Care Home: Primley Court Nursing Home

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What the care home does well People who use the service and their relatives have the information they need to decide whether Primley Court is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. People tell us that the admission process is made easier by the staff at the home. People receive a good standard of personal and nursing care. Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. Medicines are well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are good and mean that staff know how to care for some one in a safe and consistent way that meets their individual needs and preferences. People have access to a good varied programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home particularly the 1:1 sessions and opportunities to chat with staff. People tell us that the food is excellent at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. Primley Court is generally a safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. The home is well managed by the manager and Provider. What has improved since the last inspection? The Statement of Purpose and Service User guide are in the process of being updated to include more detailed information for people to decide whether the home is the right place for them to be.The pre admission assessment has improved since the last inspection. The AQAA told us that communication between families remains very good with then additional use of email to aid communication and allow pictures to be printed for people in the home. Care plans have been improved and are colour coded to show different areas of the plans and mean that staff have quicker access to the areas of the care plan. There are new staff handbooks provided to all new staff to provide them with the information they need to perform their jobs in a safe way.The home has been accredited with Plymouth University to take student nurses. This keeps the home updated with current trends and provides a good work experience opportunity for student nurses. Staff training is ongoing. Since the last inspection staff have received specialist training in nutrition and the use of syringe drivers for people who are at the end of their life. What the care home could do better: The Manager should ensure the documents provided at the home are completed thoroughly by staff when this information becomes availaible. This will mean that staff obtain sufficient information to decide whether they can care for people who use the service. The Provider must continue to protect people at the home by looking at ways of ensuring any risk of scalding from excessively hot radiators are eliminated even when the maintenance man is absent. The Provider and Manager should also look at ways of improving the quality of the environment. This should include considering replacing worn carpets and furniture. Bedside tables should be cleaned or replaced where necessary. Infection control processes should also improve to reduce the spread of infection throughout the home. Clean duvets and towels must be stored in a way that does not spread infection. Creams and lotions should also be covered and dated with the date of opening to reduce the spread of infection. Recruitment records should be reviewed to ensure the Provider and manager obtain the information needed to decide whether the applicant would make a suitable member of staff. References should be completed on all staff and requests should show where the reference has come from. Whilst informal supervision of staff should continue, records should be obtained to show that all staff receive this regular supervision and support to enable them to work in a safe and effective way. The manager must also ensure staff have received mandatory training so they are able to work in a safe and effective way. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Primley Court Nursing Home Optima Care Partnership 13 Primley Park Paignton Devon TQ3 3JP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 0 8 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 32 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 32 Information about the care home Name of care home: Address: Primley Court Nursing Home 13 Primley Park Optima Care Partnership Paignton Devon TQ3 3JP 01803555988 01803523853 primleycourt@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Optima Care Partnership care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Registered for maximum 52 DE(E) service users 65 years and over Registered for maximum 52 MD(E) service users 65 years and over Registered for maximum 6 OP Registered for maximum 6 PD(E) service users 65 years and over The home may admit up to 5 service users between the ages of 55 years to 65 years with a diagnosis of Early Onset Dementia (DE) Date of last inspection Brief description of the care home Primley Court is a purpose built 52-bedded care home providing personal and Nursing care to older people primarily with mental health problems who may also have physical Care Homes for Older People Page 4 of 32 Over 65 52 52 6 6 5 0 0 0 Brief description of the care home frailties. The home is one of a group owned by Optima Care Partnership that is spread over the South West of England. The home is in a residential area close to Paignton town centre. The home has some far reaching views from some rooms over the town and Torbay. The accommodation is arranged over a number of floors with a choice of several lounges and dining facilities. Half of the property is a new build that provides accommodation that exceeds the National Minimum Standards in terms of size of rooms and facilities. The rest of the home has been adapted to meet the needs of people in the home. The lower ground floor accommodates the Registered Managers office, kitchen and staff room and also provides level entry to people with access and mobility problems. There are two shaft lifts which access all levels of the home. The bedrooms are mainly single and 31 have en-suite facilities. The Registered Manager is a very experienced Registered Nurse with management skills and has achieved the Registered Managers Award at National Vocational Qualification level 4. The home has also been awarded the Investors in People Award in February 2004. The homes fees commence at approximately 440 pounds for personal care and increase depending upon the needs of the person. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection was unannounced and took place instead of our annual service review. Prior to this inspection we received a well completed Annual Quality Assurance Assessment from the Registered Manager. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This key inspection consisted of a visit to the home on Monday 8th December 2008. Care Homes for Older People Page 6 of 32 During this time we spoke to the Registered Manager and Provider, 4 people who live in the home. These conversations obtained limited information because of the mental illness of the people. We spoke at length to 1 visitor, and 5 staff members. We case tracked four people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at five staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. During the inspection we watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Primley Court. What the care home does well: What has improved since the last inspection? The Statement of Purpose and Service User guide are in the process of being updated to include more detailed information for people to decide whether the home is the right place for them to be.The pre admission assessment has improved since the last inspection. The AQAA told us that communication between families remains very good with then additional use of email to aid communication and allow pictures to be printed for people in the home. Care plans have been improved and are colour coded to show different areas of the plans and mean that staff have quicker access to the areas of the care plan. There are new staff handbooks provided to all new staff to provide them with the information they need to perform their jobs in a safe way. Care Homes for Older People Page 8 of 32 The home has been accredited with Plymouth University to take student nurses. This keeps the home updated with current trends and provides a good work experience opportunity for student nurses. Staff training is ongoing. Since the last inspection staff have received specialist training in nutrition and the use of syringe drivers for people who are at the end of their life. 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. 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 32 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 32 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. The information provided means that people have accurate information about Primley Court, before they come to the home. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Minor improvements would mean staff obtain detailed information relating to the person being admitted Evidence: The Statement of Purpose and Service User guide are in the process of being updated to include more detailed information for people to decide whether the home is the right place for them to be. Each document reflects the services that are provided and includes information on fees, staff, room sizes, services that are provided and how to make a complaint. Care Homes for Older People Page 11 of 32 Evidence: Relatives told us they were given sufficient information when moving to the home but the admission process led on from them attending day care at the home. The manager told us of the enquiry pack which is give to people looking at the home. Further information is handed out later in the process. The AQAA told us that the pre admission assessment has improved since the last inspection. Each person is admitted following an assessment performed by nursing staff at the home. This assessment is used alongside assessments made by other health care professionals. Together this information is used to make an initial plan of care. Evidence was also seen of involvement of the person and their family. On some pre admission assessments not all sections had been completed. The Provider told us this was because the information was not availaible rather than staff not completing the form. Records showed that some people at the home, because of their illness, are not aware of their admission to the home and the reassurance that is given. During the inspection, one person was being reassured at the inspection because of anxiety of where they were. Staff were sensitive and reassuring whilst reminding the person where they were. Each person is given a contract when they move to the home. The majority also had a contract through the NHS or social services. The home encourage the use of advocacy services in the local area for people who have no support The service also offers a day care services for a small number of individuals that operates seven days a week. The homes terms and conditions of residence, or contract, allows for the first month to be on a trial basis. The fee structure is included in the contract and is clearly stated where the service is contracted by social services including the National Health Services nurse determination payment. The AQAA told us that communication between families remains very good with the additional use of email. Care Homes for Older People Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is provided in a respectful way. The care planning systems at the home are good and mean people have their health needs identified and met in a safe way. Further improvements would mean that records are more detailed and would reflect the care that is actually provided. The management of medicines is good and helps protect people from risk. Evidence: People living at Primley Court have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes. Each person has a GP who attends when staff request a visit. During the