Care Home: Rashwood Nursing Home

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What the care home does well The home provides information to help people decide if they wish to move in, and this information is available in large print and audio formats to enable it to be assessble for people with sight difficulties. Assessments are carried out by the home manager before people move in, so that people can be confident that the home are able to meet their needs. Each person has a care plan which is based on their individual care needs. The care plans are well written and contain good information to ensure that staff know what to do for each person and each person receives a consistent standard of care. The home are able to meet people`s health and personal care needs. There is a wide range of social opportunities for people living at the home, including opportunities to go out into the community to various places of interest. A wide variety of choice of meals are available, providing a well balanced and nutritious diet. People can be confident that any concerns will be listened to and acted upon. The home provides a beautiful, safe, comfortable and well maintained environment for people to live in. Infection control is very well managed. Staff are caring and provide people with care that meets their individual needs with dignity and respect. Staff receive training to give them the skills and knowledge they need to work in the home. The home is managed well, and people can be confident that is is run in their best interests. What has improved since the last inspection? Improvements have been made to the home`s management of medication. Handwritten entries on the medication records are checked by two trained staff to ensure that mistakes are not made, which would place people at risk of not receiving their medication as prescribed. The home have taken action to reduce the temperature where medication is stored to ensure it is being stored according to the manufacturers instructions and medication is not `broken down` through being exposed to high temperatures, which may place people at risk of harm. Staff are aware of the action they need to take to ensure they follow the local procedures for refering any allegations of abuse to ensure people are safeguarded from abuse. Improvements have been made to the management of people`s monies held by the home to ensure the records remain confidential at all times. The kitchen has been refurbished to improve the facilities for staff and this area has been awarded a `five star` rating by the Environmental Health Department.Parts of the home have been redecorated and new furnishings and equipment purchased to improve the comfort for the people living in the home. Pathways in the gardens have been constructed to make them suitable for people using wheelchairs. Staffing levels have been increased following consultation with the people living in the home to improve the service they receive. What the care home could do better: The home need to improve the storage of the Controlled Drugs in the nursing units to ensure they comply with the Misuse of Drugs (Safe Custody) Regulations 1973 and to ensure they are being stored safely and securely to prevent misuse. Key inspection report Care homes for older people Name: Address: Rashwood Nursing Home Rashwood Nursing Home Wychbold Droitwich Worcestershire WR9 0BP     The quality rating for this care home is:   three star excellent 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 Bromige     Date: 2 7 0 5 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 31 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 31 Information about the care home Name of care home: Address: Rashwood Nursing Home Rashwood Nursing Home Wychbold Droitwich Worcestershire WR9 0BP 01527861258 01527861843 rashwood@efhl.co.uk www.efhl.co.uk Elizabeth Finn Homes Ltd care home 53 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 physical disability Additional conditions: Age: Dementia - Code DE age 55 and above. Physical disability - Code PD age 40 and above. The maximum number of service users who can be accommodated is: 53 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 3 Old age, not falling within any other category (OP) 53 Physical disability (PD) 53 Date of last inspection Brief description of the care home Rashwood is a 53-bedded care home. The proprietors are The Elizabeth Finn Homes Ltd, and the manager is Justine Cahill. The home is divided into three main wings, each with its own lounge and dining area. One wing provides personal care for people Care Homes for Older People Page 4 of 31 Over 65 0 53 0 3 0 53 Brief description of the care home requiring some help with activities of daily living, while the other two wings are for people who predominantly require nursing care. Facilities and services available for people include a hair salon, physiotherapy, an activities co-ordinator and a mini bus service. All rooms are single with en-suite facilities. The services offered include longterm, convalescent, end of life and respite care. The home is a large country house, which has been extended. It is set in extensive and well-maintained grounds, and is located in Wychbold, near Droitwich. Information regarding fees can be obtained from the registered manager at the home. A copy of this report can be viewed at the home. Care Homes for Older People Page 5 of 31 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: We, the commission completed the last inspection of this service on 9th May 2007. This was an unannounced inspection. One inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. we looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well Care Homes for Older People Page 6 of 31 outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives, staff working at the home and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Improvements have been made to the homes management of medication. Handwritten entries on the medication records are checked by two trained staff to ensure that mistakes are not made, which would place people at risk of not receiving their medication as prescribed. The home have taken action to reduce the temperature where medication is stored to ensure it is being stored according to the manufacturers