Care Home: Parklands

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What the care home does well The service has good information for people who are thinking of moving to the house. There is also good communication with people who live there and their families, for example through regular resident`s meetings. People using the service have good, varied and nutritious food, as well as plenty of snacks and drinks. The service manages complaints well and protects the people who live there. Staff are recruited using thorough background checks. People using the service feel safe and know who to go to if they have a concern. The manager of the service recognises where improvements need to be made and works hard to achieve them. She ensures that the service is safe for the people who live there. What has improved since the last inspection? The service has worked hard to achieve most of the recommendations from the last inspection. Improvements have been made to how people receive support with their health and personal care. People`s care plans are detailed and give staff good information. Records show that people`s needs are met and when there are changes the service acts quickly. There is now more flexibility in people`s daily routines, for example they have choices about when to get up, meals, showers and other daily tasks. The manager uses a training plan and is making sure staff training is up to date. What the care home could do better: People using this service need very different amounts of support for their physical and emotional or mental well being. When people have high physical needs a lot of staff time is spent supporting those people, which takes them away from others who may require emotional and social support. Some people using the service have very little opportunity for stimulation inside and outside the house. There is little activity on an individual level and this means people`s individual social needs may not be being met. Staff should have regular supervision meetings with senior staff. This will support them in meeting the needs of highly dependent people and provide opportunity to identify how the service could improve its social activities. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parklands Callow Hill Lane Callow Hill Redditch Worcestershire B97 5PU     The quality rating for this care home is:   two star good 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: Emily White     Date: 1 6 0 1 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Parklands Callow Hill Lane Callow Hill Redditch Worcestershire B97 5PU 01527544581 01527544393 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Steven Sadhra Name of registered manager (if applicable) Amanda Jayne Wood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Parklands is a large, detached property situated in a secluded, rural setting on the outskirts of Redditch overlooking the Worcestershire countryside. The property stands in several acres of ground surrounded by lawns and woodlands. There are car-parking facilities at the front of the premises. The house has been adapted for its current purpose as a residential care home. The residents are accommodated on the ground, first and second floor of the premises in 7 double bedrooms and 17 single bedrooms. Six of the 7 double bedrooms and four of the single bedrooms have an en suite facility. The home has a passenger lift to assist the service users to gain access to the accommodation above ground floor level. Communal lounges, dining facilities, Care Homes for Older People Page 4 of 34 care home 31 Over 65 6 12 12 1 0 0 Brief description of the care home bathroom and toilet facilities are also provided. The home is registered to provide personal care for a maximum of 31 service users. This includes 30 older people above the age of 65 years of whom 6 may be people with a dementia illness and 12 may be people with a physical disability. The homes main aim is to provide a high standard of care for older people based on individual needs in a homely and comfortable atmosphere while endeavouring to ensure that the residents retain their self-respect, individuality, privacy and independence. The fees are indicated in the service user guide ranging from £380 to £460 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the service we looked at the Annual Quality Assurance Assessment, which is information sent to us by the service. This tells us what they have been doing to improve and their plans for improvement in the coming year. We also looked at other information sent to us by the service since the last inspection. We visited the service over two days and met people using the service, the manager, deputy manager, and staff. We looked at support records, looked around the house and spent a lot of time observing daily life. We also used a formal observation called the Short Observational Framework for Inspection. We use this because some people using the service are not able to tell us directly about their experiences. This involves us observing five people using the service for two hours and recording their Care Homes for Older People Page 6 of 34 experiences at regular times. This includes their state of well being, how they interact with staff members, other people and the environment around them. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 34 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an assessment of their needs before they move, so that the service can be sure it can meet the needs of everyone. People have information about the service before they move. Evidence: We looked at the information given to people before they move to Parklands. Everyone is given a copy of the statement of purpose and user guide, which is available in the hallway of the house along with the most recent CSCI inspection report. We spoke to some people who live at Parklands who all said they had enough information about it before they moved. Most people had not visited before but all said their families had visited and that they had an opportunity to change their minds once they had been there a while. The manager gives people a questionnaire which asks about their move to Parklands. This includes questions on the information given, whether people were made to feel welcome, whether they understand the terms and conditions. We only Care Homes for Older People Page 11 of 34 Evidence: saw a blank copy of this questionnaire but the manager tells us the responses are collected as part of their checks that standards are being kept up to date. The Annual Quality Assurance Assessment tells us that a full assessment of peoples needs is carried out preferably at Parklands, and the manager attends hospitals and peoples homes as needed. Following this assessment, if someone moves to Parklands a care plan is completed within 24 to 48 hours. We looked at the assessments that had been completed for some people who had moved to Parklands within the past year. The assessment covers all areas required in the National Minimum Standards, including peoples physical needs, mental health needs and how many carers are needed for support. We saw that notes are made of peoples social interests, hobbies, religious and cultural needs. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who know them and respect their privacy and dignity. There have been improvements in the way peoples health and personal care is monitored. Where there are gaps in recording, the service is aware of this and is addressing the issues. Evidence: People who live at Parklands have very varied needs, for example some people can care for themselves with some support, others have communication difficulties arising from dementia and others have very high physical needs requiring care in bed. The last inspection report identified some areas for improvement so the service could meet peoples varied health and personal care needs better. We looked in detail at records for four people with varying support needs, and spent some time talking to and observing people who live there. The last inspection recommended that peoples care plans should be more detailed and should be more regularly reviewed with peoples representatives if needed. The Annual Care Homes for Older People Page 13 of 34 Evidence: Quality Assurance Assessment tells us that the care plans have been updated and the new key worker system means that care needs are being regularly reviewed. We saw that care plans contain a lot of detail about peoples needs, including their personal details, their preferred daily routine, their life history and identity, contacts with family and health professionals, as well as their physical care needs. Peoples preferred daily routine includes what time they like to get up, where they like to sit and who they like to spend time with. While the care plans are now very detailed, we noted that some details were missing from a few plans, such as a photo, a signature or family contacts. It is important that staff ensure all details in the care plan are complete as soon as possible after someone has moved to the service. There are monthly reviews which are carried out by the persons named key worker, which is a member of staff designated to take special interest in their needs. The reviews cover the persons relationship with others, sleep, eating, and if the care plan is working. We saw that reviews are being signed by the person, their key worker, senior staff, and family if present. Two of the four people we looked at had reviews missing throughout the previous year. The last inspection raised concerns about the detail of staff recording, health assessments being kept up to date, and assistance for people who need help with eating and drinking. The manager tells us that shortly after the last inspection a speech and language therapist helped the service to provide appropriate eating and drinking aids, for example some people now have thickened fluids and syringes are no longer used for drinking. We also observed people using cutlery to assist grip and appropriate cups for drinks. We saw that the majority of health care records are being kept up to date. Care plans contain further details of personal care and support needed, health and psychological needs, and specialised services needed such as hearing aids. Risks around nutrition, pressure areas, falls, allergies, and behaviour are clearly identified and have detailed information for staff about what to do. Staff keep a monitoring sheet for 72 hours after an accident which shows that concerns are being followed up. Records show regular professional visits with input from the chiropodist, GP, psychiatrist, and district nurse. The service is also completing and updating nutritional screening, pressure area assessments, food and fluid charts where necessary, and falls risk assessments which are all monitored monthly. It is clear that improvements have been made although some staff are not always following up consistently. We noted that two peoples nutritional assessments have not been completed because the staff are unable to weigh them. We saw that one person with frail skin did not have a body map although this is being done for others. Manual handling assessments have not been completed Care Homes for Older People Page 14 of 34 Evidence: for two people who require special equipment for movement from bed. Daily notes recording by staff has improved, and shows awareness by staff of what to do when someone becomes ill or their needs change. Some staff are writing comments such as fine today or quiet but others give more detailed reasons for behaviour, with good reports of mood and mental well being. Where there are concerns staff are recording in detail, for example when an ambulance has been called. However, for two people, where there are detailed notes from staff about doctors visits, they have not recorded this visit under the section for communication with outside health professionals. This is an important summary for all staff and should be completed particularly where there is a health concern. We spoke to and observed some staff during the day. Staff clearly know people using the service very well, and were able to discuss health concerns and peoples care plans with us. However some staff are less confident about recording in daily notes and reviews. It is important that the staff member responsible for caring for a person writes in their care plan, so the notes are an accurate picture of their care for that day. We discussed with the manager and deputy manager some of the oversights that we saw in the care plans. The deputy manager has carried out an audit of all the plans and has a list of areas to be improved. This list includes all the areas identified in this report, including signing, photographs, records of professional visits. There is a staff meeting planned to discuss the issues. When we spoke to staff they were aware of the staff meeting and what it would be about. This previous