Care Home: Riverslie

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What the care home does well Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. The assessments were consistent in detail and quality and clearly identified care needs so that a good idea of the care needs were apparent. All relatives and residents spoken with [or replied to surveys] did generally feel that they are kept informed about the care and that any medical or care appointments or reviews are reported. There are clear records of health professionals visiting. We spoke to a visiting health care professional who reported that both people she was reviewing were well placed in the home and were settled and being supported appropriately. Similarly, relatives and residents were pleased with how staff approached the personal care of residents. Residents were observed to be clean and appropriately dressed. At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people including domestic and administration staff. This means that the social life of people in the home is given some priority. Residents surveyed and spoken with were all pleased with the meals. The dining room was observed to be pleasant with tables laid and menus displayed. Residents have a choice of where they have meals. Those people spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. This helps ensure that residents are kept safe in the home. Training is ongoing in the home. Staff spoken with said that they felt supported through the training program. Currently 15 of the care staff have a National Vocational Qualification [NVQ] which is over 50% so that the home can evidence a core of staff who are competent to carry out care. The residents and their relatives gave good feedback about all staff and the manager. Comments included: `Its lovely here and staff are very nice` `We went in the garden yesterday and the staff had time to talk and help us` `I`m able to look after most of my care but when i need them the staff are very helpful`. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. What has improved since the last inspection? There is a new manager in post, Paula Claro, who is in the process of systematically reviewing all of the care practices in the home. Following the last `Key`, or main inspection of the home a year ago there were a number of requirements and recommendations made. Since then the home has had a further two visits focusing on medication management. Overall the requirements made have all been met and the quality rating for the home has improved. The main areas of improvement have been in medication management, care planning, recruitment of staff and basic health and safety management. What the care home could do better: We have made one further requirement and a number of good practice recommendations. The requirement is around maintaining consistent standards of cleanliness in the home. Most areas seen were generally well maintained although there were some inconsistencies. For example the sluice room was not clean and the staff office was also not clean. The manager accepts that these and some other areas are difficult to maintain and require upgrading so that surfaces such as floors can be more easily cleaned. Some toilets / bathrooms did not have paper towels so in one instance a staff member found difficulty drying their hands. We saw the environmental health report for the kitchen from February this year and this reported poor standards of kitchen hygiene. The manager advised us of plans to address these issues and the progress made since but this remains a concern as it evidences inconsistent standards around hygiene and infection control in the home in the recent past. There were some further recommendations around screening in shared bedrooms so that people have have privacy and additional seating for day areas. We saw that people had been assessed on an ongoing basis regarding their mental capacity. This is important so that a clear basis for decision making can be established. We did not see any assessments made on the pre admission details however. We would strongly recommend that a capacity assessment based around the ability of the person to choose to come into a care home is made at this point which can then form the basis of ongoing assessments and help clarify decision making as daily issues occur. We have made some comments and recommendations around the continued development of the `key worker` system so that care staff can be more involved with individuals in the home. Also we made some comments that important observations such as fluid intake for people are not always maintained upto to date. This is important to maintain peoples health. people reported that the provision of activities in the home is variable and still needs to be developed further. This is to help people live more fulfilled lives on a daily basis. W looked at the way the home manages the personal allowances for people and have made some good practice recommendations around the way records are maintained. Key inspection report Care homes for older people Name: Address: Riverslie 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW     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: Michael Perry     Date: 1 9 0 5 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Riverslie 79 Crosby Road South Waterloo Liverpool Merseyside L21 1EW 01519283243 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Innocare Limited Name of registered manager (if applicable) Michelle King Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Learning disability - Code LD (Maximum number of places: 1) The maximum number of service users who may be accommodated is 30. Date of last inspection Brief description of the care home Riverslie is a Care Home with nursing and personal care only. In total the Home can provide care for 30 