instructions and medication is not broken down through being exposed to high temperatures, which may place people at risk of harm. Staff are aware of the action they need to take to ensure they follow the local procedures for refering any allegations of abuse to ensure people are safeguarded from abuse. Improvements have been made to the management of peoples monies held by the home to ensure the records remain confidential at all times. The kitchen has been refurbished to improve the facilities for staff and this area has been awarded a five star rating by the Environmental Health Department. Care Homes for Older People Page 8 of 31 Parts of the home have been redecorated and new furnishings and equipment purchased to improve the comfort for the people living in the home. Pathways in the gardens have been constructed to make them suitable for people using wheelchairs. Staffing levels have been increased following consultation with the people living in the home to improve the service they receive. 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 31 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 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Prospective people are assessed by the home before admission to ensure the service are able to meet their individual care needs. Evidence: We received information from 12 people living at the home and they all confirmed they received enough information before they came into the home to enable them to make an informed decision to live there. Comments include, I came in here after an emergency and have been very satisfied and chose to remain here. Initially came due to emergency and stayed on. We spoke to a person who has recently come into the home and they told us the manager came to visit them at home to find out about the care they needed and gave them written information about the home. They also told us they had previously visited the home to look at the facilities. Care Homes for Older People Page 11 of 31 Evidence: The AQAA completed by the manager before the inspection visit told us All potential new service users are invited to the home to look around, select their room according to availability, and to meet existing service users to share their experiences also we give the opportunity for potential new service users to visit for lunch. All service users are assessed prior to admission to ensure that we are able to meet their needs and to allow for pre planning of the admission. Every resident is invited to have a trial stay before committing themselves for a long term stay or they can join us for lunch or dinner. We looked at a recent assessment completed by the manager and it was very detailed enabling staff at the home to prepare for the admission of this person and ensure any specialist equipment needed was provided, for example an appropriate pressure mattress and cushion. The homes Statement of Purpose and Service User Guide is available in large print and audio format for people with poor eyesight. The Service User Guide states the current range of fees for residential and nursing care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive the health and personal care they require based on their individual needs and choice to ensure all their care needs are provided. Some improvement is needed to the management and storage of medication to ensure records show medication is being given as prescribed and controlled drugs are being stored securely and safely. The privacy and dignity of people living in the home is respected at all times by staff. Evidence: We looked in detail at the care of two people living in the home. We found good outcomes of care for these two people. The care plans were well written and contained good information to ensure the people received a consistent standard of care. They had been reviewed at least monthly and/or as care needs changed. They reflected peoples individual needs and gave clear instructions for staff to ensure each persons individual preferences, choices and beliefs were respected at all times whilst giving or assisting people with their personal care. We spoke to care staff who had been looking after these two people on the day of the inspection visit. The care staff told us they were able to read the care plans so they were up to date with each persons care Care Homes for Older People Page 13 of 31 Evidence: needs. The care staff we spoke to had a very good knowledge of the care needs of these two people. We saw that the care plans in the two nursing units are stored on an open shelf. We spoke to the manager about the security and confidentiality of the information in the care plans. The manager told us she would arrange for the care plans to be held in each persons room. This would enhance person centered care. The care plans are also computerised so staff can access them at all times. We spoke to a person who had recently moved into the home. They told us they had not seen their care plan and had not been given the opportunity to discuss the content. The AQAA completed by the manager told us the organisation uses a computerised care planning system which allows for comprehensive assessment of all our residents needs based on the Roper Logan and Tierney model of care. We identify the condition of the resident, we establish mutual goals and agree the actions required to achieve the goals and evaluate this together with the resident on a monthly basis or before if needs change. We received 12 surveys back from people living at the home and 11 told us they always receive the care and support they need and one said they usually do. Comments in surveys from people living at the home told us the home, always caters for the individual needs of the patient,to date all my care needs are met without question and to my satisfaction and since I arrived here I have received healthcare, devoted care and I am happy. A GP visits the home every Tuesday and there is never any hesitation in calling a Doctor at any time. The residents are all threated as individuals and all the staff from the top to the bottom know each resident and respond personally to their needs always. Comments in surveys from relatives of people living in the home told us, personal care of high standard, with staff who are concerned