Care Home: Peacehaven

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What the care home does well The spiritual needs of the people who use the service is made a priority as the home provides care for people from the Christadelphian community. The lifestyle provided by the home aims to support the preferences and values of people living in the home. The people who use the service feel they receive a good level of care to meet their individual needs and have a good quality of life. People were observed to look well cared for and five out of six people stated on their comment cards that they feel their needs are "always" met. During the inspection staff were observed to be caring, friendly and supportive whilst encouraging people to be independent as far as possible. One person stated "the home and the staff are absolutely excellent". Another stated "staff are very very good". Five out of six people stated in their comment cards to us that staff "always" listen and act on what they say. A good range of social activities are provided and there is a dedicated Social Activity Organiser who supports people to participate in these on a regular basis. One person commented that arranging physical activities is something the home does well. The home provides a spacious, pleasant and personalised environment for people to live in with no unpleasant odours, people told us they feel the home is kept fresh and clean. The home has exceeded the standard for 50% of care staff to achieve a National Vocational Qualification II in Care. This training helps staff to provide safe and appropriate care to people living in the home. What has improved since the last inspection? A deputy manager has been appointed to help support the effective management of the home. There have been some improvements made to the environment including the lounge being redecorated and new carpets fitted so that people can benefit from more pleasant surroundings. The laundry facilities have been improved with a new wash-hand basin being fitted so staff can maintain good hygiene practices. The cracked hand-wash basin in the downstairs bathroom has been replaced with a new one so this is more pleasant for people to use. Social activities are now advertised on individual dining tables to allow people to be better informed of what activities are taking place and when. Records for recording complaints have improved so that it is clearer how complaints received have been managed and resolved. What the care home could do better: The Service User Guide needs to include a summary of our inspection report, Statement of Terms and Conditions for the home as well as a sample contract to ensure people have all the information they need to make a decision to stay. Where people are considered at risk of falls, appropriate risk assessments need to be completed detailing all risks assessed and actions that are being taken to help prevent the person from falling. Risk assessments also need to be regularly reviewed to ensure the actions detailed remain appropriate to promote the safety of the person. Medication management is in need of review and improvement to ensure people are not placed at risk of not receiving their medicine to maintain their health. Care plans need to clearly demonstrate any changes in the health of people so that staff can meet the needs of people effectively. Staff duty rotas should be reviewed to detail all staff working in the home so that it is clear there are sufficient staff to provide effective care and services to people consistently. A review of staffing should be carried out to ensure there are sufficient staff available to meet the needs of people consistently. Induction training needs to incorporate "Skills for Care" modules with sufficient training being provided within each module to demonstrate the person is competent. Receipts should be issued for all money transactions undertaken so that it is clear how people`s money is being managed. Key inspection report Care homes for older people Name: Address: Peacehaven 12 Kenilworth Road Leamington Spa Warwickshire CV32 5TL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Peacehaven 12 Kenilworth Road Leamington Spa Warwickshire CV32 5TL 01926422079 01926424894 peacehaven@cch-uk.com www.cch-uk.com Christadelphian Care Homes care home 21 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 14, Old age, not falling within any other category (OP) 21 Date of last inspection Brief description of the care home Peacehaven is a large, period house, which is situated off the main road leading into Leamington Spa town centre and its amenities. The Bethany Guild owns the home and there is a Christadelphian Hall attached. The home is registered to provide care to 21 elderly people. Accommodation is provided over two floors with access via a passenger lift, stair lift or stairs. All rooms except one have ensuite facilities. Peacehaven has a dining room, two lounges (one of which is used as a social activity lounge), conveniently situated toilets, shower rooms and bathrooms. There are Care Homes for Older People Page 4 of 34 1 0 1 1 2 0 0 8 14 0 Over 65 0 21 Brief description of the care home extensive gardens and ramps to assist those with mobility difficulties. Some of the rooms are more accessible than others in that there are some changes in the level of corridor and bends to negotiate which could make it difficult for wheelchair users. At the time of this inspection the fees ranged from £436 - £650 per week. These are subject to change and persons may wish to obtain more up-to-date information from the service. Chiropody is included within the charges but there are fees for hairdressing. The homes `Welfare Fund provides for outings and some other activities at no cost to the people who use the service. 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: one star adequate 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: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.50am and 7.25pm. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services Care Homes for Older People Page 6 of 34 provided. Comment cards were also sent out to people living in the home, staff and GPs to ascertain their views of the service. We received two responses from GPs, six responses from people living at the home and one response by a member of staff who works at the home. Information contained within these as well as the AQAA has been included within this report where appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, complaint records, financial records, maintenance records and medication records. Both breakfast and lunchtime was observed to see what this is like for people living in the home. A brief tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? A deputy manager has been appointed to help support the effective management of the home. There have been some improvements made to the environment including the lounge being redecorated and new carpets fitted so that people can benefit from more pleasant surroundings. The laundry facilities have been improved with a new wash-hand basin being fitted so staff can maintain good hygiene practices. The cracked hand-wash basin in the downstairs bathroom has been replaced with a new one so this is more pleasant for people to use. Social activities are now advertised on individual dining tables to allow people to be better informed of what activities are taking place and when. Records for recording complaints have improved so that it is clearer how complaints Care Homes for Older People Page 8 of 34 received have been managed and resolved. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 are provided with some information about the home to help them make a decision to stay. An assessment of peoples needs is undertaken prior to them staying at the home to ensure their needs can be met safetly and effectively. Evidence: There is a Residents Guide available which gives some information about the care and services provided to help people make a decision on whether they would like to stay. This does not contain a copy of our summary inspection report, a Statement of the Terms and Conditions for the home or a sample contract to make sure people have all the information they need to make a decision to stay. Of the four comment cards received from people living the home one person felt they had been provided with enough information to decide if the home was right for them. Two people have stated they dont know if they were provided with enough information and one person has stated no they were not given enough information. Care Homes for Older People Page 11 of 34 Evidence: The Assistant Manager advised that a new Service User Guide was in the process of being developed and the draft copy was viewed. This contained much more information specific to Peacehaven. We were advised that this should be available to people soon. The AQAA completed by the manager states when someone expresses a wish to come into the home I or a colleague from one of the Christadelphian Care Homes will go out to see the potential resident along with their families to discuss things fully. I usually take some photographs of residents engaged in activites and pictures of various areas of the home. The admission process was confirmed during the inspection with the manager. People who may be interested in living in the home are asked to complete an application form. This is then usually followed up by a visit to their home by the manager who completes an assessment of their needs to determine if these can be met by the home. The manager explained that trial visits can be accommodated to help people feel reassured that the home is right for them. Files viewed for people new to the home contained an assessment of their needs which had been completed prior to them choosing to stay. There were clear instructions on the form that the pre-assessment documentation must not be removed from the file. This is so that the original assessment of needs is always available to staff and they can monitor any progress or deterioration of their needs. One person spoken to said that they had chosen to stay at the home due to their failing health. They advised that they kept a Christadelphian Diary which contained details of all of the homes and they had chosen to make a trial visit to this home to see if they liked it. They stated they were quite happy with the decision they had made. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having their care needs met but cannot always be confident that they will receive their medicine as prescribed which is necessary to maintain their health. Evidence: The AQAA states at peacehaven we have very good detailed care plans. We use an assessment which covers all the main areas of care detailed in the care standards and make the plan. We also have a daily task sheet that .... where care staff sign for the must do tasks that they do for residents care. To find out if this was the case we case tracked the care of two people. This involved looking at their care files talking to them, observing them during the day and speaking to the staff that care for them. People at the home were seen to rise at their own pace and receive unhurried support to eat their breakfast of choice. Everyone was well groomed and dressed in appropriate clothing for this time of year indicating they are supported to maintain a Care Homes for Older People Page 13 of 34 Evidence: good self image. People appeared happy and smiling and regularly interacted with staff. Two care files were viewed. These covered all the main areas of care including some information on medical history, personal care, pressure care, nutrition, continence, mental health and mobility. There was evidence to show that some improvements had been made to care records in that a brief history of a care need was identified with review dates of these care needs. Each persons care needs were being assessed on a monthly basis and information collected as part of this assessment had been used when completing care plans. Staff were signing a sheet each day to show how they were supported each person in addition to recording other information on a daily record sheet such as the condition of their skin, how they were feeling and if they had eaten well or not. Discussions with staff and people using the service indicated that care needs were being met but care plans were not always reflective of the support being provided. For example a person with a visual impairment had various pieces of equipment to support them. Staff explained how they always put items in the same place, how they organised this persons wardrobe in a certain way, how specific items were used to support them to eat. This information was not fully reflected in the persons care plan for sight. Failure to do this could result in staff not supporting the person in a consistent way which could reduce