residents. There are 22 single rooms and four double rooms, some of these with en-suites. Bedrooms are situated on all floors. There is a single lounge located on the ground floor and a dining area that has two separate sittings for lunch Care Homes for Older People Page 4 of 31 Over 65 0 30 1 0 2 3 0 3 2 0 1 0 Brief description of the care home and dinner also located on the ground floor. Riverslie is a converted building on three storeys and provides a small passenger lift to all floors. There are gardens to the rear of the Home that are accessible from the ground floor. All areas of the Home are accessible to the residents and there are handrails and ramps provided throughout Riverslie for this purpose. Riverslie is situated in the Bootle area near to the local parks and the docks. The surrounding area is mainly residential. The Home is set back from a dual carriageway. Parking is available to the front of the building and there are main travel routes that provide easy access to the Home. Mike Dempsey is the Responsible Person and the current acting manager is Paula Claro. The range of fees is currently from GBP 387 to GBP 550 per week. 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: 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: The inspection was unannounced and was conducted over a period of one day [9 hours]. All day areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken with along with members of staff and the Manager. Comments have been used in the report. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focusing the inspection. We also sent out some surveys to residents and staff prior to the visit so that we could get some views and comments. Care Homes for Older People Page 6 of 31 During the visit we were able to speak to a visiting care professional. Care Homes for Older People Page 7 of 31 What the care home does well: Prior to admission the senior staff complete a preadmission assessment by going out and visiting the resident. The assessments were consistent in detail and quality and clearly identified care needs so that a good idea of the care needs were apparent. All relatives and residents spoken with [or replied to surveys] did generally feel that they are kept informed about the care and that any medical or care appointments or reviews are reported. There are clear records of health professionals visiting. We spoke to a visiting health care professional who reported that both people she was reviewing were well placed in the home and were settled and being supported appropriately. Similarly, relatives and residents were pleased with how staff approached the personal care of residents. Residents were observed to be clean and appropriately dressed. At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people including domestic and administration staff. This means that the social life of people in the home is given some priority. Residents surveyed and spoken with were all pleased with the meals. The dining room was observed to be pleasant with tables laid and menus displayed. Residents have a choice of where they have meals. Those people spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. This helps ensure that residents are kept safe in the home. Training is ongoing in the home. Staff spoken with said that they felt supported through the training program. Currently 15 of the care staff have a National Vocational Qualification [NVQ] which is over 50 so that the home can evidence a core of staff who are competent to carry out care. The residents and their relatives gave good feedback about all staff and the manager. Comments included: Its lovely here and staff are very nice We went in the garden yesterday and the staff had time to talk and help us Im able to look after most of my care but when i need them the staff are very helpful. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. Care Homes for Older People Page 8 of 31 What has improved since the last inspection? What they could do better: We have made one further requirement and a number of good practice recommendations. The requirement is around maintaining consistent standards of cleanliness in the home. Most areas seen were generally well maintained although there were some inconsistencies. For example the sluice room was not clean and the staff office was also not clean. The manager accepts that these and some other areas are difficult to maintain and require upgrading so that surfaces such as floors can be more easily cleaned. Some toilets / bathrooms did not have paper towels so in one instance a staff member found difficulty drying their hands. We saw the environmental health report for the kitchen from February this year and this reported poor standards of kitchen hygiene. The manager advised us of plans to address these issues and the progress made since but this remains a concern as it evidences inconsistent standards around hygiene and infection control in the home in the recent past. There were some further recommendations around screening in shared bedrooms so that people have have privacy and additional seating for day areas. We saw that people had been assessed on an ongoing basis regarding their mental capacity. This is important so that a clear basis for decision making can be established. We did not see any assessments made on the pre admission details however. We would strongly recommend that a capacity assessment based around the ability of the person to choose to come into a care home is made at this point which can then form the basis of ongoing assessments and help clarify decision making as daily issues occur. We have made some comments and recommendations around the continued development of the key worker system so that care staff can be more involved with individuals in the home. Also we made some comments that important observations such as fluid intake for people are not always maintained upto to date. This is important to maintain peoples health. people reported that the provision of activities in the home is variable and still needs to be developed further. This is to help people live more fulfilled lives on a daily basis. W looked at the way the home manages the personal allowances for people and have Care Homes for Older People Page 9 of 31 made some good practice recommendations around the way records are maintained. 