Care Home: Risby Hall Nursing Home

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bramley Avenue (73)
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home

What the care home does well This is a large building, which is home to up to thirty four people, the majority of whom may have one form or another of dementia, the dinning and sitting areas are both in one big room that could potentially be over busy and be unsettling. However with the use of screens and grouping the chairs into smaller groups, they have been able to create an atmosphere that is calm and relaxing. Staff find time to spend with people individually, even if it is just a few minutes to offer comfort or to chat a while. The staff we spoke to talked positively about people living in the home and showed a good understanding of their needs. Interaction between the staff and people was observed to be friendly and open. The manager is committed to providing a good service to the people living in the home and people told us they were happy there, visitors we meet there all agreed that they thought the home looked after their relative well. One relative said in their survey, "I am very happy with the way my relative has settled in, they seem settled and content too." They also said when asked what the home does well, "It gives individual care in a friendly and caring way." The new electronic care plans enable staff to have fast access to all areas of people`s records, they also make it easier to keep information updated. Many of the surveys that have been returned to us said that the home offered a good quality of care in a kind and supportive way and that the manager was approachable and committed to providing good outcomes for the people in her care. What has improved since the last inspection? The manager has many years experience of working with people with dementia and since coming to the home, less than a year ago, is beginning to make positive changes to the care that is offered to this group of people. They tell us in the AQAA that, "Staff have undertaken certified dementia training. This has benefited both the home and staff members, individuals feel that they are more informed regarding the needs of those living with dementia and how best to care for them." An area in the garden has been fenced and the gate made secure so that people who like to walk can get out into the garden have unrestricted access to it. The garden is a safe environment and is attractively managed with areas of interest and comfortable seating. Some areas of the home have been improved to appear more homely and some rooms have been decorated and re-carpeted. People`s bedrooms have been given new curtains and matching bedding. A shower room has been refitted and all of the bathrooms and showers have all been refurbished and now promote a more homelike ambiance. What the care home could do better: We have not made any requirements during this inspection but the manager has clearly shown in the AQAA that she is fully aware of what improvements she wants to implement in the home. These are some of the improvements the home hopes to make in the next year. They want to find ways to enable staff to have opportunities to develop and progress within the company, in the AQAA they tell us "We believe that individual staff appraisals can identify what they would like to achieve and where they feel they need to develop. There are various areas in which the registered nurses are able to take the lead such as wound care and plans are in place to introduce a formal clinical lead position within the home to address this and other similar areas. We also intend to review the contents of the induction pack, and develop personal development plans for the remaining categories of staff." The home also say they need to improve their arrangements to monitor and address staff absence and that they are planning for the structure and format of their health and safety training to change following the training coordinator`s own recent health and safety training. It is also planned that that they will continue to further develop the front and rear gardens so that people and their families will be able to sit out and enjoy the surroundings more. In addition they are in the process of opening a sensory garden which everyone will be able to access. Key inspection report Care homes for older people Name: Address: Risby Hall Nursing Home Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS     The quality rating for this care home is:   two star good 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: Ann Wiseman     Date: 2 1 0 7 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 32 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 32 Information about the care home Name of care home: Address: Risby Hall Nursing Home Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS 01284810921 01284811950 risbynursinghome@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Partnership in Care Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Risby Hall is a care home for older people providing nursing care and has been established for many years under the proprietorship of Risby Hall Nursing Homes limited. The registered proprietors are actively involved in the management of the home. Risby Hall is situated on the edge of Risby village in West Suffolk and was converted from a farmhouse and outbuildings. The accommodation is all on the ground floor with level access throughout. The facilities are homely and comfortable and there are 20 single bedrooms and 7 shared rooms. The home registration was changed in 2006 to allow the home to accommodate people with Dementia. The home can accommodate 34 people. Care Homes for Older People Page 4 of 32 Over 65 34 34 0 0 0 4 Brief description of the care home The fees for the home range between £400 and £620 weekly depending on the accommodation occupied and the level of support required. The fees do not cover hairdressing, newspapers, toiletries, clothing, chiropody or the cost of an escort for attending external appointments. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection; we arrived at 10.00am in the morning and stayed for eight hours. The manager was at the home when we arrived and she facilitated the inspection, which she did in an open and helpful manner. Whatever files and documents we asked to see were produced quickly. During the day we had a look around the home and observed interaction between the staff and people living there. We also had opportunities to talk with them to get their opinion of the care they get. Before the inspection we had sent surveys to people who had been chosen at random from the information sent to us by the manager in the AQAA, nine surveys were returned directly to us. Some people were helped to complete the survey by a family member. They all gave positive responses to the questions. We also sent surveys to some of the other professionals involved in the home and some of the staff. One doctor who replied said that, We have a good working relationship and good Care Homes for Older People Page 6 of 32 communication between the general practise and the nursing home staff. When asked what the service did well they said Good nursing home care of patients with complex needs. Fifteen staff members returned their questionnaires, the majority were positive and some made constructive suggestions on how the care could be improved. We looked at information belonging to five people and some of the of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. The manager had sent us the Annual Quality Assurance Assessment (AQAA) she had completed prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. The detail given to us in the AQAA was detailed, informative and it gave examples to reinforce the information given to us in it. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: We have not made any requirements during this inspection but the manager has clearly shown in the AQAA that she is fully aware of what improvements she wants to implement in the home. Care Homes for Older People Page 8 of 32 These are some of the improvements the home hopes to make in the next year. They want to find ways to enable staff to have opportunities to develop and progress within the company, in the AQAA they tell us We believe that individual staff appraisals can identify what they would like to achieve and where they feel they need to develop. There are various areas in which the registered nurses are able to take the lead such as wound care and plans are in place to introduce a formal clinical lead position within the home to address this and other similar areas. We also intend to review the contents of the induction pack, and develop personal development plans for the remaining categories of staff. The home also say they need to improve their arrangements to monitor and address staff absence and that they are planning for the structure and format of their health and safety training to change following the training coordinators own recent health and safety training. It is also planned that that they will continue to further develop the front and rear gardens so that people and their families will be able to sit out and enjoy the surroundings more. In addition they are in the process of opening a sensory garden which everyone will be able to access. 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 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 given to people of thinking of moving into Risby Hall is detailed enough to allow people to make an informed choice about whether the home would suit them and everyones needs are assessed before they move in. Evidence: Risby Hall has a comprehensive statement of purpose which is given to people thinking of moving into the home. It contains details of all aspects of life in the home and was reviewed in July 2008. The service user guide was updated in January 2009 and contains all the required information including the terms and conditions of residence, services that are included in the fees and those that arent, there is also and a summery of the previous years quality assurance survey so that people are able to see what those already in the home think about it. Once people move in they are given a Welcome to Risby Hall booklet that gives more basic day to day information such as mealtimes and an explanation of where Care Homes for Older People Page 11 of 32 Evidence: people can eat and how they choose their meal. They are also invited to make suggestions if your favourite dishes do not appear on the menu. The booklet also details the complaints procedure, activities in the home and suggests that people may like to personalise their rooms by bringing in pictures and other personal possessions. Information given in the AQAA says that, The Company is currently devising a colour brochure and website which will include photographs. The aim of which is to provide prospective service users with more choice at the initial stage as they will have a better feel for the environment of the home. The use of pictures will also aid any individual with communication difficulties to make an informed choice. We examined the files of five people during this inspection and saw that they each contained pre-admission assessments completed by the home as well as their local authoritys community care assessment. They contained a lot of good information and covered a wide range of the persons needs including their diet, continence, skin integrity, mental state and any known allergies. Details of their preferred leisure and social activities were also recorded and notes were made of their previous living situation and some life history work. All of this information enables detailed care plans to be developed. The manager told us in the AQAA that, For service users who are referred through care management we obtain a summary of the care management assessment and care plan however this does not replace our own pre-admission assessment which is carried out for all service users. We also welcome the contribution of information from the persons family or representatives and aim to work in a partnership with the potential service user to enable them to make appropriate decisions about their choice of Home. Risby Hall doesnt offer an intermediate care service. 