the persons independence. This person explained that they were able to maintain some of their independence due to the help and support staff provided to them. For example staff had explained where to find light switches, locate the call bell and how to find the location of their clothes. On viewing the persons room it was evident they also had access to talking clocks and a cassette so they could have talking books. The person said staff are very very helpful. A care plan for a person who had a reocurring sore area to their skin did not make it clear if their skin was currently clear or if they still had a problem with this. The care plan did state staff were to apply cream to this area but daily records did not always report on the skin condition. In one case staff reported one day that the person had a sore area but the next day there was no follow up report to state whether the skin was still sore and if any actions were necessary. Discussions with staff confirmed they were all aware that this person could develop sore areas and that they were monitoring this on a daily basis and applying cream when necessary. It was evident that a special pressure cushion had been obtained for this person to help prevent further breakdown of the skin. Care Homes for Older People Page 14 of 34 Evidence: One person with dementia was identified to have fallen on several occasions. The monthly assessment record showed that the person was falling much more often. Care records stated that this person had been checked by the GP and no physical reason had been identified for these falls. Medical records viewed did not demonstrate that the GP had been involved in investigating a possible reason for these falls. It was therefore not possible to evidence that appropriate actions had been taken to follow up this matter to safeguard the person. Care records indicated that the falls may be due to a medical condition the person had, one member of staff felt it could be due to low blood pressure, other reasons included a poor and varied sleep pattern. All staff were aware that this person could fall, one stated we always keep an eye on X if X wants to walk around we go with X another person said X suffers with confusion we need to guide X through the day. It was not clear that the use of bedrails to prevent the person from falling out of bed had been regularly reviewed. This is important as they can be considered as a form of restraint. The manager stated the use of these had been agreed with the family. Staff reported that the person sometimes climbed over the rails. This information was not indicated in the risk assessment and it was therefore not clear if this risk had been considered when making the decision to use the bedrails. The manager agreed to look at this and stated a mattress was being placed on the floor to help prevent any injury to the person should they fall. Comment cards received by us from six people living in the home show that five out of the six feel they always receive the care and support they need, one person feels they usually do. One person has stated I am satisified with present arrangements. We audited the medicines of two people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines were not always being managed correctly. A review of medication found that medicines were stored in a medication trolley which is kept in a locked room when not in use. Staff secure the trolley in the lounge/dining area when administering medications. Medication Administration Records (MARs) did not always detail the amount of medication available at the beginning of a prescribing period. This meant that it was not possible to audit all medicines to make sure the amount available, given and remaining was correct. This issue was raised at the last inspection to the home. Incorrect codes had been used on the MARs when medication had not been given. For Care Homes for Older People Page 15 of 34 Evidence: example some contained the code F to indicate the medicine had run out but there was medicine available. In other cases the code F and G had been used to indicate the person was asleep so the medication had not been given. It was not clear on speaking to staff that there was a clear protocol in place on what should be done if a person did not receive their medication due to being asleep. It was also not clear that this issue had been folllowed up with the GP to ensure there were no detrimental affects to the persons health if they did not take their medication. There were several gaps on the MARs so it was not clear if people had been given their medication or not. A bath additive had been prescribed to be used as directed but there was no information on the MAR to show what the GP had directed to make sure staff were using this as prescribed. It was established on looking at the MAR that one person had been prescribed a special item of clothing to prevent one of their joints from swelling. There was no indication in the care plan records that this had been prescribed and how staff should manage this although records were signed to say staff were applying it. One person had been given a medicine that had not been prescribed for them suggesting they were using another persons medication to enable this to happen. People must only be given medication that has been agreed and prescribed by the GP. Using medication not prescribed could result in the person suffering ill health. We found that audits of medication were not being routinely carried out to make sure that staff were managing this appropriately. The manager agreed that this was something she would initiate. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and people were spoken to respectfully. We observed a person being supported to their room to change their clothing after spilling a drink. During observation of working practice it was evident that staff were knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. We were told by a member of staff Every effort is made by care staff to uphold the correct principles of care (individuality, confidentiality, privacy, freedom, dignity, ability to pursue their interests and spirituality - faith, hobbies and choice). 