inspection people looked cared with the finer details such as eye care, nail Care Homes for Older People Page 13 of 32 Evidence: care and appropriate foot wear present. The AQAA stated that the home use the services of an optician. Visiting health care professionals and relatives all said they thought the standard of personal and nursing care was good at the home. One professional told us staff at Primley Court care very well for people with extremely challenging mental health needs. One relative told us he thought they cared for his wife very well and that she always looked clean and well presented. One person who had recently moved to the home said the staff were wonderful. Health care needs are monitored in well written care plans. The AQAA told us that care plans have been improved and are colour coded to show different areas of the plans. Each person has a care plan, which sets out his or her specific needs. Each plan contains assessments for such issues as falls, nutrition, moving and handling and more general risks. Risk assessments included Waterlow, nutrition, falls and mental health assessment. There is also a risk assessment completed when the use of bed guards (bed rails) has been considered. These assessments are generally reviewed each month or where a change occurs. Plans of care are generally well written and explain how care needs for each person will be met. The majority of forms used to plan the care had been well written but examples of gaps or incomplete records were seen in 4 of the five care plans inspected. The AQAA told us that staff have received specialist training in nutrition and the use of syringe drivers for people who are at the end of their life. Specialist health care professionals are sought for advice and guidance. Progress of the person is recorded in notes made by the staff and also by health care professionals such as chiropodist and Doctors. The home has its own activities staff who also have their own sheet to record activities that each person has been involved in and their response to the activity. The management of medications is performed well at the home. We looked at the treatment rooms where medications are stored in either locked trolleys or locked cupboards. The Registered Nurses are responsible for management of the medication from receipt to disposal. Medicines are supplied mainly in a monitored dose system. The medication trolleys were clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. Fridge temperatures are recorded daily to ensure correct storage of medications. The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. Used medications that were to be disposed of were kept initially in a locked cupboard then placed in a returns container that securely held medication. All medications for disposal are recorded and signed for on collection as Care Homes for Older People Page 14 of 32 Evidence: per the company and government policy. People who use the service are encouraged to join in with physical exercise programmes provided by the activities coordinator. On the morning of the inspection a member of staff was performing movement to music which several people were enjoying. People were encouraged to move freely around areas of the home. Walking aids were present for those that required them. Grab rails were present throughout the home and ramps were availiable to reduce risk. We saw staff transfer people from wheelchair to chair using a hoist. This was done safely and sensitively with staff giving explanation and reassurance to the person being transferred. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and activities and addressed using their chosen term of address. Screening is availiable in the rooms where people share a room. The home cares for people with dementia type illnesses. Some staff have been trained in the specialist ways of caring for people with these specialist needs and care plans show how care is delivered in a person centred way. Appropriate use of diversionary tactics and orientation methods was also used throughout the inspection to calm anxiety and prevent escalation of some behaviours. Care of the dying is performed well at the home. Staff use the Liverpool Care Pathway where all health care professionals work together and record together the care that is planned and given to ensure end of life care is coordinated, continuous and effective. Care Homes for Older People Page 15 of 32 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. The varied, well organised social and therapeutic activities provided for people is excellent. People also benefit from a wholesome balanced diet. Evidence: A full time Activities Organiser and also one other activity person are employed at the home. They have their own office within the home and a budget to use for the benefit of people in the home. The service users records have a separate sheet that is used to record the activity and individual has taken part in and what level of involvement and enjoyment they received from it. A notice board in the entrance hall shows photographs and a programme of the many forthcoming events. Staff told us the majority of events are held in the conservatory although activities are rotated throughout the home. Recent activities included a visit by a local donkey sanctuary. On the day of inspection people were enjoying music and movement in the morning and a visit from local primary school who were singing Christmas carols. The activities organiser also brings her pets to the home for people to enjoy. One Care Homes for Older People Page 16 of 32 Evidence: person was seen obtaining great pleasure from the dog. The home also have birds and a cat who wanders around the home. Staff told us the activity programme is varied and involvement varies on the person and their mood that day. Staff also told us that religious services are organised at the home from two different religious denominations. People in this home predominantly have Christian beliefs. Staff gave an example of a