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 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 this home have good care plans and have access to health care. Medication is managed safely, but could be better maintained by the proper use of an audit trail. Evidence: The manager told us that, We practise a person centred approach where people are actively encouraged to participate in decisions concerning their care and activities of daily living. The process of planning care is carried out in partnership with the person moving in and their relatives, with the individuals agreement. We examined five care plans during our visit to the home, they reflected the needs of the person involved and they have been updated since the last inspection and have been reviewed regularly throughout the year. They contained risk assessments that are developed to minimise the risk of harm in peoples every day activities, which enable them to live a full and active life without being restricted unreasonably. The plans were written in a way that reflects the person as a whole, their personality Care Homes for Older People Page 13 of 32 Evidence: and their personal preferences are also evident. People moving into the home or their representative are asked to indicate that they have read and agreed with the the care plan by signing and dating them. This helps people feel that they are still in control of their lives and encourages them to make more choices by including them in drawing up the care plan and gives then them the opportunity to tell staff how they want to be helped. The AQAA told us that, Our care assessments and care planning are becoming more detailed. We have implemented version 2 of the computerised care planning system and a nutritionist is now visiting the home regularly; menus have been adapted to service users requests and needs and there has been specific training on nutrition and wound care. We were shown the electronic care planning system, it enables contemporaneous notes to be kept on a wide range of topics and allows information to be speedily accessed from any computer connected to the system and care plans can be quickly updated. A hard copy of the care plan is then printed off and kept on file. We saw that the paper files were kept up to date and we were reassured that none of the computers on this system were connected to the internet so peoples privacy is not compromised and access to the system is further safeguarded as the computers are finger print protected. We were told that each person has a named nurse who is responsible for ensuring that the care plan is appropriate, meets peoples needs and wishes and who ensures it is up to date. We saw evidence that peoples health care needs are met, there were copies of specialist reports such as speech and language and psychology. Doctors and other health care professional visits are recorded along with any treatment given so that staff can be made aware and can monitor any changes. We examined the medication and the way it was managed and stored. We found that all the medication including the controlled drugs were stored as required. We saw in their care notes that one person was confined to their bed because they were very frail. When we visited the person in their room they looked clean, comfortable and were relaxed. There was a drink available in the room but the turning record sheet hadnt been completed since early in the morning and there was no fluid intake chart. We had seen staff in the room earlier but the visit had not been recorded on the record sheet. It is important that the care of people who are frail and at the end of their life is properly recorded so that staff can make sure they receive all the Care Homes for Older People Page 14 of 32 Evidence: care they need to keep them comfortable and free from pain. Care record sheets also enable senior staff to monitor that care to ensure it takes place. When we looked at the medication and its recording charts we saw that one person is prescribed a medication to help manage their constipation, which was prescribed to be taken twice a day but the tablets have been given as a PRN and is not given as prescribed. PRN means that the medication is not prescribed for regular daily use, but is taken as needed and the type of drugs given as PRN can vary from simple painkillers to strong psychotic medication. All medication should be given as the doctor directed, if it is felt that the medication no longer needs to be taken as prescribed the doctor should be contacted for advice. The service uses a monitored dose system where most of the medication is dispensed by the pharmacy into blister packs, we were told that sometimes people may not use all their medication because of a stay in hospital or similar circumstances and that the home does not return the unused tablets at the end of the medication cycle but continues to use them. We saw that they dont complete the record sheet by recording what medication is left over at the end of the month, nor do they carry it over to the new sheet, so therefore they are not keeping a complete audit trail which would enable medication to be tracked while it is in the building. We randomly checked one persons medication and records, some tablets are not suitable for putting into the blister packs and are stored in boxes. The amount of one of the un-blistered tablets didnt correspond to the number recorded on the record sheet. There were forty tablets too many. Because the audit trail was not in place we couldnt check if this was because the tablets had been carried over from the