about the welfare of the residents and provides excellent care with current care plan. They involve me in the planning of my husbands care. Comments in surveys from health professionals who visit the people living in the home told us the home refers appropriately when specialist input required e.g refers frequently to specialist palliative care service, tissue viability, diabetes etc, whilst providing excellent generalist care. Have received very positive feedback from patients and relatives about care at Rashwood. I rate Rashwood very highly and would be happy to reside there myself! Provide a truly caring, homely environment where the rights of individual patients are respected. Both people we looked at were assessed as needing specialist equipment such as a Care Homes for Older People Page 14 of 31 Evidence: high risk mattress and chair cushion to prevent their skin from breaking down. This information was clearly recorded in the care plan with the type of air mattress and cushion in use and the setting they should be on for the size and weight of each person. We saw this equipment in use for both people. We saw that neither of the air mattresses were on the correct setting as stated in the care plan. We told the manager about this at the time of the inspection. We looked at the management of medication for these two people. We made a requirement and recommendation about medication at the last inspection in May 2007 and both of these have been implemented. We saw that the medication charts were mostly printed by the pharmacy, although any handwritten entries were clear and had been signed by two trained staff to make sure they had been written accurately. There were some gaps on the medications records for both people for ointments and creams. The nurse told us this is because the care staff apply these creams. We advised the home they need to be signed to show they had been administered as prescribed. This was actioned by the home before the end of the inspection visit. One person was receiving all their medication including specialist nutritional feeds via a special feeding tube. We saw one identified medicine was prescribed to be given one hour before the liquid food is started. The medication administration record showed they were both being given at 17:00hrs. We discussed this with the trained nurse and they told us this was not accurate as the liquid food was being given later in the evening. We advised the home to record the time of administration on the medication chart. We carried out an audit of some controlled drugs and this was accurately recorded. We looked at how the home store controlled drugs and we found the cabinet for the nursing units was not correctly secured to a solid wall. The controlled drug cabinet in the residential unit was fixed correctly to a solid wall. The home have taken action since the last inspection to ensure medicines are being stored at the correct temperatures to prevent them from going off. The home check and record the room and medicine refrigerator temperatures each day to ensure they remain within the required range of temperatures as recommended by the manufacturers. We saw one person was prescribed a food supplement due to recent weight loss. There were gaps on the medication chart where this had not been given. The trained nurse told us the person was refusing the medication. We advised the home they need to enter the correct code on the medication chart to show it is being refused and not to leave it blank. Comments in surveys from people living at the home told us, nursing and medication is always administered on time and correct. We spoke to the two people whose care we looked at and they assured us they were happy with the care they received. One person said, it is very nice here and you cant fault it. We saw staff closing doors whilst in bedrooms assisting people with Care Homes for Older People Page 15 of 31 Evidence: personal care. We saw staff knock on doors before they entered. Staff addressed the people in the manner they wished and were very polite and respectful toward the people living in the home. The surveys we received from five health professionals all told us the staff in the home always respect the privacy and dignity of the people living there. Care Homes for Older People Page 16 of 31 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. A range of social and recreational activities are provided to encourage and enable people to continue their hobbies and interests and meet their individual needs and expectations. Meals are well managed, creative and provide an excellent daily choice of menu to ensure peoples choice and cultural nutritional needs are catered for. Evidence: We looked closely at the social care for two people who are living in the home. One person was very dependent on the staff for all of their care needs and spent most of their time in their bedroom. The care plan for work/play said they liked to watch the television and being taken around the grounds. It stated in the action plan the Activity Co-ordinator was to assess this persons abilities and interests. We spoke to the Activity Co-ordinator who was appointed at the beginning of April 2009. They told us this person did not have an activity programme at present. Staff told us this person liked to watch television and being taken around the gardens of the home. One person chose not to join in with the activities provided by the home. The information in the AQAA told us, we have a recognised shortfall in our social activity programme. A new activity/events co-ordinator has been recruited with the plan to increase and improve the activity and events held within the home. Despite Care Homes for Older People Page 17 of 31 Evidence: the lack of continuity due to the changes of staff for this role, the newly appointed activity co-ordinator works five days a week, currently Monday to Friday to provide a good range of activities for the people living in the home. For example, people were able to celebrate Easter as a service took place in the home. Other events include a St Georges Day theme meal, a Victorian tea party to celebrate Elizabeth Finn founders day and an Ascot Day is planned where the ladies and gentlemen living in the home can decorate hats and enjoy a drink of