specific religious belief and explained how staff assist that person meet their spiritual needs and associated dietary needs. Visiting is open at the home. A visitors book in the entrance records visits for fire security reasons. One relative told us that he is always made to feel welcome and is delighted the manager has invited him to spend Christmas day at the home. Staff told us there is a Christmas party organised by the home with over 30 relatives being invited. Due to the complex illnesses people at the home are not able to manage their own financial affairs. The home does provide guidance for their advocate to make secure arrangements should they need it. The manager told us the home do not handle the finances of any people at the home. People are able to bring personal items to the home to personalise their space. Property lists are performed on admission. Relatives, staff and people told us the food at the home was excellent. There is a choice of breakfast foods and main meals. People who could make a choice were asked what they would prefer prior to the meal and at the time the meal was served. The food was very well presented, of good portions, and had a nice aroma. People spoken to during the meal said that they were very happy with the meal they had received. The kitchen was very organised and the chef had his Safer Food, Better Business records, temperature records and environmental health records available for inspection. A record of likes and dislikes regarding food is found in each persons file. A nutritional assessment is also performed on admission to ensure nutritional risks and needs are met. This information is communicated to the chef who then produces each meal in a way that was palatable to the individual such as normal presentation or pureed. The pureed meal of the day was sampled. A meal of minced beef, carrots and mash was sampled. All samples were full of colour, texture and fresh flavour. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 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 who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge of staff, and procedures and training in place helps to protect people from abuse. Evidence: The Commission for Social Care Inspection recieved a complaint earlier this year. The complaint questioned how the complaint was managed by the home. A random Inspection was performned to investigate the issues in the complaint. Since this time the manager has updated the complaints procedure and taken steps to address the issues raised in the complaint. The updated complaints procedure, which displayed around the home for the benefit of people who use the service, staff and visitors to the home and includes how to contact the Commission for Social Care Inspection. The procedure is also displayed in the Statement of Purpose and Service Users Guide. The home has a book to record any complaints in along with the outcomes following an investigation. The home have attempted in the past to set up a relatives group to enable relatives and friends to express their views. The manager told us this group was not sucessful Care Homes for Older People Page 19 of 32 Evidence: but relatives tend to feed back any concerns on a one to one basis. The manager told us there are advocates in the Torbay area which can be contacted for people who have no family or representation. Because of the mental illness people who use the service expess their disatisfaction with issues verbally and physically. During the inspection we saw staff anticipate behaviours and triggers for people to ease their discomfort and distress. All interactions seen on the day of inspection were appropriately affectionate, kind and professional. Relatives we spoke to said I am not sure of the official way but I would certainly speak to the manager. Another person said he had not needed to complain as small things get sorted out straight away. Staff we spoke to said they felt able to talk to the manager about any worries or concerns. The home also operates a supervision and appraisal system in which staff raised concerns that are discussed, recorded and acted upon. Staff told us they would have no hesitation to complain if the situation arose and would certainly report poor practice. Staff also told us their Protection of Vulnerable adults (POVA) training occured each year and was booked for the following week. The manager showed us a training matrix which highlighted who had received POVA training. The manager is aware of the processes to follow if a safeguarding alert is received. Staff also have a CRB (Criminal Records Bureau-police check) and a POVA register before their employment to ensure they are suitable to work with vulnerable adults. Care Homes for Older People Page 20 of 32 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. Primley Court is generally a safe and pleasant place to live and work. However, improvements to some carpets and furnishing could improve appearance of the home. Minor improvements to the infection control processes would reduce the spread of infection. The home does not have robust procedures to ensure people are protected from some unguarded radiator surfaces that are too hot. Evidence: Primley Court is a large Victorian house set on a hill in a residential area of Paignton. The house has been extended to provide a newer purpose built unit. All areas of the home are accessible by people who use the service. The older part of the home has been adapted with grab rails, ramps and passenger lifts for those with mobility problems.The main entrance of the home is at the front and there are several steps up to the front door. To improve the access to the building there is access along the front drive to another door at the side of the building next to the managers office. This provides entry into the home and to the shaft lift avoiding the steps to the front door. Internal staircases are fitted with stair gates which can be opened by people who are able and used to protect people in a confused