previous month or if the home had failed to give them, on this evidence it would be easy to assume that the person had not been given the medication at all and a lack of an audit trail makes it impossible for staff to check if the medication had been given if it there was any doubt. On this occasion the home was able to show in the care notes that the person involved had recently spent some time in hospital which accounted for the unused tablets. It would be advisable for the service to revise the way they manage the medication that is left over at the end of the cycle and they should maintain an audit trail. During the day someone told a carer that her legs were sore, the carer was passing through the lounge carrying a tray and told the person that she would finish what she was doing and would return and walked on. The carer did return within a few minutes and sat on the foot stool and gently massaged the persons legs and feet, once she Care Homes for Older People Page 15 of 32 Evidence: was done she asked if that felt better and the person said yes and thanked her for her time. It was good to see that staff keep their promises to people and were prepared to spend a bit of time making them more comfortable. In the AQAA the manager told us that, We have to date purchased a profiling bed that lowers to the floor to minimise the use of bed rails. We have purchased pressure mattresses that accommodate service users at high risk of compromised skin integrity to replace the noisy electric pressure relieving equipment that is in place. We were shown the new bed and equipment during the inspection and saw that it was in working order. Induction training includes preserving peoples dignity and keeping confidences and the manager assured us that she monitors that people are treated respectfully by direct observation and will reinforce training at staff meetings and during supervision. When not in use private information is stored in a locked cupboard in the office and is not left lying around in communal areas and information that is stored on a computer is also protected. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are offered a well balanced diet in pleasant surroundings and can take part in meaningful activities. Evidence: People we spoke to said they were happy with the activities they were offered and the two homes, Risby Hall and Risby Park which share the same grounds, have a group of four staff responsible for coordinating activities, which they do with individuals and groups of people. People can increase their social activities by joining in with those held at Risby Park if they want to. There is also a mini bus that the home has access to so that they can take trips and outings further afield. People are also supported to take advantage of dial a ride for individual activities. Records are kept of the activities offered to people and who participate in them. Photographs of people taking part in some of the sessions and outings are on display in the home. In the AQAA we were told that, ......we are currently part way through a group wide review of activities provision, and in particular those aimed at service users with dementia. As part of this review we have employed a further activities coordinator who spends her time solely on one to one and small group activities for those with dementia. Care Homes for Older People Page 17 of 32 Evidence: A student from the Suffolk College goes to the home two days a week to support people in social activities as part of a work placement scheme and a volunteer visits the home every week and spends time with some of the ladies doing activities like knitting, crocheting and other arts and crafts. A room, that was underused, is being refurbished as a reminiscence room and has become a popular room for people to sit with their families and visitors as it is a quiet room and has facilities for making tea and coffee. We were given examples of ways that the home has taken positive action in finding ways to better support people with dementia and records show that they seek advice, consult families and draw up guidelines when trying new techniques. People told us that visitors are welcomed into the home and family and friends are invited to parties and BBQs that are held to celebrate special days. There is a room available for visitors to use if they have travelled a long way or want to stay close to their family member. The home has one large open plan dining and sitting room, and the dining tables are placed close to the kitchen and those who can get to the table eat there together. Other people are supported to eat in the lounge area or in their bedroom if they prefer. The tables were attractively set and each table had fresh flowers along with condiments and fresh drinks. People were given the choice of two meals and one person, who hadnt eaten anything, was offered an alternative and chose a bowl of soup, which they went on to completely finish. The meal was served in ample portions and looked and smelt appetising. People were able to eat at their own pace so that they could enjoy their dinner without being rushed and once dinner was finished tea and coffee was bought round. Many people remained at the tables to have their drink and chatted to each other. One staff member stood at the table by the person she was helping and ignored them apart from loading the fork and leaving it on the plate for the person to put in their mouth them self. It is poor practise to stand above someone and not to interact while helping them, but this did not appear to be the usual practise for all the staff. Other carers helping people sat by their side supporting them while engaging with them and the others on the table, explaining what they were doing, what was on the plate and generally passing the time of day. Care Homes for Older People Page 18 of 32 Evidence: People were given large bibs to wear to protect their clothes while they ate, some of which finished their