through the use of colours, tiling and use of light. New carpets in bedrooms are not patterned, to avoid causing perception problems for people with dementia; the manager said such consideration would be given when re-carpeting communal areas. People we asked said they liked their bedroom and were satisfied with its facilities (lighting, hot water supplies, etc.). They confirmed that they were satisfied with the levels of cleanliness at the home. Staff said one area of the home had some problems with the time taken for water to run hot. The manager had already told us that new boilers were being installed soon. Staff told us that repairs were addressed quickly, and that the handyman was very efficient - checking plugs of appliances, etc. Care Homes for Older People Page 23 of 35 Evidence: We saw various adaptations around the home to promote peoples independence such as raised toilet seats and handrails. The home has level access showers as well as baths adapted for people with mobility problems. A platform lift has been fitted since our last visit in one part of the home where previously there was only stair access. Although the main entrance does not have level access, there is another wheelchair-accessible entrance, and ramp access to the garden. There are paths in the garden that follow a circular route, or that go from one door to another, helpful to people with cognitive problems who wish to walk unescorted. Minutes of the last residents meeting included approval of recent changes made in the garden areas. In surveys for people who lived at the home, 2 said it was usually clean and fresh, with 3 saying it was always clean and fresh. We also found the home looked clean, with three housekeeping staff working around the home during our visit. Staff told us that they used disposable gloves when helping people with personal care. We saw disposable gloves and aprons, with hand-washing facilities and special bags for soiled laundry, around the home. At the time of our visit, laundry staff had been employed Monday-Friday, with care staff covering at week-ends, but we spoke with someone who would be working one day at week-ends. The manager told us recruitment was ongoing to provide cover all week-end. The laundry area was orderly. The washing machine programme in use showed that appropriate measures are used for dealing with soiled laundry, to ensure it is cleaned thoroughly. The staff member on duty clearly knew the appropriate programmes to be used for different loads. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from development of the staffing arrangements at the home, which ensure that they are looked after safely and well. They are protected from unsuitable staff by the homes robust recruitment procedures. Evidence: The expert reported: On the day of the visit, the Manager was on duty, also the Care Manager, Team Leader, and 2 activity co-ordinators. I was told that there were 3 care staff working upstairs with 20 residents (including 2 people who were fairly independent and needed minimal support,) and 5 care staff downstairs for the remainder of the residents. In addition to care staff, there were housekeeping staff on duty. Everyone in the home looked well dressed and well cared for, with attention to detail for their clothes, hair makeup and jewellery etc. which could indicate adequate staff time. People who were in their rooms all had call bells and all were satisfied with the general level of response to their calls. The staff appeared busy, but they were orderly and organised, and drinks, meals and medication were being given out at appropriate times. They were very welcoming and polite in their response to me. Comments about the staff, from people living at the home, were very positive - The staff are very kind, and The staff couldnt be better - theyre a grand bunch, for example. Care Homes for Older People Page 25 of 35 Evidence: Staffing levels did seem adequate, but I feel that the nature of the building with its many rooms and corridors could create problems for staff to be able to observe and support people at certain times during the day. On the day of our visit, care staff were also supported by an administrator, a maintenance person and kitchen staff, in addition to housekeeping staff and activity co-ordinators. Staff rotas for the week of our visit confirmed that there were usually 9 care staff on duty in the morning, 7 in the afternoon, 6 in the evening and 4 staff overnight from 8pm, for 48 people. Care staff told us it could be busy at times, but also told us that staffing levels had been increased (from 3 staff) at night-time. Day staff said this helped them because people who wished to stay up later in the evening could receive help at a more appropriate time. The housekeeping staff said they helped the care staff - by removing peoples breakfast trays, for example, which also helped housekeeping staff to get to know everyone. A relative commented that all staff, including the manager, make a continuous effort to ensure all residents are well looked after. Of 4 people who replied to our survey question, 2 said staff were usually available when they needed them, and 2 said they were always available. Of staff surveys, 4 of 5 respondents thought there were always enough staff on duty. We checked the files of 3 staff members (care and ancillary staff) recruited since our last inspection, all of who were employed in the 3 months prior to our visit. Each file contained required information such as two written references, proof of identity and police checks - all obtained before people began working at the home, as is good practise to ensure that suitable people are recruited to work in the home. Interview records showed gaps in peoples employment history were discussed. We saw they underwent an induction relevant to their role, as well as receiving training on safe working practises; two had had training relevant to working with people who have dementia or confusion. A new staff member confirmed their induction had been useful. A training matrix was kept, providing an overview. This was monitored by external management, we were told. The current training programme included palliative care, nutrition, and equality and diversity. The manager also told us that staff meetings included question and answer sessions, with speakers such as a Community psychiatric nurse and a psychologist invited. Staff surveys indicated they thought they had the training they needed. Care staff we Care Homes for Older People Page 26 of 35 Evidence: spoke with said theyd had training on subjects such as helping people with eating difficulties (training given by by speech and language therapists), safeguarding and fire safety, and that this had been relevant and helpful training. The manager told us that all staff, including ancillary staff, undertook training entitled Caring for confusion and on safeguarding. A new staff member working in the laundry told us they had had training on fire safety and safe handling recently. Some staff were undertaking an accredited distance-learning dementia course through a Devon college. The AQAA stated that more than half of the care staff have now achieved a recognised care qualification. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people living there, with action taken to promote the health and safety of everyone at the home. Evidence: Sue Gooding, the registered manager, was registered by the Commission in July 2007. She had previous management experience in hospital and care home settings, mainly in working with older people and people with sensory impairment, and she has a post graduate certificate in management. She has more recently undertaken an advanced first aid course, and, with other staff, undertaken the distance-learning dementia course. A Community Psychiatric Nurse we spoke with noted the improvements in care since Sue Gooding was appointed, particularly in the homes ability to care for people with more complex or challenging behavioural needs. Staff we spoke with found her approachable and helpful. Staff surveys indicated they felt they were getting good support, in various ways, to help them look after people well. Care Homes for Older People Page 28 of 35 Evidence: Comments about the home, on surveys from relatives of people who lived at the home, described the home as Cheery, Friendly and Happy. It was very positive that the AQAA referred to the views of people living at the home for evidence of what the home was doing well. In places, we noted there was little information on what the home could do better and for self-assessment of certain core standards. The expert reported: One person told me about meetings they have with the manager, saying We have a residents group and people are able to meet with the manager, about every two weeks, there are about ten or twelve people who attend regularly. We talk about food and general things. The manager is wonderful and we can tell her any worries we have. Weve recently asked to have baked beans and croquette potatoes added to the menu and were all very pleased that this has happened. The person I spoke with felt that the group tried to reflect the general views of people living at the home as far as possible and anyone could attend. Staff told us that there were staff meetings for both day and night staff groups, and that they felt they were listened to if they made suggestions or raised issues at these meetings. An annual questionnaire was sent out by the home to people who lived there and their families or representatives. The action plan based on peoples responses was shared at residents meetings, as well as being put into the Service User Guide. The manager was in the process of addressing individual points raised in the latest surveys, most of which were not anonymous. The home does not act as appointee for anyone living there, leaving people to retain control of their finances as they wish. Some people hand personal spending monies to the home for safekeeping or for minor expenses. Receipts had been given for such deposits. We checked cash balances and records held for three people, and found these tallied. Two signatures had been obtained to verify transactions recorded, with corresponding receipts available. Peoples outgoings included hairdressing, purchases from a mobile clothing shop, toiletries, tuck and the cost of staff escorts to hospital appointments. When more personal monies were needed for an individual whose finances were managed by someone else, a copy of the record sheet was sent with the request for more funds. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. The manager said they had spoken with relevant Care Homes for Older People Page 29 of 35 Evidence: professionals about one matter but had been told they did not need an authorisation. There were capacity assessments and assessments in relation to deprivation of liberty in the care plans of those we case-tracked, although some hadnt been fully completed yet. We found from the homes accident records that 61 accidents had been reported in 67 days. Only one serious injury has occurred since the beginning of this year, however. Recent records for those we case-tracked showed they had fallen, but with no obvious common cause; two had fallen at times of day when there were less staff on duty. Staff we asked about accidents and falls told us about one person who had a medical condition that caused them to fall. They said that they would report any hazards they encountered in their workplace, and also pointed out there were relevant risk assessments in peoples care plans. We noted that there was the same guidance on minimising individuals risk of falling in all these risk assessments, whether the person was deemed at high risk or low risk. The manager said this was because the highest level of measures was applied, regardless of the level of risk. Staff we spoke with confirmed they had been shown how to use the equipment needed to move some people. The manager told us a physiotherapist was employed to hold a fortnightly exercise class for people living at the home, and to see residents that staff referred to her (which included all new people), arranging necessary equipment or aids for them as required. Accidents were audited monthly, although we could not look at recent audits because these were currently with the managers line manager. Where causes of falls had been identified, we were told action had been taken such as using pressure mats after consultation with peoples advocates and GPs, a carpet had been changed to plain flooring, white marking had been put on the edge of steps on the main staircase, and medication reviews by GPs had taken place. The manager said she had risk assessed and increased night staffing, partly because of the falls audits and since a visit by the fire service. We noted that the laundry door (labelled a fire door) wasnt closing properly, which the manager said she would get addressed immediately. The log of fire safety checks showed these were recorded regularly; the manager confirmed the weekly checks were supposed to include fire doors and exit routes. The AQAA indicated that servicing of appliances and facilities was up to date except for Care Homes for Older People Page 30 of 35 Evidence: heating and gas appliances. This evidence has now been provided. A file in the kitchen had health and safety information on cleaning products used in the area, as well as risk assessments which were reviewed earlier in the year. The area was clean and orderly. We noted leftovers in the fridges were covered but not dated, which we brought to the managers attention. The home had been inspected by Environmental Health Officers within the last year and it appeared, on our visit, that the home had addressed the recommendations made. The homes Health & Safety committee, made up of staff with different roles within the home, had an input into the training offered to staff. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must ensure that there are effective arrangements for the recording and administration of medicines, especially regarding Recording administration of variable dosage medication with inclusion each time of the dose given 02/11/2009 So that peoples medicines are managed safely and their health needs are met. 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 7 It is recommended that there is sufficient information in each persons care plan about the individuals care needs and how to meet them, to ensure people receive all the care and support they need, consistently. It is recommended that all care plan evaluations indicate the outcome or effectiveness of planned care, enabling Page 33 of 35 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations properly informed reviews of care plans. 3 12 It is recommended that you continue to develop the skills of care staff so that people are offered every opportunity for fulfilment through leisure, recreation or meaningful activities. It is recommended that dining arrangements are further developed to ensure everyone at the home enjoys the same opportunities, choices and pleasant experience at mealtimes. It is recommended that, by training or other means, staff know local multi-agency safeguarding reporting procedures, to ensure the home has robust procedures for responding to suspicion of or evidence of abuse. 4 15 5 18 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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