Care Home: Royston Nursing Home

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What the care home does well Assessments are carried out on the physical, social and health care needs of prospective resident before they are admitted to the care home. This means that prospective residents will know if the care home is able to meet their needs. Communal areas of the care home are comfortably furnished and decorated. Relatives and friends of residents are able to visit when they choose. They are made welcome by the staff. A range of activities is provided within the care home for residents to enjoy. What has improved since the last inspection? Care plans have been reviewed and amended to ensure they include information about how staff should meet each residents identified need. Care plans have also been reviewed and amended to ensure they accurately reflect the current care needs of residents. Menus and food provision have been reviewed and improved to ensure the dietary needs of residents are provided for. All staff who are employed at the care home have been provided with appropriate training, including induction training, to ensure they have the skills and knowledge to meet residents needs. A number of bedrooms have been redecorated and refurbished. What the care home could do better: Whilst we have noted that the manager has made significant improvements to care plans and medication records, further work is required to ensure they include sufficient and up to date information for staff to follow to ensure care is provided consistently and continuously, and in accordance with residents wishes. Care plans should include information with regard to as required medications for pain relief. This will ensure medication is administered safely and in accordance with the prescribing GPs instructions. Whilst activities have been provided within the care home, they do not appear to have satisfied individual residents social and recreational interests and needs. Staffing levels have been increased since our last visit. However the manager needs to ensure there are sufficient staff on duty to meet residents needs at peak times of demand such as meal times. In addition, there is still work to be done by the management to monitor and supervise staff to ensure the improvements that have been made become embedded within care practices. This will mean that residents will continue to receive better quality care. Key inspection report Care homes for older people Name: Address: Royston Nursing Home Brighton Road Clayton Hassocks West Sussex BN6 9NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Bannier     Date: 1 1 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 33 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 33 Information about the care home Name of care home: Address: Royston Nursing Home Brighton Road Clayton Hassocks West Sussex BN6 9NH 01273845603 01273842018 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care Reminiscence Limited Name of registered manager (if applicable) Margaret Nyambe Wakunguma Malumo Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is (17). The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home Royston is a care home, which is registered to accommodate up to seventeen residents in the category OP old age, not falling within any other category. It provides personal and nursing care. Royston is located in the rural village of Hassocks and is a detached three-storey property, which provides accommodation in single, and double bedrooms located on the ground, first and second floors. There are also two lounges, which are Care Homes for Older People Page 4 of 33 Over 65 0 0 Brief description of the care home located on the ground floor. A vertical passenger lift provides access to all floors. The registered provider of this service is Care Reminiscence Ltd, who has appointed Mr Lance Herbert as the responsible individual to supervise the management of the care home. The registered manager is Mrs Margaret Malumo who is responsible for the day to day running of the care home. Current fees are £650.00 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. The quality rating awarded on completion of the inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment when requested to do so. This document is referred to in this report. We visited the care home on Tuesday 11th May 2010. As this was an unannounced inspection we gave the manager and provider no notification of our intention to visit. We met and spoke to some of the residents accommodated. We also observed care practices and interactions between residents. We also met and spoke to some relatives who were visiting at the same time. This helped us to form an opinion of what it is like to live in this care home. We also spoke to some of the staff who were on duty in order Care Homes for Older People Page 6 of 33 to gain a sense of how it is like to work at the care home. We also viewed some of the accommodation and examined some records. We were accompanied by an expert by experience during part of our visit. An expert by experience is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live there. The visit started at 9.45am and was completed by approximately 4.30pm. The expert by experience arrived at 11am and stayed until approximately 1pm. it was planned that they would be present over this period in order to observe lunch. The responsible individual and the registered manager were present during our visit and provided us with information about the service. We gave feedback of our findings to them before the end of our visit. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Whilst we have noted that the manager has made significant improvements to care plans and medication records, further work is required to ensure they include sufficient and up to date information for staff to follow to ensure care is provided consistently and continuously, and in accordance with residents wishes. Care plans should include information with regard to as required medications for pain relief. This will ensure medication is administered safely and in accordance with the prescribing GPs instructions. Whilst activities have been provided within the care home, they do not appear to have satisfied individual residents social and recreational interests and needs. Staffing levels have been increased since our last visit. However the manager needs to ensure there are sufficient staff on duty to meet residents needs at peak times of demand such as meal times. In addition, there is still work to be done by the management to monitor and supervise staff to ensure the improvements that have been made become embedded within care practices. This will mean that residents will continue to receive better quality care. Care Homes for Older People Page 8 of 33 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 33 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 33 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 care needs of all prospective residents have been assessed before moving into this care home. Evidence: From evidence gathered during our last visit we made a judgement that the care needs of prospective residents had been assessed. However, it was not clear if this process was completed before they moved into Royston Nursing Home. On this occasion, we were informed that one resident had been admitted since our last visit. We examined assessment records for this person and found that their needs had been assessed prior to admission. Documentation seen indicated that the areas of need covered included personal care, physical wellbeing, mental state and cognition, mobility and dexterity, sight, hearing and communication, oral health and foot care, continence, social interests, hobbies, religious and cultural needs. Care Homes for Older People Page 11 of 33 Evidence: We spoke to care staff who were on duty. They demonstrated they had been made aware of the needs of this resident and what was expected of them to ensure they have been met. We found no evidence to demonstrate intermediate care is provided at Royston Nursing Home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents health, personal and social care needs have been set out in an individual plan of care. However improvements are needed so that there is sufficient information for staff to follow with regard to the administration of medication prescribed on an as required basis to ensure all needs are met. Care plans must also routinely include the wishes of individuals to ensure their dignity and right to privacy is upheld. Residents health care needs have been met. No residents are responsible for their own medication. They have not always been protected by the homes policies and procedures for dealing with medicines. AS already mentioned, care plans do not include sufficient information for staff to follow with regard to the administration of medication prescribed on an as required basis. Residents have not always been treated with respect and their right to privacy has not always been upheld. Care Homes for Older People Page 13 of 33 Evidence: From evidence gathered during our last visit to the care home we made a judgement that care plans had been drawn up for each resident. However, they needed to be improved to ensure that the staff team had clear and detailed information about services users needs and wishes. On this occasion we sampled a selection of care records and found that improvements had been made as required. Care plans have been amended and included more details of residents identified needs together with clear information for staff to follow so they know the action they are expected to take to ensure they have been met. We also identified those records where further information is still required. We spoke to the manager and to the responsible individual about this. We were given assurances that care plans will be kept under review and amended where necessary. We spoke to the relatives of two residents who was visiting at the time. We were informed they were satisfied with the quality of care provided. One person told us, I am happy with the care provided to my mother. There was evidence that confirmed care plans have also been routinely reviewed. This means that information about residents care needs is kept up to date. We spoke to a group of care staff who were on duty. We asked them about the care needs of residents identified for the purpose of case tracking. They demonstrated they understood the needs of each resident and what they were expected to do to ensure they were met. We also observed care practices and found that staff are respectful when speaking to residents. The expert by experience sat with residents during the main meal of the day. They observed that all by one resident were provided with bibs to protect their clothes whilst they eat their meal. They also observed that linen napkins had also been provided but were not used. We discussed these observations with the responsible individual and with the manager. We were informed that the purpose of this was to afford protection to residents clothes whilst they ate their meal. They were unable to give a reason why napkins were not used except that, in some circumstances, napkins may not be sufficient for the job. However, it was agreed that, in the interests of maintaining residents dignity, napkins will be used instead. Staff were seen to ensure residents are treated with dignity when personal care is being provided. They ensured doors to bedrooms and toilets were closed before they began to provide personal care. Staff were seen to address residents using the name and title they prefer. As most bedroom doors were open we noted that staff did not Care Homes for Older People Page 14 of 33 Evidence: always knock on the doors to residents private accommodation and wait for a response before entering, even though residents were in their room. The expert by experience was asked to consider the following questions. Do the care staff understand what residents need and are they able to provide the right level of care. They reported, The Manager told me that the residents currently in the Home have been transferred from other homes or hospital. Although most of the bedrooms were not occupied at the time of my visit the bedrooms I did see, apart from one, had TVs but very little personal possessions. Some of the rooms were quite small and sparse. They didnt appear cosy so wouldnt encourage the residents to spend any personal time in them. All the bedroom doors were open regardless of whether they were occupied or not. The rooms I saw were not en suite so the residents would need to call out for attention. I didnt see any bells. I asked three residents if they needed attention at night but none could remember. They thought they slept through the night. Two told me that they had to call out in the morning to go to the toilet and sometimes they have to wait because