meal without making a mess of themselves. There were several people who use wheelchairs but the dinning tables didnt allow the wheelchair arms to go underneath so people had to sit a long way back from the table to eat; this made it difficult for them to eat without spilling their food. If people could get closer to the table they may not need to use the large bibs to keep their clothing clean and could manage with a serviette, which would be much more appropriate for adults to use as the use of bibs could be seen as demeaning. The home should consider alternative ways to help people keep their clothes clean while eating. They should also consider whether it is necessary for staff to wear blue latex gloves while they are taking plates to the table and helping people eat. Care staff dont prepare the meal and unless they are using their fingers to serve the food they dont come in contact with it and wont contaminate it. However people receiving support may wonder why whenever staff approach them they come wearing gloves. When they had finished eating we talked to a couple of people over a cup of tea, they told us that they had enjoyed their lunch and were always happy with the food on offer in the home. We talked with the cook who was knowledgeable about peoples special dietary needs and told us how she was happy to prepare an alternative meal if she was asked to. When we looked in the fridge, freezers and larder we saw that there was ample frozen, dry, tined and fresh food available. Care Homes for Older People Page 19 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 can be assured that complaints and concerns are managed in line with the homes policies and procedures and that action would be taken to investigate any complaint. Staff training and procedures help to protect people from abuse. Evidence: In the AQAA the manager told us that, We ensure that all new service users, their relatives and staff are aware of the complaints procedure. This is included in the preadmission documentation, is available at the entrance to the home and in the information packs that are given to each service user to keep in their room. We examined the homes complaints procedure and found that it provided the necessary information on how to raise any concerns or complaints about the service, we also saw that there is a recording system for complaints with is set out in a way that enables people to see that the complaints policy is followed. The manager told us that she makes herself available and prefers people to speak to her about their worries and concerns so that they can be sorted out before they escalate to become a complaint. She also said in the AQAA, By holding service user meetings, which are announced in advance to enable families and visitors to attend, we aim to encourage service users to express their ideas, thoughts, concerns and wishes. Care Homes for Older People Page 20 of 32 Evidence: We were also told that if people want to take part in the political process and vote, the manager makes arrangements to enable them to have a postal vote. The home does not manage peoples finances; families are expected to help their relatives to manage their own money. We were assured that if anyone was assessed as lacking capacity to manage their own money and didnt have anyone to act on their behalf the home would help them get access to an advocacy service. Small, everyday expenses, such as the hairdresser, will be covered by the home and the family would be invoiced. People are protected from abuse by staff training, we saw evidence in the training files that staff have undergone safeguarding vulnerable adult training and there are policies in place around recognising and reporting abuse. The home has reported incidents of suspected abuse to the local authoritys safeguarding team in the past and has been cooperative with investigations and has also shown themselves able to carry out thorough internal investigations and to take appropriate action. Earlier this year we received an anonymous letter that said people who live in this home are given a poor quality of care, are being neglected on a regular basis and that they are not being watched. The allegation was generalised and didnt give specific incidents or dates. However we took this accusation seriously and instigated a safeguarding alert which resulted in a safeguarding meeting, which involved us, Suffolks safeguarding manager and their qualities and monitoring officer as well as representatives of the home. During the meeting the homes manager showed us that she had carried out an investigation and produced information and evidence that refuted the allegations. The local authoritys quality monitoring team had recently carried out a survey of the homes private residents and told the meeting that no issues had been raised. It was agreed that block reviews would be carried out by the reviewing team, but no further action would be taken by the safeguarding team and the case is now closed to safeguarding. We also felt that an appropriate investigation had taken place and that the allegation was unfounded. Care Homes for Older People Page 21 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. This home offers a safe environment with comfortable communal facilities designed to maintain independence. Evidence: Risby Hall is a converted farm and all the accommodation is on the ground floor making it accessible to everyone. It is a large rambling building with a large central area that is separated into two areas with the dinning area on one side close to the kitchen and the lounge in on the other side. With the use of screens and by arranging the easy chairs into smaller groups to break up the room they have managed to give it a more intimate atmosphere. New chairs and soft furnishings have been bought and pictures and mirrors have been provided for all the communal areas. The lounge/dinner can be a busy area at times with a lot of coming and going, but there