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 10 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 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are carried out prior to residents being admitted and these are clear so that a completed picture of care needs can be obtained. Evidence: We saw that each bedroom had a copy of the service user guide which is booklet containing information about the home. Those residents spoken with said that they had received a visit from the manager prior to being admitted to the home and that they had been given enough information so that they were aware of the type of home they were coming to. There is also information such as the complaints procedure and a copy of the last inspection report available. The pre inspection information [AQAA] completed by the manager says: The pre-admission assessment information is followed by a post admission assessment process which is aligned with and follows on from the pre-admission Care Homes for Older People Page 12 of 31 Evidence: process so that information is not lost in the process. Pre admission assessments are carried out by the Manager. We found this to be the case.The assessments we reviewed were consistent in detail and quality and clearly identified care needs. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that a good idea of the care needs were apparent. There were also some risk assessments completed which were appropriate. This ensures that people are admitted appropriately. We saw that people had been assessed on an ongoing basis regarding their mental capacity. For example one person has been carefully assessed regarding the administration of medication which is now given in that persons best interest to promote their health. This is important so that a clear basis for decision making can be established. We did not see any assessments made on the pre admission details. We would strongly recommend that a capacity assessment based around the ability of the person to choose to come into a care home is made at this point which can then form the basis of ongoing assessments and help clarify decision making as daily issues occur. Care Homes for Older People Page 13 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. The way care is delivered continues to be developed positively so that peoples right to health and personal care continues to improve. Evidence: The AQAA for the service tells us: Care planning has been developed from its previously unacceptable standards in the past, and planning is now more effective, and assessed risks and other information more effectively brought into the care planning and review process. There has been more involvement of families in the care plan reviews and processes. We reviewed two care files and found this to be the case. One person has very complex nursing needs and at the previous inspection was found to have poor care planning so that there was a risk many of the care needs were not being fully met. On this visit we found the care records to be very detailed and it was easier to follow the care given. For example staff are given guidance in one care plan around how to approach the person regarding verbal hostility that may occur. Also there was a Care Homes for Older People Page 14 of 31 Evidence: detailed plan regarding the care of the persons diabetes including advice to staff on how to recognize signs of illness in the person. We spoke with the person concerned who was able to give a full account of the care given and it was clear that staff were able to give support in a relaxed and well paced manner. Staff ensured that medical appointments are kept and that medical reviews are carried out regularly to support the person. On the day of the inspection the GP attended to complete a review. We spoke to a visiting health care professional who reported that both people she was reviewing were well placed in the home and were settled and being supported appropriately.This means that people in the home have good support and access to health care. Generally people spoken with said that they felt staff approached them well and they were respectful of their privacy and dignity. We observed staff interacting with people in the home and it was clear that they had a good rapport. One example was how staff supported a person who was clearly distressed using the hoist. Staff spent time and reassured the person so that the care could be carried out appropriately. We did find some examples of care which still need to be addressed if there is to be overall consistency. For example one persons fluid intake needed careful monitoring due to a medical condition. The records maintained had not been completed for two days. Also: * A shared bedroom did not have any screens in place so that the occupants could maintain privacy and dignity. We spoke to the manager who reported that screens had been removed for health and safety reasons. We would strongly recommend that this is reviewed and appropriate curtain screens put in place [see environment section of the report]. * We spoke with staff who reported that personal care is generally carried out by same sex staff as this respects peoples dignity. We observed however one female resident being supported to the toilet by a male carer. Also care plan documentation made reference to one person having to make a request that no male