Pimms and champagne with strawberries. On the day of the inspection visit a quiz was being held in the afternoon and the previous day people living in the home had planted herbs for use in the kitchen. Raised beds have been put in the garden to enable people to grow vegetables and plants. Some trips out in the homes minibus have been planned for later this month. The home are looking to recruit further staff to provide social care activities and support seven days a week. The home has a shop where people can buy toiletries, cards, confectionery and other items. There is a licensed bar which has just been refurbished to a very high standard which is open five days a week for pre-dinner drinks. The home has a well stocked library of books including large print and audio books. The books are changed each week by the local library with books selected by the people living in the home. The home has set up a webcam with a television in the library so people can watch the blackbird and her babies in the nest. A portable computer with wireless connectivity to the web is available for use. The computer has a large touch screen and large alphabet keyboard. Internet access available and programme for individual accounts called Simply Unite. Comments in surveys from the people living in the home said the home looks after all my needs providing interesting and varied entertainment in which we can take part personally or as a group. Welcoming any family or friends or guests who visit me. Above all they do what I want, i.e. the home is run for the residents, so they are very flexible about when I get up/go to bed, whether I have breakfast in bed or in my chair. Activities of interest arranged regularly. Residents meetings are held at regular intervals to discuss menus, social activities and other information relating to staffing. A survey from a relative of a person living in the home told us, recent appointment of an activities organiser means that there are now many activities to stimulate X (persons name) and encourage social contact with other residents. Staff surveys told us they felt the home could improve the activities for residents who stayed in their rooms and doesnt want to mingle with other residents and more trips Care Homes for Older People Page 18 of 31 Evidence: out for residents were needed. Maybe a little more activities going on. People are kept informed about future events in the home through the in house monthly magazine called the Grapevine. We looked closely at the nutritional care for two people who are living in the home. Both people were assessed as being nutritionally at risk. One person received specialist liquid food via a feeding tube and one person had lost a lot of weight before they came into the home. Both people had gained significant amounts of weight since they moved into the home. Menus are given to each person to enable them to make a choice of food. The menus are also displayed in the home. There is a dining room on each unit and people also choose to eat in the privacy of their own room. We were offered lunch on the day of the inspection and were given the menus to choose from. We were served lunch of pate with bread, followed by sweet & sour vegetables with rice, potato and cauliflower and lemon meringue pie for dessert. The food was hot, well presented and very tasty. We looked at the current Spring menu which shows a cooked breakfast is available every day with cereals/porridge, toast/croissants etc. For lunch there is a starter every day. A choice of two main courses (one being a vegetarian option) and on the alternative menu options there is a further choice of salad, omelette, fish, jacket potato, fishcakes and sausages. For supper there is homemade soup every day and choice of a hot meal, sandwiches (various fillings) and salad. Desserts are on the menu for lunch and supper with a further choice of yoghurt, ice cream or fresh fruit. The alternative menu options shows people can also have eggs cooked in a variety of ways, jacket potato, mushroom stroganoff, cheese on toast, or hot sandwiches such as sausage or bacon. Home made cake is served everyday. A new Summer menu starts next week. The menu offers all of the above choice plus a choice of fish meal each day. Comments in surveys from people living in the home said, the food is superb, huge variety, cooked food and choice three times a day, well presented, alternative choice of the actual meal. Residents consulted on future menus. The chef visits the dining room at each lunch time to get first hand comments as to how the meal has been received so that any criticism can be taken on board. Care Homes for Older People Page 19 of 31 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 excellent 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 are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. Evidence: The information in the AQAA told us a large print and audio version of the complaints procedure is provided for people with sight difficulties. We saw a copy of the homes complaints policy and procedure on display at the entrance to the home. The AQAA told us they had received one complaint since the last inspection. We looked at the complaint records. The outcome of this complaint was not recorded on the homes records, although it had been resolved. All staff who completed surveys and we spoke to were aware of the homes complaints procedure. The completed surveys we received from people living at the home told us they knew how to complain and one person told us, I feel able to speak to the staff if there were any problems I had. The staff we spoke to had received training and were clear of the homes policies and procedures for the protection of people from abuse. The two people whose care we looked at closely both told us they felt safe and secure living at the home. The AQAA completed by the manager prior to the visit told us, we have a rigorous recruitment policy to ensure that all staff are recruited appropriately and are of good Care Homes for Older People Page 20 of 31 Evidence: character. Training on protection of adults is provided for all staff. Staff have a continual supervision process in place. A whistle blowing policy is in place which all staff are aware of. The completed staff surveys all confirmed