inspection raised concerns about the management of medication at Parklands and recommended that the system be improved to enable audits to be taken. The Annual Quality Assurance Assessment tells us that medication procedures have improved and regular monitoring continues by the manager to ensure the medication policy is adhered to. We looked in detail at some people medication records. In their care plans people have a current list of prescribed medications, a past medical history, and homely remedies guidance. One person uses a controlled drug which is in appropriate storage. Creams are stored in bedrooms, are dated when opened and thrown away monthly. We looked at the medication trolley and saw that everyone has a photograph and a list of prescribed medications. Senior staff check the administration records daily and the manager audits them monthly. We observed lunchtime medications being given, we observed staff handing people their tablets with a drink, making sure they have been taken and recording this appropriately. The Annual Quality Assurance Assessment tells us that people are involved wherever possible to make their own decisions and family or relatives are also involved in this Care Homes for Older People Page 15 of 34 Evidence: decision making. Privacy and dignity of residents is respected for example knocking before entering peoples rooms. During our observations of staff we noted that peoples privacy and dignity is respected. We saw people being taken to the toilet from the lounge, in a sensitive manner, for example staff whispering in the persons ear. There is sensitive use of mobility aids for example one person is helped to walk to the toilet with a frame, but another staff member walks with a wheel chair behind in case they get tired. Daily notes observe moods and emotional well being, and are written in a sensitive manner. One person using the service tells us staff are very good, sensitive, help me do what I can myself. We observed staff responding appropriately to questions from people using the service. The manager tells us that as far as possible the service tries to respect peoples wishes to remain in their home at the end of their life. This means that some people living at Parklands may require palliative or end of life care. We looked at records for one person whose care plan has been stopped as they are near the end of their life. Daily records for this person are very detailed and the monthly reviews are being used to update care needs. These records show appropriate care is being given, for example a bed bath, mouth and eye care, and district nurse visits. There is also careful documentation of family requests for treatment. It would be good practice for the service to have a clearer palliative care plan set out for people nearing the end of their life, which clearly demonstrates the involvement of relevant outside health professionals. This would show that all staff are familiar with the principles of end of life care and can put them into practice when needed. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences for their daily lives and social activities are well recorded, and care plans are personalised. The service must consider its resources so that it can provide the appropriate level of activity to meet everyones recorded preferences and needs. Evidence: The last inspection report recommended that the activities in and out of the home are developed so that peoples individual interests are recognised, and that an activities coordinator should be appointed. The Annual Quality Assurance Assessment tells us that staff have greater input with activities since the key worker system has been up, with a broader range of activities to take into account peoples different skills, hobbies and enjoyment. We observed that there is a notice board in the hall with activities, and in both lounges there are boards with the date, weather and season in clear letters. During our visit we spoke to several people using the service and staff, and spent a large part of the time observing life at Parklands in the morning and afternoon, in the dining room and two different lounges. The observations show that some people have a positive experience, but for a large part of the day people are passive, which means Care Homes for Older People Page 17 of 34 Evidence: showing no signs of positive or negative mood. Most peoples activity outside of mealtimes involves watching TV. For most of the time there is very little interaction with staff, and often interactions are about practical things like offering sweets or drinks or to help to the toilet. We note that the TV is on very loud which may be to accommodate those with hearing impairments, however there is no area for quiet activity, as the conservatory area is not in use. We did not observe any individual activity taking place, and note that staff presence in the lounges is often limited to one staff member. For example, during our visit one member of agency staff stood by the door for some time watching the room. During the afternoon we sat with one person who was asleep and another person whose care plan states she does not like television. During the afternoon there was very little interaction with these people, and the television played childrens programmes. The activity notice board for the days of our visit said board games and pampering. During the afternoon we observed people watching a quiz on television, and responding to the questions. During this time staff turned the TV off to announce an activity without asking if people wanted it. The activity was 45 minutes of play your cards right and hang man. We spoke to staff about the activities at the service, and comments varied. Staff generally tell us that activities could be a lot better, there is no equipment such as board games and there are no individual activities, only group activities. Some staff are very enthusiastic about activities and others consider an activity to be just playing music. We observed some examples of good practice. Although people using the service found it difficult to tell us about the activities on offer, several people spoke enthusiastically about the recent parties and summer fair. During the activity session we observed staff getting good responses from people, directing questions to encourage people to join in. In the morning some residents chatted to each other and obviously felt comfortable with each other. Peoples cultural needs and social activities are