staff attend to personal care and this was later reviewed and said now does not mind male staff attending. We would strongly recommend that this area of care is reviewed by the manager so that there is a consistent policy that is carried through to the care given. This will ensure that people receive personal care with supports their right to privacy and dignity at all times. We spoke with staff and the manager who said that the processes around the way the Care Homes for Older People Page 15 of 31 Evidence: care is planned and carried out is still being developed. For example the key worker system that has been developed to help ensure more personalised care and that each resident has access to a member of staff who can help co ordinate care, still needs further work so that it is more consistent. Also care staff access to care plans is limited as they are held centrally and finding time to look at these is limited. One staff commented; things have improved but realistically we can only look at care files at the end of shift if we have time. Things should be better once the care files are kept in the residents rooms as planned. We looked at how medication was managed in the home. We have visited twice since the last main inspection to look specifically at medicines and the way they are administered. The manager has completed reviewed all processes and there have been improvements so that medication is now safely administered. The records we saw where clear and any changes were recorded appropriately. The manager carries out weekly medication audits which have helped to identify any issues and correct them. We spoke with people who said that they get their medication on time and this is well managed. The manager plans to develop things further which will help to ensure that administration is more personalised and errors can be further reduced [storage of medicines in individual rooms] and training for care staff who can then assist with some medication administration in the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life and social care for residents continue to be developed so that residents generally are supported to feel relaxed and at home. Evidence: The AQAA completed by the manager states: A wider range of activities support material will be introduced (already started) so that residents can be tempted to engage in social and personal activity that suits them and their needs more easily, as opposed to mainly being invited to take part of group activities. All staff are to be coached to understand that support for social activity, including contact with families and other interests, is the responsibility of all staff, and not the sole responsibility of an activities organiser. The care planning format is being modified to promote this understanding and process, and there will shortly be training to introduce the new format. This statement was the same made a year ago with the previous AQAA received from the service. Over all we found that activities for residents and the social fabric of the Care Homes for Older People Page 17 of 31 Evidence: home was similar to our last full inspection. The manager is new and has only been fully in post for 3/4 months. We saw some evidence that staff are trying to build up a range of regular activities and these are posted on the notice board. For example an external trainer attends weekly to do armchair aerobics. One person told us about attending church twice a week and how staff support her to do other activities such as going into the garden [the day previously]. Other people where not as well supported however. One person said: The home is very nice and relaxed but the manager told me there would be activities to do but Ive not seen this. The surveys returned support this mixed view and it is clear that daily activities for people need to continued to be developed. At the time of the inspection we found the home to be very warm and welcoming. Residents were happy to chat and to tell about life in the home. Staff were seen to actively interacting and supporting people including domestic staff and the administrator. The manager plans to develop things further and to include relatives on more occasions. This means that the social life of people in the home are given some priority. Residents surveyed and spoken with were all pleased with the meals provided. The dining room was observed to be pleasant with tables laid. Residents have a choice of where they have meals although with the dining room now moved to a larger room there is better provision for people generally. A staff member canvases people daily as to their preferences and everybody spoken with said there was plenty of choice. We saw a designated staff member responsible for meal times and this helps top provide a more immediate and consistent service for people. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected Evidence: There is a complaints procedure available for people in the home. This is displayed in the service user guide. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. We asked about any complaints made about the service in the last year. There has recently been a complaint made to CQC from an ex member of staff. This was referred to the homes management to investigate and was carried out appropriately so that redress was apparent. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. One staff told us of a situation she had been in and how this was managed very well and things were reported and investigated appropriate. She had felt supported by the processes in the home. The manager was able show us copies of the homes policies and procedures. The staff training ensures that all staff have up to date information regarding current good Care Homes for Older People Page 19 of 31 Evidence: practice. The manager was knowledgeable and could explain how to contact the local safeguarding team and understood how an investigation would be organized and has experienced this. This helps ensure that residents are kept safe in the service. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general environment of the home continues to be developed so that people can be accommodated comfortably. Evidence: The AQAA for the service lists a number of improvements to the home since the last inspection: Some maintenance and improvements to the environment in the home. The acting manager had radically changed laundry procedures to make them consistent with good infection control practice. Purchase of additional moving and handling equipment Stand Aid hoist, 4 electrically operated full movement beds Purchase of five additional specialist mattresses and two air wave cushions Decorated seven bedrooms, and lounge Re carpeted four bedrooms, and lounge Re floored two bedrooms Purchased and fitted door Fireguards, replacing some older units and adding new ones to all doors requiring them. Purchased and fitted magnetic door catches for wheelchair users Purchased and fitted additional infection control equipment, soap and towel dispensers in all bedrooms and service areas, dispensers for aprons, gloves and hand gel for staff. Dining room and lounge areas upgraded to provide more flexibility for both food service and relaxation All fire escape doors fitted with alarms to central unit Dining room external window and door fitted with new locking mechanism Replaced all vertical blinds to front of building found to not be fireproof Kitchen area fitted with half Care Homes for Older People Page 21 of 31 Evidence: door to reduce unauthorised entrance by staff and residents, but facilitate food service Front entrance area refurbished, floor ramp re-laid. At the time of the inspection we found the home to be warm and welcoming. Residents were clearly settled and found the surroundings comfortable. The improvements were commented on by some of those spoken with particularly the development of the dining room. Most areas seen were generally well maintained although there were some inconsistencies. For example the sluice room was not clean [discussed with the manager] and the staff office was also not clean. The manager accepts that these and some other areas are difficult to maintain and require upgrading so that surfaces such as floors can be more easily cleaned. Some toilets / bathrooms did not have paper towels so in one instance a staff member found difficulty drying their hands. We saw the environmental health report for the kitchen from February this year and this reported poor standards of kitchen hygiene. The manager advised us of plans to address these issues and the progress made since but this remains a concern as it evidences inconsistent standards around hygiene and infection control in the home in the recent past. The home is not purpose built and we saw how this presented staff with difficulties in providing personal care. For example using the hoist in confined spaces and protecting peoples privacy when using the hoist in toilet areas [problems trying to close doors]. The manager and staff have done their best to assess these difficulties however and to make as many areas as possible accessible. The purchasing of disability aids as listed above evidences that the home is aware of peoples diverse needs in this area. At the end of the inspection we discussed with the manager our observations and she was able to evidence further planned upgrading of the home which has been agreed with the provider [including upgrading the lift for example]. Some more observations are listed below to further inform the process of continuous improvement and are listed as recommendations at the end of the report. * One room is currently shared. We could see no evidence of screening to protect peoples privacy. The manager said that the screening available had been removed as one person had found difficult to maneuver and it presented as a risk of injury. We would strongly recommend that suitable screening is made available as discussed so that people in the room can make use of this independently [ this would involve a Care Homes for Older People Page 22 of 31 Evidence: curtain fixed to the ceiling]. *The changes to the dining and day areas means that there is currently insufficient seating for all residents. This can be improved by developed the seating area in the dining room. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment and training of staff ensure that care needs can be met. Evidence: The AQAA for the service says: Staffing levels are believed to be above those of similar homes, and this expenditure has been authorized by the Provider in order to continue to improve standards in the home, and give opportunities for staff to continue training and development. We looked at the duty rota and found that generally staffing was stable and this was supported by staff interviews. This is an improvement from the last inspection where we found a lot of staffing inconsistencies. There is ancillary staff support such as domestic staff and laundry staff as well as staff working in the kitchen. There is also an administrator to provide support for the manager. We saw that ancillary staff were keen to support care staff and spend time with residents in the home. Staff described good team work generally.People in the home who were spoken with generally felt that staff were responsive and the pace of the care was relaxed and unhurried. Overall we found evidence that staffing was generally sufficient to meet care needs. Care Homes for Older People Page 24 of 31 Evidence: Training is ongoing in the home. Staff spoken with said that they felt supported through the training program. Currently 15 of the care staff have a National Vocational Qualification [NVQ] which is