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain a lifestyle which matches their preference and which enhances their quality of life. Evidence: Christadelphian Care Homes (CCH) were set up by the Christadelphian community specifically to accommodate members of the Christadelphian Ecclesia. Most of the people who live in the home are members of the Ecclesia. We found that the lifestyle that individuals experience has specific Christadelphian characteristics which matches peoples expectations and preferences in terms of spiritual values. The home is adjoined to the local Chistadelphian Hall enabling people to access services with the local Christadelphian Community. In addition, daily Bible Readings and study takes place each day. The AQAA completed by the manager states Peacehaven has a very good programme of activites. Employ a full time activity coordinator. We do our best to see that residents have got opportunity to chat together regularly and to join in with activities when they want to. Our Activities Co-ordinator has resources for craft, games to play, jigsaw puzzles and a real mish mash of things to mess about with. There are Care Homes for Older People Page 17 of 34 Evidence: photographs on the wall of residents out and about on outings and simply doing or making things in the home. We found that there is an Activity Organiser who works full time and who is dedicated to providing social activities in accordance with the wishes of people who live in the home. She keeps records on a daily basis of activities undertaken with people and these showed that a range of social activities are being provided on a regular basis. We observed a number of people in the Activity lounge participating in arts and crafts, needlework, colouring and reading newspapers. People were being supported by the Activity Organiser to do their preferred activity. For example one person was completing a collage using different coloured paper but needed prompting in apply the glue. Another needed the detail of their picture explaining to help them use the correct colours. Some people participated in various different activities as the day progressed. One person with dementia and who could become agitated was taken to the local shops by a member of staff and came back with a plant for their room. In the afternoon most people attended a picture slide show in the main lounge. Everyone seemed to enjoy this. There were displays of the arts and crafts carried out by people on the walls of the activity lounge as well as some areas of the home. There were also photos of people on outings and joining in activities. Since the last inspection improvements have been made in how people are notified of social activities to take place. These are now advertised in booklets made available on individual dining tables. Records showed that monthly coach trips are organized. Some of these included a trip to Severn Valley Railway, the Transport Museum, garden centres and a seaside trip to Weston Super Mare. Trips had been well attended by people living in the home. One person told us that they went on a weekly visit to a local centre of interest to them and how pleased they were that staff could support them to do this. Comment cards received by us show that five out of six people feel there are always social activities they can take part in if the want. One person has declined to answer this question. At lunch time people were assisted to the dining room and seated at tables of their preference. Prayers were said and silence was maintained during this time. Meals were then served and consisted of a choice of cottage pie with swede and vegetables or salad or bacon. Most had the cottage pie which looked hot and appetising and staff offered the gravy separately and also additional vegetables for those that wanted Care Homes for Older People Page 18 of 34 Evidence: these. One person said I cant fault the food another said they enjoyed the meal but the cabbage was a bit hard. The lunchtime was a socialable occasion with people chatting amongst one another and taking their time to enjoy their meals. Staff were on hand to prompt and assist people as required and plate guards (which fit around the edge of the plate to prevent spillage) were available to those people who needed them to help promote their independence. Comment cards from six people living in the home show that four people always like the meals and two people usually do. Menus were seen on each of the tables in the dining room detailing the choices for the week and these demonstrated a varied range of meals are being provided. Snacks and drinks throughout the day are also made available. Care Homes for Older People Page 19 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 living in the home are confident that their concerns will be listened to and acted upon to protected them from the risk of harm or abuse. Evidence: The AQAA states The complaints book is prominent on the notice board in the hall along with a copy of our complaints procedure and the telephone numbers and addresses of CQC West Midlands. We found there is a book kept in the reception area of the home where any complaints can be recorded. The manager also keeps a file of all correspondence relating to any complaints. Two complaints had been received by the home one of which related to a member of staff raising their voice to a person in the home. The member of staff had apologised and records showed this complaint had been managed effectively and resolved. We have received no concerns or complaints in relation to this service. Comment cards received from five people tell us that they know who to contact if they are not happy. A detailed policy on abuse was seen as well as clear procedures for staff on how this needs to be reported although our contact address was not up-to-date and the Care Homes for Older People Page 20 of 34 Evidence: manager agreed to update this. Staff spoken to were clear on their responsibilities on reporting any abuse and were aware of other parties that may need to be involved in investigations such as the police. Staff confirmed they had attended abuse training. Care Homes for Older People Page 21 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. The service provides a clean, comfortable and homely environment for people to live in and enjoy. Evidence: Peacehaven is a period building with period features such as high ceilings and large windows. The building, although on two levels, has various areas which lead off them via steps or a stair lift. There is also a shaft lift to the first floor for those people with mobility difficulties. Entrance to the home for people with wheelchairs is via a ramp at the back of the home which