or disorientated state. Care Homes for Older People Page 21 of 32 Evidence: The home has a lounge and dining room on the ground floor and a further lounge on the first floor. Each are of a good size and reasonably decorated. Some individual tables were worn and stained with food debris. Some carpets in communal areas were worn and stained. Some furniture throughout the home were displaying signs of general wear and tear, but the manager told us these were planned to be replaced in the near future. The arrangements for the maintenance of the home remain very good with very good records of all the maintenance that has been carried out by the companies maintenance man or outside contractors. However, some radiators in the old part of the building were unguarded and very hot to touch. The Provider explained that the maintenance man usually checked these temperatures on a Monday morning but was on holiday this week. The Provider confirmed that he had noticed that four radiators were very hot to touch and would ensure steps were taken to ensure these are safe. At the time of writing this report the Provider has submitted evidence of how these risks are managed effectively. Risk assessments mentioned radiators in general but there were no detailed risk assessments for these rooms relating to the people who occupied them. There are attractive gardens and seating areas which are used in finer weather. The gardens and outside areas are well maintained. The home has suitable numbers of toilets with disabled access for people to use and these are well placed around the building. The bathrooms provide modern bathing facilities with built in hoists thus improving the use of the available floor space. There is also a wheel in shower on the first floor level. There are also portable hoists, stand aids and two shaft lifts to access all floors of the home. The clients are mainly provided with their own single bedroom. Many have en-suite facilities. There are two double rooms that are used. These have mobile screening curtains. Rooms contained items, photos and small ornaments to personalise them. Some rooms have been provided with adjustable beds for individuals who require nursing care. Some beds are new and are fully adjustable and have built in bed rails that are only used after a risk assessment is done and the outcome agreed with the person in the room and their relative. Bed rails that had been fitted to beds were being used after a detailed risk assessment. Staff use protective equipment when providing personal and nursing care. Gloves, aprons and hand washing are available for staff use. Creams and lotions in peoples Care Homes for Older People Page 22 of 32 Evidence: rooms were correctly labelled but not dated with day of opening to reduce the infection risk. One pot of cream had no lid which poses a risk of the spread of infection. There were macerators available in the home for the disposal of commode liners. Whilst this is recognised as good practice, this room was also being used for the storage of clean towels and duvets this could mean that infection could be spread. The home has its own laundry that is large and well equipped with industrial type washing machines with sluicing cycles and large dryers. The laundry has washable walls and impermeable floors. There are dedicated staff who operate the service. Care Homes for Older People Page 23 of 32 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. Although people who use the service are cared for by a stable group of staff, minor improvements to the recruitment procedure would show they have had all the pre employment checks Evidence: The home is Managed by a Registered Mental Health Nurse who has also achieved the NVQ level 4 in Management. She has over 13 years experience in the management of this and other care homes that provide nursing to older people who have a mental health problem. She is supported by other registered nurses who are also experienced in this field of care and between them provide registered nurse cover over the 24 hour day. The care staff have received training in both general care duties such as manual handling, the provision of personal care activities, etc. Some care staff have had additional training to understand the more complex needs of mental health problems including dementia. The training records show that the home has made a consistent effort to keep the work force well informed and equipped to meet the needs of the clients and their advocates. However, the training matrix showed that not all staff were up to date with mandatory training. Care Homes for Older People Page 24 of 32 Evidence: Staff told us that many care staff have an NVQ in care at level 2 or above. The home successfully achieved the Investors in People Award. The AQAA told us that the home has been accredited with the University of Plymouth to take student nurses and associated with Exeter College to take work experience students. Off duty records are maintained and show that staffing levels are stable and supplied in sufficient numbers to meet the complex needs of people who use the service. In addition to the nursing and care staff, additional ancillary staff to clean, cook and attend to the laundry. Relatives told us that there always seemed to be enough staff on duty to meet the needs of their relative. One relative said there was always a member of staff in the upstairs lounge to keep an eye on the people sitting there.People who use the service were spontaneously complimentary about the people who use the service. The home continue to cover shortages themselves to provide continuity of care, so agency use is kept to a minimum. The cover shortages themselves to provide continuity of care, so agency use is kept to a minimum. Staff recruitment folders showed that the recruitment process is consistent with all staff being interviewed following completion of an application form. This application form contains criminal declaration and health questionnaire. More recent staff files