are other areas that people can use if they want to sit somewhere less busy. The home has recently made a room that wasnt used much into a reminiscence room that has easy chairs and drink making facilities that is used by people who have visitors and want to talk privately. During a tour of the building we noted that the home was clean, well maintained, furnished comfortably and was safe. We were told that fresh flowers are bought into the home every week and we saw several attractive flower arrangements throughout Care Homes for Older People Page 22 of 32 Evidence: the building. We didnt identify any health and safety infringements on this occasion. A house keeper has been appointed who has the responsibility of maintaining the hygiene standards and cleanliness in the home and has introduced new cleaning schedules and monitors that they are carried out. The kitchen is large and appropriately appointed for a home of this size. The cook is responsible for maintaining hygiene standards in the kitchen and has a cleaning schedule and showed us how she keeps records of the cleaning undertaken and other health and safety checks. The bedrooms we saw contained items of personal furniture and possessions that made them individual to the occupant. Several new carpets have been put down and rooms have been decorated to match. New matching bedding and curtains have been provided to all of the rooms. One of the bedrooms had a underlying smell of stale urine, the manager explained that they clean the carpets in this room often but it is an ongoing task. The home is considering replacing the carpet with a form of flooring that can be washed regularly so they will be able to eliminate the smell altogether. As we looked around the home the manager pointed out that all the old florescent lights have been replaced with chandeliers and other light fittings to help give a more homely appearance. The bathrooms and toilets are sufficient in number and were clean. Some of the bathrooms and toilets have specialist equipment and adaptations to meet the needs of the people living in the home and to prolong independence. A new shower room has been fitted and pictures and ornaments have been provided to make all of the bathrooms more inviting so that bath times can be calming and relaxing. Personal protective equipment was available for staff use to enable them to maintain good infection control. However, while it is good practise for care staff to wear gloves while supporting people with personal care if it is likely they may come in contact with bodily fluids, we saw that gloves are sometimes used in situations that arent always appropriate. Unless staff are preparing and actually handling food it is not necessary to wear latex gloves while taking plated food to people or helping them to eat. Risby Hall is situated in attractive grounds within a rural setting and most of the bedrooms have views of the grounds. A garden area has been safely enclosed to enable people to have free and safe access to a garden where there is outdoor furniture, an ornamental pond and bird feeders. We spoke to one person sitting in the Care Homes for Older People Page 23 of 32 Evidence: garden with their visitor who said they really enjoyed sitting there and always got out if the weather was good. We carried out random checks of health and safety records and found them to be in order, PAT testing has taken place to make sure portable electric equipment is safe to use and hoists are serviced regularly. Care Homes for Older People Page 24 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. People can be confident that staff are aware of their roles and responsibilities and are qualified. The home has safe recruitment procedures in place and training is appropriate to the needs of the people living in the home. Evidence: When we arrived at the home we found that sufficient staff were on duty to meet the needs of the people living in the home. There were eight care staff on duty with a registered nurse and a clinical lead, we also noted that the people on duty corresponded to the rota, which showed that similar numbers of staff are on duty every day. In the Annual Quality Assurance Assessment (AQAA) the manager said, We have a recorded staff rota in place. The staffing budget and allocation is regularly reviewed in consideration of the service users needs. Staff are present at the key moments of the day and there is always at least one trained nurse on duty. Staff personnel files are kept at the home and we examined four of them in detail. They held all the information and documents that are required to be kept as set out in schedule 2 and 4 of the National Minimum Standards. The staff members we spoke to confirmed that all the checks that safeguard people are carried out before people start working at the home and that they took part in induction training when they first Care Homes for Older People Page 25 of 32 Evidence: joined the workforce. In the AQAA the manager said, The homes recruitment procedure is thorough. Roles are clearly defined through job descriptions; the interview process respects equal opportunities and promotes an appropriate selection of candidates. References and CRB disclosures are obtained for all staff. The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs. Information given to us in the AQAA tells us that the home has met the minimum of 50 of its staff having attained the NVQ 2 in care or its equivalent, the manager told us that, We encourage care staff to obtain their NVQ 2 in care. Those who do gain this qualification are recognised at an annual awards ceremony held by the company. Care staff are supported to go on to complete their NVQ 3 in care should they wish to do so. We were told that the staff handbook has been revised and improved to ensure clear understanding of the homes expectations. The staff records show evidence that the home offers the mandatory training, and staff have access to specialist training