leads into the lounge area. The home is traditionally decorated and there are two lounges. One of these is used as a social activity lounge and the other is a large lounge where people can sit quietly, read or watch the television. This lounge adjoins the dining area and has various different chairs and seating to provide a comfortable and homely environment. The AQAA states We have had the lounge painted in a magnolia to make it lighter and airier. We have had a lot of the rooms decorated and purchased some new furniture to replace some of the old furniture. There has also been a number of new carpets purchased and fitted to ensure that residents rooms are looking pleasant and have no trip hazards caused by ill fitting or wearing carpets. Following comments Care Homes for Older People Page 22 of 34 Evidence: made in inspection last year we have revamped the laundry and had a hand wash basin fitted. We found that these improvements to the home had taken place. The home was suitably warm, bright, clean and tidy and there were no unpleasant odours. Bedrooms seen were pleasantly furnished and decorated and people had personalised them with their own items such as photographs, soft furnishings and small pieces of furniture. Comment cards received show that five people feel the home is always fresh and clean and one person feel it usually is. There are two main bathrooms available to people that have assisted facilities to help those who are less able to access the bath. There is one bathroom on the first floor and one on the ground floor. During the last inspection the wash-hand basin on the ground floor had a large crack across it. This has now been replaced with a new washhand basin. The laundry was viewed and seemed organised with no build up of items waiting to be washed. Staff confirmed that dirty laundry is transported in bags to maintain good hygiene practices and it is then and sorted before being washed and dried and put into named baskets. Staff then return laundered items to people each day as appropriate. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of trained staff on duty to meet the needs of people living in the home. People are safeguarded by robust recruitment procedures. Evidence: The AQAA states In general we have a good core staff and there is not much change. There are only a handful of staff that have not done at least NVQ 2 and we have a good ratio of staff per resident. We also have a good number of support staff such as cleaners and kitchen assistant and laundry assistant. This helps carers to be able to focus on care and residents well being and interraction with the residents rather than having to focus on tasks that have to be done. We found throughout the inspection staff were supportive and caring towards people living in the home. Since the last inspection a new deputy manager has been employed to support the manager in the effective running of the home. The manager said she aims to have one senior carer and four carers on duty during the morning, one senior and three carers during the afternoon/evening and two waking night staff. Duty rotas seen confirmed that these staffing numbers are being achieved although this is with the support of agency staff. Both the manager and deputy manager work in a supernumerary capacity and sometimes work opposite shifts so there is management support from 9am to 10pm on some days. Care Homes for Older People Page 24 of 34 Evidence: There are also specific staff to undertake, cleaning, cooking and laundry duties each day and an Activity Organiser who works Monday to Friday. Duty Rotas had been completed in first names only which does not provide a clear audit trail when viewing these retrospectively. It was also found that there are staff who are working a late shift followed by a night shift which does not allow staff to have a sufficient break and could impact on their effectiveness. Records viewed in the home showed that staff had raised the issue of shortage of staff with management. Staff spoken to said there were enough staff but they had been working with agency staff which meant they had to spend more time with them which did impact on their work. They also acknowledged that new staff had been employed so that shifts could be covered by permanant staff. Comment cards received from people living in the home showed that five out of six people felt there were always staff available when they needed them and one person stated usually is. One person said staff are very very good, another said staff are very good and confirmed that if they used the call bell staff came to their assistance quickly. Staff training is provided on an ongoing basis. An at-a-glance training record showed staff had completed up-to-date training in fire safety, manual handling, food hygiene, abuse, first aid and dementia. The Deputy Manager confirmed that there are 23 care staff employed at the home. The training record showed that 15 of these staff had either achieved a National Vocational Qualification (NVQ) II or III in Care. This helps staff to provide more effective care to the people they support. Staff complete induction training but it was not clear this had been completed in accordance with the Skills for Care Common Induction Standards. The manager did have a guidance booklet on these standards but it was not clear that an appropriate training package for staff had been devised from this. Training should consist of a number of modules which staff complete over a number of weeks to demonstrate their competence in caring for people safely. Induction records in place did not demonstrate how staff competencies had been achieved. Information record in the AQAA states that staff have undergone full checks before starting work. We found that this was the case. Two staff files were viewed these contained application forms, two written Care Homes for Older People Page 25 of 34 Evidence: references and information to confirm that a Criminal Records Bureau (CRB) check had been received for each member of staff prior to their employment with the home. This confirms the home have a recruitment procedure in place which helps to protect people living in the home. 