also contained more robust CRB recording information and equal opportunity forms. One of the files inspected did not contain two written references.This member of staff was not providing personal care. All files contained a photograph and up to date Nursing and Midwifery Council check where appropriate. Some recruitment documents were not written in a way to obtain maximum information from the applicant. The references were brief and did not contain evidence of who had completed the reference. All staff files showed evidence that staff had completed an induction programme and had had a recent appraisal. There are new staff handbooks provided to all new staff to provide them with the information they need to perform their jobs in a safe way. Care Homes for Older People Page 25 of 32 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 run in an effective and efficient way. Improvements are needed to the training programme to show that all staff have received all mandatory training. Evidence: The Registered Manager is an experienced Registered Mental Health Nurse with many years experience of managing care homes in the private health care. The Registered Manager has also completed the Registered Managers Award and NVQ 4 in management. The manager and Provider have also steered the home through the process of achieving the Investors in People Award. The Registered Person has a background in accountancy and monitors finances in the home to ensure the performance of the business is effective. Insurance certificates are displayed in the home and show sufficient cover. Care Homes for Older People Page 26 of 32 Evidence: The Provider makes weekly visits to the home and carries out his Regulation 26 visit on a monthly basis producing a report which is made availiable for the Commission for Social Care Inspection. This report also generates a management meeting where any issues are discussed and addressed. The home also conduct questionnaires for relatives and other stakeholders to give feedback. Thank you cards and letters are also kept to show appreciation from families. Communication between the manager and Provider is very good. The manager told us she has access to budgets for the day to day running of the service and is able to purchase equipment easily. Staff said the manager is very approachable. Staff described her as fantastic and excellent. Staff told us she was very approachable, supportive and maintained confidentiality when personal issues are shared. Staff said they could come and discuss issues at any time. Staff meetings are held on a regular basis where staff are informed of changes and are able to express their views. Relatives told us that the manager and staff were always there to answer questions and were always welcoming. The manager told us that the home did not handle the personal affairs of the people at the home. This was either managed by relatives, friends, power of attorney or friends. Relatives said they paid the hairdresser directly. Staff said they felt supported by the manager on a day to day basis. Staff said that although they did not always receive formal supervision, they were able to meet with the manager at any time. The manager said she performed appraisals but staff supervision was done informally. Records at the home were generally well maintained. Some records were less robust than others. Some care plans had not been completed. One staff file did not contain a reference, although this member of staff was not performing personal care. Training records were well written but showed gaps where staff were out of date with mandatory training. This training includes fire safety, infection control, moving and handling, first aid, and food hygiene. At the time of writing the provider had given an update of the training records. Other records were very well maintained. Maintenance records were evident for checks on equipment and services such as gas safety, waste management, electrical safety, Care Homes for Older People Page 27 of 32 Evidence: prevention of legionella, fire systems, hoists, lifts medical equipment and laundry services. Inspection records from the supplying pharmacist and environmental health departments were seen. Any minor issues had been promptly addressed. Care Homes for Older People Page 28 of 32 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 29 of 32 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 25 13 Systems must be in place to ensure that radiators do not present a risk of scalding. This will mean that the risk of scalding from radiators is eliminated even when the maintenance man is absent. 01/07/2009 2 38 18 The Manager must ensure all staff are up to date with mandatory training This will mean that staff have received the training to perform their roles in a safe way. 01/07/2009 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 Care Plans should be completed sufficiently to provide sufficient information for staff to be able to care for the person. The Provider should consider replacing worn carpets and worn furnitures where possible. 2 19 Care Homes for Older People Page 30 of 32 3 4 26 26 The Manager should reduce the spread of infection by ensuring bedside tables are replaced or cleaned sufficiently The Manager should reduce the risk of spread of infection by ensuring clean linen and duvets are not stored in areas which are not appropriate. The Manager should reduce the spread of infection by considering labelling creams and lotions with the date of opening and keeping lids of creams in place when not in use. The Manager should ensure that all staff working at the home have two written references in their file. The manager should consider changing the recruitment records in order to obtain sufficient information on new staff The manager should ensure staff receive formal supervision sessions. 5 26 6 7 29 29 8 36 Care Homes for Older People Page 31 of 32 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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