the carers are busy. One of the Carers told me that in the morning when they start their shift the residents have already had a cup of tea and most have been washed and dressed. In the evening the day shift will prepare residents for bed. If any residents preferred to wait then the evening shift will prepare them when they are ready. All residents are in their rooms by 8.30pm. The Manager told me one of the residents always wants to retire after tea but they manage to keep her up later otherwise she wont sleep through the night. We observed that all medication had been securely stored in a locked facility. We also looked through records of medication administered to residents. We noted that on one or two occasions, there were gaps where the person responsible for giving medication to residents had not signed this record to confirm this had been done. This means that, on these occasions, there is no evidence to confirm that residents have always been administered medication as prescribed by their GP. We discussed this with the manager at the time. She confirmed she would look into this and take the necessary steps to prevent this occurring in future. We noted that some residents had been prescribed medication, mainly for pain relief, on an as required basis. However, records seen did not include details of the reasons why this medication was administered, the dosage and what the outcome had been. We also discussed this with the manager who agreed to draw up a care plan to include the relevant information so that care staff know what is expected of them. Care Homes for Older People Page 15 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have been provided with activities and entertainments. However, from observation they have not always satisfied individual residents social and recreational interests and needs. Residents have been encouraged to maintain contact with family and friends. Residents have not been supported in maintaining contact with the local community. Residents have not been helped to exercise choice and control over their lives. Routines of the home continue to be designed to ensure tasks are completed rather than encouraging residents to make choices about their lifestyle. Residents have received a wholesome appealing balanced diet which meets individual residents nutritional needs. Evidence: During a previous visit we were informed that an activities organiser had been appointed who works from 10am to 4pm each day. Care Homes for Older People Page 16 of 33 Evidence: During the morning of this visit we went into the lounge where we observed six residents sitting around the room. Whilst the television was on no one appeared to be watching it. One resident was reading whilst others were dozing. We were informed that organised activities take place after lunch. We were shown a copy of the previous weeks activities that each resident took part in. They included television, reading, exercising, playing cards, word games, discussion groups, board games and singing. A programme of activities is also on display on a notice board in the front hallway of the care home. Also on display are posters advertising entertainments which had been organized. We noted that a musician was due to visit the following week who would be playing the violin. We could find very little information about their interests and hobbies in each residents care records. It was therefore, not possible to confirm that activities and entertainments which had been organised were meeting residents needs. The expert by experience was asked to consider if residents have enough to do during the day.They reported, I sat in the lounge with the six residents for 40 minutes until staff took each resident to the toilet and then into the dining room. During that time nobody spoke. One was looking at a magazine, one was sleeping and the other four were just staring into space. The feeling in the room was one of apathy. When the carers did come in to the room residents were only spoken to when asked if they wanted to go to the toilet. Once in the dining room again the residents were left sitting at the table in silence for 20 minutes until their meals arrived. Although the table was laid with napkins and place settings and a small vase with an artificial flower large bibs were fastened around each residents neck except for one resident who used a napkin over her lap. All the residents fed themselves and, apart from one resident, ate without spilling their food.Napkins would have been sufficient for all the residents, even if tucked into their neckline, to preserve their dignity. When the manager or carer came in they were happy to talk over the residents heads to me even if comments were about a particular resident. I observed that the residents were only responding to one of the carers who to get their attention would lower herself to face level and speak loudly and clearly otherwise they were not responding well when spoken to by other members of staff.I observed the residents sitting in the lounge with tables in front of them. Some of the tables had a collection of plastic boxes containing some personal effects but also had toilet rolls for use as tissues. When I asked the manager what activities took place she told me a lady came in to play the violin which was popular with the residents and at Christmas they had a party. One of the carers undertook activities with the residents in the afternoons and when I asked Care Homes for Older People Page 17 of 33 Evidence: was told mostly one to one such as word search puzzles. The expert by experience also noted, I havent been able to provide quotations from the residents as they had very little to comment on. I only received responses when talking to them about their past life and even then one of the residents kept falling asleep. We discussed these observations with the expert by experience, the registered manager and the responsible individual. We were informed that some residents had difficulty communicating with each other and with staff as they were hard of hearing. As part of her feedback, the expert made some suggestions with regard to how the problem of communication may be overcome. The manager and responsible individual agreed to give consideration to how care practices may be improved in this area. We noted that care records include details of residents families and next of kin, including telephone numbers, so that they may be contacted. A visitors book was on