suitable for the assessed needs of the people living in the home. We saw that staff have recently completed training via a computer program on the mental capacity act and that other training received over the last year included nutrition, wound care, infection control and catheter training from a continence specialist nurse as well as protection of vulnerable adults and fire training. The AQAA told us that the home helps staff to access literacy and IT training and support for those who feel they need additional support in this area. The training coordinator has recently completed a palliative care course and has attended further health and safety courses and is in the process of arranging training sessions in these areas. Someone who returned a staff survey said, Training is good at the home, the manager is supportive to staff members and is always willing to listen. They also commented that they thought they would benefit from more training and would like the rotas to be more flexible. Some of the staff said they could be paid more money and one person suggested that if the pay was better staff would stay longer, leading to more continuity and that would lead to people being cared for better. Care Homes for Older People Page 26 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. This home is well run and the ethos of its management is empowering to the people living in it. Health and safety is promoted and necessary checks are made and records kept. Evidence: The manager was at the home when we arrived and she facilitated the inspection, which she did in an open and helpful way and was able to produce everything we asked for, she seemed well organised and comments we received indicated that she is well liked by the people living in the home and the staff. The manager has been in the home for less than a year but is experienced, having worked with older people for over 25 years including those with dementia. She has been involved in managing care homes for ten years and has completed her registered managers award. The managers office is situated in the front entrance of the home and is shared with Care Homes for Older People Page 27 of 32 Evidence: the clinical lead and the administrator, they have a good relationship which she thinks is helpful in promoting the friendly, helpful environment that has become Risby Hall. In the AQAA the manager tells us that, The manager maintains close contact with the service users and audits their care plans on a monthly basis, providing additional clinical and best practise guidance to the trained staff. Service users and their representatives are involved as far as possible in the care planning process and consulted about their care. When we examined the care plans we saw evidence that the care plans are revised every month and that people are involved in the completion of the care plans. A staff member told us in their survey that, I feel that Tanya (the manager) is a great asset to the care home. She is approachable and fair, she is very caring to the residents. Another staff member said, There is a great team spirit among all the staff. The home managers enthusiasm for her role is reflected in the care that is offered to residents by all her staff. Regular resident meetings are held, we saw that they are advertised in advance to give families an opportunity to attend, the manager says that they have an open door policy and that she is always happy to talk to people and is open to suggestions and constructive criticism. Regular regulation 26 visits are held, when the clinical or resource director visits the home and carries out their own inspection which includes checking documentation, compliance to regulations and speaking to staff, visitors and people living in the home to canvass their opinion on quality of care offered by the home. We noted from the staff files that there is evidence that people get supervision and that regular staff meetings are held and that staff are encouraged to add items to the agenda. Staff we spoke to confirmed that they received supervision and the manager told us that, Staff are regularly supervised, care staff all have a named mentor, a system which fosters team spirit and encourages the development of favourable professional relationships. The home has a quality assurance procedure in place that involves them sending annual surveys to staff, people in the home and their relatives. The information collected is collated and a report is produced and a copy made available so that people can what areas need attention and what steps are going to be taken. The organisations polices and procedures are comprehensive and are reviewed and updated as legislation dictates. The AQAA lists the polices that are in place and Care Homes for Older People Page 28 of 32 Evidence: confirms that they have all been reviewed in the last couple of years. Records are kept up to date and are stored appropriately. Personal details are stored away from public gaze and are kept confidential. Computers that hold personal information are not connected to the internet and are security protected. staff are asked to read and sign the organisations policy on confidentiality when taking up their post. A sample of health and safety records were inspected and were found to be in order, we didnt identify any health and safety infringements during this inspection. Care Homes for Older People Page 29 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 30 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 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 8 All medication should be given as the doctor directed, if it is felt that the medication no longer needs to be taken as prescribed the doctor should be contacted for advice. It would be advisable for the service to revise the way they manage the medication that is left over at the end of each monthly cycle and they should maintain an audit trail. 2 8 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!