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 home is managed in the best interests of people living in the home and the manager is suitably qualified to care for people effectively. Evidence: The manager for the home has been in post since July 2006 and is registered with us. She is experienced in the care of older people and is appropriately qualified holding the Advanced Management in Care Certificate and the Registered Managers Award NVQ Level 4. Since the last inspection a new deputy manager has been providing additional support to the home. The AQAA states My assistant and I have identified many areas that needed improvement in order to meet standards and improve them further. We have put together an action plan to move the home forward in a structured way to achieve the improvements necessary and raise morale. We have training logs and we have reviewed the residents money. This is regularly checked by our trustee and following the inspection we have made sure that we get an invoice for the newspapers and have a slip signed for money where possible. We have implemented a schedule of care meetings every 8 days and meet with the seniors on a Care Homes for Older People Page 27 of 34 Evidence: fortnightly basis. We found that an action plan was in place which identified a number of areas for improvement. Recruiting more staff was one area identified and the manager was able to confirm two new members of staff were due to start. The service operates the Christadelphian Care Homes (CCH) Quality Assurance programme to ensure that the home is run in the best interests of people living in the home. This includes regular visits to the home by Trustees of CCH to establish the quality of care and services provided as well as regular meetings with people in the home. Notes of these meetings are kept to confirm areas discussed and proposed improvements. The Welfare Committee also assist with the annual quality assurance process by assisting with the completion of questionnaires with people and their families. They help with fundraising for social activities and visit people in hospital. Questionnaire responses in the home all contained positive responses demonstrating that people are happy with the care and services provided. Comment cards received by us also contained positive responses. One person states the home and the staff are absolutely excellent. A visiting professional has commented provides a caring happy family like environment for the residents. Always carry out my instructions I advise. A member of staff has commented Peacehaven is a happy home staffed by people who genuinely care for each and every resident as individuals. The management of personal allowance monies for people was reviewed. The manager explained that all records are computerised and statements can be sent to relatives where this is appropriate and if they request. The records and money was checked for two people. The computerised records were viewed as well as receipts. Records seen showed that the money available was accurate in accordance with the records. It was not evident that people are issued with individual receipts when depositing money into accounts or for expenditure such as hairdressing. This will need to be addressed so that there are robust systems in place for the effective management of peoples money. Records of health and safety checks were viewed to ensure these were being done within the recommended guidelines. Records confirmed that checks for water, electrics, call bells, fire, gas, passenger lift and hoists had all been completed to Care Homes for Older People Page 28 of 34 Evidence: ensure these were safe. 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 8 13 A detailed risk assessment must be carried out when bedrails are used and any action deemed necessary taken to reduce the risk of potential harm or injury. This should be regularly reviewed. This is so that people are not placed at risk of entrapment or of falling if trying to get out of bed. 30/11/2009 2 9 13 Medication Records must be completed appropriately with clear explanations of any gaps and the correct codes used to show how medication has been managed. This is so it is clear whether people have had their medication as prescribed. 30/11/2009 3 9 13 Medicines prescribed must only be administered to the person they are prescribed 30/11/2009 Care Homes for Older People Page 31 of 34 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 to. The practice of administering medicines dispensed to one person to another must cease. This is to ensure people are not given medicine which is not prescribed for them and which could result in their ill health. 4 9 13 A system for auditing 30/11/2009 medication must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that all medicines are administered as prescribed and this can be demonstrated. 5 9 13 The quantity of all medicines 30/11/2009 received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. Care Homes for Older People Page 32 of 34 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 This is so that is it clear medicine is being managed safely and appropriately for 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 1 3 The new Service User Guide in the process of being developed needs to include a summary inspection report, Statement of Terms and Conditions for the home as well as a sample contract to ensure people have all the information they need to make a decision to stay. Care plans should clearly identify what actions are to be taken if a person is prone to miss taking their medication at the specified times. This is to ensure the persons health is effectively maintained. Care plans should clearly indicate changes in a persons health and how these are to be met by staff. This is so staff can ensure the health and wellbeing of the person is maintained. A review of staffing should be carried out to make sure there are sufficient staff available to meet the needs of people. Duty rotas should contain staff surnames so there is a clear audit trail should there be a staffing issue that needs to be followed up retrospectively. Staff induction training should be reviewed to ensure staff work to the Skills for Care Common Induction Standards. Records should demonstrate that staff are competent in training modules completed relating to these tandards. Receipts should be issued when money is deposited and people should be issued with individual receipts for any transactions that are undertaken on their behalf. This is so that people are clear how their money has been managed. Page 33 of 34 2 7 3 7 4 27 5 27 6 30 7 35 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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