the home had carried out Criminal Record Bureau (CRB) checks before they were employed at the home. The AQAA tells us staff have received training about the Mental Capacity Act 2005 and senior staff have received training about deprivation of liberty safeguards which came into force on the 1st April 2009 to provide further protection for people receiving care. We have received one complaint since the last inspection about the management of the home. The complaint was referred to the service provider to investigate and it was not upheld. There have not been any safeguarding incidents or referrals for this service. Care Homes for Older People Page 21 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home continues to be improved enabling people to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: The information provided in the AQAA prior to the inspection told us they have improved the home as 20 bedrooms have been refurbished with new furniture. All furniture in communal areas has been replaced. Wheelchair friendly pathways have been constructed in the gardens. A new kitchen finished construction in October 2008. A garden club has been commenced to ensure service users can enjoy the outdoors even if they are unable to walk outside. SKY TV has been installed at request of service users - available if service users wish to subscribe. We looked at the bedrooms and facilities used by the two people we tracked. The bedrooms were single rooms with en-suite toilets. They were nicely decorated and furnished. Specialist profile beds were available. A call system was provided and accessible to each person to enable them to call for assistance. The communal bathrooms contained specialist baths and hoists to enable people with physical disabilites to use them with assistance from staff. The two nursing and the residential units each had a lounge and dining room. All Care Homes for Older People Page 22 of 31 Evidence: communal areas were furnished with good quality, comfortable furniture. The tables in the dining room were nicely laid with linen tablecloths and napkins. There is also a conservatory, licensed bar, shop and hairdressing salon for people to use. The residential unit is on two floors and has a lift to enable access to the second floor. The nursing units are single storey. A loop system has been fitted to assist people with hearing difficulties. The manager told us there is further major refurbished planned and budgeted for to include a new staff room as staff use the communal areas at present, repainting of the outside of building and replace the guttering. Refurbishment of three bathrooms. New handrails in the corridors. New furniture for the bar area and to purchase five high/low beds for the residential unit and 10 more specialist profile beds for the nursing units. Comments in surveys from people living in the home told us the home is always clean with no offensive smell. They provide a clean caring environment. Property maintained to a high standard. Grounds maintained to a high standard. We have such a beautiful well kept grounds to walk in and pendents to wear which give a feeling of security when doing so. I am grateful for a library and a visiting hairdresser. We have a bar which means we are able to choose to have a drink if we wish to do so and where we can meet and talk to other residents. If there were any problems or difficulties I feel that I could ask for help including hanging a picture or two or anything I needed help with such as replacing a light bulb. Relatives comments told us there is a high standard of cleanliness and hygiene. A relaxed environment and lovely grounds allowing a walk each day which X (named person) love. Beautiful surrounds. A visiting health professional wrote very pleasant surroundings both inside and outside the home, which people can enjoy living in. All parts of the home we saw were clean and tidy and there were no unpleasant odours. Staff were using gloves and aprons whilst attending to personal care needs to prevent cross infection. In one bathroom the join in the non slip waterproof floor had split in three small areas. We told the manager about this at the time of the inspection. The Environmental Health Officer has visited the home to look at the practice and cleanliness in the kitchen and has awarded the home five stars, which is an excellent outcome. Care Homes for Older People Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and insufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The manager told us in the AQAA that Rashwood maintains a very stable workforce, many of the staff have been employed here 10 years plus, indeed quite a few 20 years plus. One member of staff has just received her 30 years continuous service award. A robust induction programme is in place with continuing ongoing training and supervision. Staffing levels have been increased for care both days and nights and activity and reception hours have been increased. Staffing levels have increased following comments from service users. The home employs male and female staff from a multi-cultural background. The three units are all staffed separately. Staff spoken with told us there were enough staff on duty. They told us the manager has addressed the staffing levels since she started work at the home. There is one extra carer on each day shift and they now have two team leaders who are trained nurses in each unit and they both have an administrative day each month to enable them to review and update the care records. Staffing levels have improved at the weekends. There are extra reception hours to answer the telephone at weekends and a new activity co-ordinator. Care Homes for Older People Page 24 of 31 Evidence: Comments in surveys from people living in the home told us there are always staff available when needed. Comments included, staff always sympathetic to my needs and always efficient. The atmosphere is very friendly. The staff are always friendly cheerful and do their best to my personal needs. They are super people. All carers and nurses are wonderful. They carry out their duties with friendliness. Their attitude is always helpful. Relatives comments in surveys told us, all duties are carried out in a professional way but always friendly and kind. All the staff