identified in their care plans, for example needs to sit with others who like to talk. We observed this being carried out in the lounge. Activities are not recorded on an individual basis, and peoples daily notes do not reflect the social side of their life at Parklands. However the manager keeps an activity monitoring file which records group activities and who has taken part. Examples of activities are group discussion, music, play your cards right, films, reminiscence, extend exercises, and pampering. The manager has started to make improvements, and has been able to get some outside entertainments to visit the house and organise parties and events. Following the success of a visiting animals day, the manager has considered purchasing a cat which may be of benefit to people using the service. The service is also trying to recruit an activities coordinator. However we did not see Care Homes for Older People Page 18 of 34 Evidence: enough evidence to support the service guide which says there is strong emphasis on structuring leisure time, our activities organiser will advise on how individual residents can pursue their own hobbies and interests and participate in group activities. A range of activities is offered. We discussed the possibility of using the budget for the activities coordinator more creatively with existing staff who show an interest in activities. The previous inspection report recommended that there should be more opportunity for people using the service to go out into their local community. The Annual Quality Assurance Assessment tells us that people can keep in touch with family and broader community through the open visiting arrangements for families and relatives. Any external transport to accommodate wheelchair users is booked as and when necessary. However we did not see any evidence to show that people are supported to go out into their local community on regular trips or walks. The previous inspection report recommended that peoples individual choice, preferences and daily routines should be promoted and recorded. The service has improved the way it promotes peoples autonomy and choice. For example people have a detailed preferred daily routine in their care plan which covers for example preferred time of getting up, preference for breakfast in dining room or bedroom, preferred dining room companions, time of day for bath or shower, particular interests and ways to help, preferred time to bed, preference to read or watch TV. People have a life history which records what matters to them, important events, who they are now, and what is unique and individual about them. We discussed these with some people sing the service who all said for example, I can do what I like, go to bed whenever, staff are friendly, I can speak to them about anything sometimes we have a laugh. We also note that some people have keys to their own bedroom. The last inspection report recommended that people have a daily menu, choice at all mealtimes which includes nutritious foods, appropriate assistance from staff that know them and a record is kept of what individuals eat. During our visit we observed that all of these have now been put in to place. The Annual Quality Assurance Assessment tells us that the house has an experienced cook who provides good nutritious menus with choices. There are three meals and snacks and drinks each day and special diets are catered for. We saw that in peoples care plans any dietary needs are detailed and the kitchen staff are aware of them. The cook is aware of everyones personal preference and also keeps a record of what everyone has eaten that day. People using the service tell us there is a lot of choice and the food is very good, its nice and nice lunch. We observed a lunch time where people had the appropriate assistance from staff. One person showed distress and a staff member comforted her and helped her move to Care Homes for Older People Page 19 of 34 Evidence: another place where she was more comfortable. We note good staff interactions over dinner, for example pointing out things on the plate, asking if someone would like it cut up. However we also noted that some people waited half an hour from sitting down until they had their lunch, one person commenting that she is always left till last and always has to wait for food. We also noted that there was a CD playing during lunch which began to skip and was not addressed by staff for some time. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints are listened to and acted upon. Improvements have been made to training so staff are more aware of how to protect the people they support. Evidence: The Annual Quality Assurance Assessment tells us that everyone using the service is informed of the complaints and concerns procedure. Complaints are listened to and taken seriously and issues are discussed at an early stage. It says the service deals with allegations and complaints swiftly following their procedures. Staff and families are familiar and confident about how they can make complaints, and that any complaint made will be taken seriously. During our visit we saw that the complaints procedure is available in the guide and in the hallway. We spoke to people using the service who know how to complain. There is a complaints log, which records that there have been no complaints. The last inspection report recommended that training for staff in safeguarding vulnerable adults should be updated. The staff training pan shows that many staff have had safeguarding training in late 2008 and some staff are due to have the training this year. The Annual Quality Assurance Assessment tells us that training is planned for updates on vulnerable adults on an ongoing basis, and the service plans to include protection of vulnerable adults in staff supervision sessions. We spoke to staff Care Homes for Older People Page 21 of 34 Evidence: who understand the meaning of safeguarding, and whistle blowing, and know what to do if they are concerned about the well being of people using the service. The service notifies CSCI of any incidents that affect the well being of people using the service, and incidents are followed up appropriately. We discussed the Deprivation of Liberty Safeguards with the manager. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the house and its cleanliness. There is a maintenance and improvement plan which the service should complete for the house to be fully accessible for the people who live there. Evidence: The previous inspection report recommended that the seating arrangements in the main lounge should be reviewed, and there should be a review of the home, bathrooms and gardens to ensure that all areas are suitable for frail people to use and where necessary specialist equipment and environmental adaptations provided. It also recommended that the advice of a qualified occupational therapist should be sought to assist in this review. The Annual Quality Assurance Assessment tells us that the service has commissioned an independent occupational therapy audit of the home, and the ongoing maintenance programme is updated in line with improving the home environment. The Annual Quality Assurance Assessment also tells us that they have funding to improve the access to the back gardens of Parklands which should be finished by March 2009. Refurbishment of four ground floor bedrooms all with ensuite facilities has been completed, and furniture for the majority of bedrooms has now been replaced including new vanity units. Chairs have been replaced in the communal lounges and lighting changed in the communal areas. Care Homes for Older People Page 23 of 34 Evidence: During our visit we looked at the report by the occupational therapist which was a general assessment of the house and did not assess any of the individuals living there. We can see that work has started to improve the premises although there is still work to be done. We saw a newly decorated bathroom as an example, which is much more welcoming than the others which have yet to be redecorated. There are new mobility rails in place in all toilets, and coloured signage for downstairs bathrooms. Rooms have radiator covers throughout. The deputy and manager have been on a dementia training course and have plans for improvements to suit the needs of people with dementia, which include coloured toilet seats, signs in the lounges and dining room, redecorate the large lounge, obtain colour contrasting door furniture, more comfortable seating in the dining room and lever handle taps in bathrooms and toilets. The last inspection report recommended that some aspects of hygiene and infection control should be improved. The Annual Quality Assurance Assessment tells us that there is a continuous programme of cleaning and cross infection procedures. Training is provided in control of infection as part of health and safety training, and all staff are aware of the importance of prevention. The service has purchased an automatic commode pot cleaning system and has recruited two domestic staff. During our visit the house was generally clean with infection control practices being observed. On the upper floor we noted a rolled up towel with clothing inside left on the side, and a number of terry towels in bathrooms. Towels for communal use present a risk of spread of infection and should be replaced with paper towels. We note that infection control training was last completed in 2007 for most staff, and is planned for updates in 2009. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who are well qualified, know their jobs well and care about their well being. Staff are not spending adequate time with all people using the service due to the varied needs of those people. Evidence: The evidence gathered in this report under Health And Personal Care and Daily Life And Social Activities shows that people using the service have highly varied support needs which may be affecting the quality of life of those who are more able. Evidence shows that staff work hard to meet the health needs of highly dependent people, but on occasions recording is missed out or is minimal for those people who are more independent. Evidence also shows that few activities are provided for individuals and people spend a large part of their day without staff input. Where staff are involved, we observe that their interactions are functional and they appear to have little time for more positive interactions. The rota tells us that there are five staff on during the day, three from five until nine PM, and two waking night staff. During the late morning we were not able to find a member of staff to speak to, as they were all occupied with people using the service. When we spoke to staff, they confirmed that they spend a lot of their time with the more highly dependent people. Staff feel that health care and flexibility is maintained, Care Homes for Older People Page 25 of 34 Evidence: but activities and one to one time are difficult to manage. From observation staff do have the skills to interact positively with people using the service, but have little chance to do so. It is important for the service to consider flexible use of resources so that peoples social and emotional needs are not ignored when there are highly dependent people who also need to be supported. The Annual Quality Assurance Assessment tells us that the service has a thorough recruitment process and all staff receive a job description, handbook, induction training and regular updates and codes of practice. 50 of the staff have obtained a NVQ Level 2 or above. We looked at staff files and training records which confirmed safe recruitment practices and a high level of qualified staff. The Annual Quality Assurance Assessment tells us that the training plan clearly shows training planned, ongoing and completed. Staff files confirm this and show that there has been recent training in vulnerable adults, fire safety and manual handling. Five staff have undertaken level 2 training in dementia care, with plans for more staff to take this. We spoke to staff who say they are well supported with training, and are pushed by their manager to take further courses and improve their work. All staff have an individual training plan and keep their own portfolio, which includes an induction which meets the required standards. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a registered manager who has made significant improvements to the service and recognises where there are still improvements to be made. Evidence: The Annual Quality Assurance Assessment tells us that the management structure has greatly improved as the manager is now registered. Both the manager and the deputy manager are equally able to run the home and are supported by experienced team leaders. The Annual Quality Assurance Assessment identifies areas to work on including working towards person centred care planning and organise appropriate training for staff. We met the manager and discussed some of the changes that have been made. As identified in this report, many of the recommendations from the last inspection have been implemented or planned for improvements. Significant improvements have been made to peoples health and personal care support and changes so that routines are more flexible. The manager recognises that some staff have struggled with this and with the idea of person centred support. Care Homes for Older People Page 27 of 34 Evidence: As the manager tries to implement changes and as more highly dependent people move to the service, it is very important that staff are given the support they need to adjust. The last inspection report recommended that staff should have regular supervision to support them in their jobs, including a development plan and appraisal. Staff tell us they are well supported and have regular staff meetings. However during one discussion a staff member said they did not know what person centred meant and they were not confident with some of the recording systems. We looked at two staff files whose last supervision sessions were in September 2008 and June 2008. The manager tells us she is aware that supervision is not as often as it should be, however she is developing a system where senior staff are being trained to carry out supervision. The service has a way of keeping on top of its standards by using questionnaires, which are set to people using the service every year. The Annual Quality Assurance Assessment tells us that the comments from people, families and visitors are collated and reviewed to assess the quality of service provided. Family meetings are held every month which are well attended. We saw the minutes of these meetings and note that families and residents are very involved. The service has an annual development plan for 2008 and will be writing one for 2009. The Annual Quality Assurance Assessment tells us that peoples money is recorded and kept secure. A safe place is provided for people to keep valuables and money and a record of this is kept. For those who cannot manage their own finances, arrangements are put in place by ensuring a lasting power of attorney is appointed. We saw that monies in and out are checked, and money kept in safe in separate wallets. The last inspection recommended that training be kept up to date and more staff be trained in first aid. A requirement was also made that fire doors must be kept shut or fitted with automatic door closures for the safety of people, and a risk assessment be carried out with the advice of the fire brigade. We saw that all risk assessments relating to safety have been carried out and the service has installed automatic door closures for those doors which are left open. The Annual Quality Assurance Assessment tells us that fire policies and risk assessments are in place which have complied with the local fire service requirements. Risk assessments have been conducted and are reviewed annually. The service has a new health and safety booklet which has been introduced for staff. A full electrical inspection has been completed by KES engineers. We saw records which show that the manager carries out an audit every two months which covers the environment, fire, food and kitchen, risk assessments, staff and care plans. We discussed with the manager that it would be good practice for a manual handling Care Homes for Older People Page 28 of 34 Evidence: assessment to be carried out for those people who require special equipment for moving, such as a hoist or electric bed. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 (2) (n). People using the service must be given opportunities for stimulation through leisure and recreational activities in and outside the home which suits their assessed needs, preferences and capacities, as written in their care plans. People using the service need to be confident that their individual needs are being met. This particularly relates to people with dementia and other cognitive impairments, those with visual, hearing or dual sensory impairments, and those with physical disabilities. 15/04/2009 2 36 18 (2). Staff must receive formal supervision at least six times per year. People using the service need to be confident that 15/04/2009 Care Homes for Older People Page 31 of 34 staff keep up to date with developments in the service and are able to meet their changing needs. 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 The service should ensure that all administrative details of the care plan are completed promptly and that all reviews are completed monthly. This will make sure that peoples support needs are met in a timely and consistent way. The manager should make sure that all staff are confident about the records used to monitor health care so they are completed in a way that supports the needs of people using the service. It would be good practice for the service to have a clearer care plan set out for people nearing the end of their life, which clearly demonstrates the involvement of relevant outside health professionals. This would show that all staff are familiar with the principles of end of life care and can put them into practice when needed. The service should consider the possibility of using the budget for an activities coordinator more creatively, for example working with existing staff who show an interest in activities. People using the service should benefit from a range of activities and stimulation. People should be supported to go out into their local community on regular trips or walks, to provide opportunity for stimulation outside the house. To ensure that good practice is maintained, remaining work to the bathrooms, outside access, and planned work for signage and decoration in the large lounge should be completed. This will provide people using the service with a home appropriate to their needs. People using the service should have their own towels and the use of paper towels in communal areas, to reduce the risk of spread of infection. The service should consider the varying needs of people using the service and review the allocation of resources so that everyone is able to benefit. 2 8 3 10 4 12 5 13 6 24 7 26 8 27 Care Homes for Older People Page 32 of 34 9 38 It would be good practice for a manual handling assessment to be carried out for those people who require special equipment for moving, such as a hoist or electric bed. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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