over 50 so that the home can evidence a core of staff who are competent to carry out care. The manager provided further information on staff training. This shows that the training opportunities and training needs of the staff team have been identified. The manager reported that the staff training program is developing and records seen showed a progressive ongoing program and staff interviewed had attended relevant courses. The residents and their relatives gave good feedback about all staff and the manager. Comments included: Its lovely here and staff are very nice We went in the garden yesterday and the staff had time to talk and help us Im able to look after most of my care but when i need them the staff are very helpful. Staff were observed to be warm and respectful with the residents throughout the course of the inspection. Staff were present in the lounge throughout the inspection and were readily available to meet the needs of the residents. We looked at the staff files for two new members of staff in order to assess the staff recruitment and selection procedures at the home. The files were complete and up to date and all of the necessary recruitment checks had been made. This is important so that the home can evidence that staff employed are fit to work with vulnerable people. This has improved since the last inspection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management systems that can monitor and improve the care in the home so that the home can be run in the best interests of the people who live there. Evidence: The AQAA for the service says: Audits have become regularised.With an acting manager in place, for the first time in a number of years, the opportunity arises to move from requiring a new manager in a crisis, who tend to be short tenure, to one where a longer tenure and more appropriate manager appointment is possible. Paula Claro is the new manager for service and has been in post for 3 or 4 months. During this period she has made improvements to the service so that there now appears greater consistency. The previous inspections had made a number of requirements and all of these have now been met. From reviewing the AQAA and speaking to the manager there is good awareness of where the service is in terms of Care Homes for Older People Page 26 of 31 Evidence: progress made and also further progress needed. The inconsistencies highlighted previously with respect to maintaining safe practice have all been addressed. There is a development plan and the manager was able to tell us about both short term and longer term plans for the home. This shows that the management is proving effective in developing and maintaining standards in the home. We looked at various management systems and although not all have been reviewed yet, those highlighted previously have been reviewed and improved on. These include management of residents personal allowances. These were reviewed and are managed by the new administrator in the home. The records seen recorded expenditure and the balance of funds was correct when checked. We would strongly recommend, however, that all entries are signed by two people [preferably the resident unless lacking in capacity] not just the administrator [this was recommended previously]. Also there should be evidence that the personal allowance accounts are checked by managers [manager or responsible person] to allow for correct auditing which can pick up any anomalies. We also looked at how health and safety is managed and again although not all systems have been reviewed yet there are basic risk assessments being carried out and key systems such as the fire system have been reviewed and updated. We saw the environmental health report carried out in February this year and the issues highlighted are being addressed by the manager. The home are now fully aware of reporting processes so that any untoward incident has been reported through to the Commission [CQC] as required. This shows that the manager is open and is seen to be accountable for events in the home and is communicating with statutory bodies positively. Care Homes for Older People Page 27 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 28 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 26 16 All areas of the home must be consistently maintained in a clean condition. This ensures that the home is clean and safe to live in and the risk of infection is reduced. 21/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 We would recommend that the mental capacity assessments carried out begin with the pre admission details. The proposed developments around the care planning and key worker system should be implemented which may ensure consistency of care. All observations necessary for the monitoring of peoples health care should be completed consistently. The homes policy around delivering personal care with same sex carers needs to be reviewed and delivered consistently. The daily planning of organized activities for people still Page 29 of 31 2 7 3 4 8 10 5 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations needs to be developed so that all peoples needs are met. 6 7 20 24 The extra seating planned for the dining room area should be actioned with some priority. We would strongly recommend that permanent screening is supplied in the shared room discussed which people can use independently. The manager should apply to the Commission [CQC] for registration as a matter priority. All personal allowance accounts should have signatures by two people to reduce the risk of any errors. The accounts should be audited routinely by senior management and entries made on the account sheets to evidence this. 8 9 31 35 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - 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. 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