are cheerful and approachable. Nine of the 12 surveys received from staff said there are always enough staff on duty. We asked staff in the surveys what was good about the home and they wrote, good staffing, staff recruitment and long service - Rashwood staff are very caring and good at their work. Staff are well trained. Adequate equipment available willingness to change if possible any policy and updated information. Flexibility in working hours for staff. Provides support to employees and to the residents. Also provides up to date training to give good care. Staffing levels have increased and we feel the benefit of this. We are still trying to get extra weekend staff and have just recruited again. Rashwood is an extremely good place of work - everyone always exhibits the highest standards and promotes a very professional attitude at all time. People are proud to say they work at Rashwood. The numerical information in the AQAA told us, recruitment checks had been carried out for all staff employed in last 12 months. They have a staff development programme in place and 25/36 care staff have achieved NVQ two or above. All staff have received induction training recommended by Skills for Care. Staff we spoke to all told us they had received the required core training in the last twelve months, for example fire and moving and handling. Trained nurses were asked about training opportunities and they told us you can do any training you want and all training is paid for and the time to attend. Senior staff have received training about the Mental Capacity Act 2005 and the deprivation of liberty safeguards and their implications for practice and care planning in the home. We looked at the recruitment file for the most recent employee and this showed all relevant checks were carried out prior to the recruitment of this person to ensure the people living in the home are protected from any potential harm. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager, to promote and protect the safety of the people living and working in the home. Evidence: The manager was registered with us in April 2008. The homes Statement of Purpose contains information about the managers qualifications and experience. She is a registered nurse. She gained her Registered Managers Award NVQ4 and ENB 997/998 Mentors and Assessors Course in 2005. She has a current personal identification number (PIN) with the nursing and Midwifery Council. She told us she has attended training updates this year for a variety of subjects such as First Aid and Mentoring and Assessing. She has completed all of her core training, for example moving and handling and fire. She has attended two training sessions about the deprivation of liberty safeguards and their implications for day to day practice. She is also studying for an addition recognised qualification in health and safety management. Care Homes for Older People Page 26 of 31 Evidence: The manager completed an AQAA before the inspection visit. This document was well completed and the information it contained was supported by appropriate evidence. It showed the home has a good understanding of the importance of equality and diversity and showed people living in the home had been consulted and listened to. The AQAA demonstrates a high level of self-awareness and recognised the areas that it still needs to improve. The home carry out regular audits to assess the quality of the service. The deputy manager told us monthly audits are carried out for any accidents, pressure ulcers, medication and care plans. The notice board at the entrance to the home contains information about the outcome of the most recent consultation in March 2009 with people who use the service. The manager told us following this consultation changes were needed to the homes approach to activities and food and this has been implemented. The Statement of Purpose states residents committees are held to enable residents to debate issues regarding the home and the environment and to make suggestions, improvements or commendations. Meetings are minuted and a copy displayed on the notice board. Comments in surveys from people living in the home confirmed this, residents meetings are held at regular intervals to discuss menus, social activities and other information relating to staffing. I have been happy staying here and the home give a good service considering the changes made. Staff told us the new manager has been in post for 18 months. Staffing levels have increased and we feel the benefit of this in the main. Excellent team spirit. A relative commented they do everything well. Comments in a survey from a health professional said, the service is well run and friendly. The staff are professional but approachable. The last inspection report made a recommendation about the management of peoples monies. The AQAA completed by the manager told us with a new management and administration team now in place we have revisited the policy for signatures on service users pocket money. Two members of staff now always sign for any service user expenditure. We saw this practice in place when we looked at the management of peoples monies. The numerical information in the AQAA told us all of the equipment in the home has been serviced in the last twelve months. We saw a service label on a hoist in one of Care Homes for Older People Page 27 of 31 Evidence: the bathrooms and this confirmed it had been serviced in the last six months. On the day of the inspection a Health & Safety meeting was scheduled and took place with all of the heads of departments in the home. These meetings are held every three months and are minuted. We saw checks recorded for bedrails and wheelchairs, which are done by designated staff from each unit. The records for the management of Legionella and water temperature checks were recorded. Care Homes for Older People Page 28 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 13.2 To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. To ensure controlled drugs are being stored safely and securely to prevent misuse. 02/08/2009 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 Care Homes for Older People Page 30 of 31 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. 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