display in the front hallway. This showed us evidence that relatives and friends of residents do visit the home each day. We also observed that some residents had received visitors during our visit. Relatives we spoke to confirmed that they are made welcome by staff and are offered tea and coffee on arrival. The expert by experience reported, Although there were no visitors during my visit the manager told me that a small number of residents do receive fairly regular visits from relatives but the other residents receive either no visits or irregular visits. One of the residents who remains in his room receives weekly communion from a Catholic priest. Visitors have unrestricted access. I observed that if a visitor met with a resident in the lounge there is a lack of spare chairs and as the lounge is quite small its layout would make it difficult to have any privacy. The manager mentioned to me that the visitor could take the resident into the dining room and sit at the dining table or take them to their room. The expert was also asked to consider if residents can go out to visit the hairdresser or barber, chiropodist or opticians if they want to. They were also asked to consider if residents can go out shopping. They reported, None of the residents leave the nursing home. They are frail and confused and need assistance and there is no transport available from the Home. The Manager told me the GP is excellent and will call within a few hours of being requested. A chiropodist calls every six weeks. I noted that one of the residents wasnt shaved very well as under his chin the hair was quite long and his fingernails needed cutting. Apart from one resident I didnt see any evidence of residents having their hair styled. The residents in their rooms appeared Care Homes for Older People Page 18 of 33 Evidence: not to have any teeth. The manager told me that one has only one tooth and wont have dentures. I didnt see any residents wearing glasses and only one glancing through a magazine. In two of the rooms the TV was on even though both residents were sleeping. There was no TV on in the lounge. All of the residents I spoke to were deaf and I had to speak quite loudly to get a response. One of the residents has a hearing aid in each ear but I wasnt sure they were working as she had difficulty in hearing me. The Manager said she would get a staff member to check the batteries. The Manager told me that residents were offered a bath or shower twice a week and the one resident confined to bed was regularly turned to avoid friction. The expert by experience also considered how staff look after residents laundry. They reported, One of the residents remains in bed and isnt dressed. The two other residents who remained in their rooms were dressed but were both in bed covered with bedclothes. Of the other six residents only one looked groomed and colour coordinated. The others wore non descript clothes which did not look as they had been chosen with particular care. The clothes however were clean and laundered. During our previous visit we formed a judgement that residents had not been given a wholesome, appealing and well balanced diet. We have since been provided with information by the provider which has demonstrate they have consulted with a nutritionist to ensure food is of good quality and provides for the needs of residents. During this visit we spoke to the cook who informed us that the main meal of the day was to be fish pie with peas and sweet corn or ham or cheese salad followed by a choice of bread and butter pudding or lemon posset or butter scotch mousse. We were also informed that the care home caters for residents who require diabetic, soft and liquidised diets. We were also given copies of recent menus to look through. They demonstrated that a varied and wholesome diet has been provided. We asked the expert by experience to consider the following questions. What is the food like. Is there enough, is there sufficient variety and is it to the residents liking. They reported. Breakfast is a selection of cereal or porridge and toast. Apart from three residents who remain in their rooms, the other six residents eat breakfast in the dining room. Lunch was served to five of the residents in the dining room as one resident preferred to stay in the lounge as she wasnt feeling well enough to be moved. There was a choice available from fish pie with vegetables, cheese salad or ham salad. I was offered sandwiches which were excellent. There were two choices of pudding from Lemon Posset or Bread and Butter Pudding. The food looked very appetising and fresh and was well presented on plates slightly smaller than a dinner plate. Everyone at the table ate all their food although one of the residents appeared to need some Care Homes for Older People Page 19 of 33 Evidence: encouragement although did eventually finish her meal. None of the residents could remember what else they had to eat during the rest of the day so I asked one of the Carers. During the morning there is a choice of either a hot or cold drink and the same in the afternoon. Sandwiches are served at 5.30 but often some of the residents dont feel like eating. If they are hungry later on either the day or night staff will make them a sandwich. There did not appear to be a hot food option in the evening. Care Homes for Older People Page 20 of 33 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. Residents, their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents have been protected from abuse Evidence: Following a previous visit we found evidence which enabled us to form a judgement that a complaints procedure was place. This would ensure residents relatives know that any complaints they make will be listened to, taken seriously and acted upon. During this visit we noted that a written complaint procedure was on display in the front hallway of the care home. One relative we spoke to confirmed they knew how to make a complaint if they were dissatisfied with any aspect of the care and services provided. Another relative was unclear about this procedure. They informed us, As next of kin, my sister deals with this sort of thing. I am sure she would know what to do. During our previous visit we expressed concern that staff working at the care home had not been provided with training in identifying and reporting incidents of abuse and neglect. The responsible individual has since demonstrated that a programme of training has been set up to ensure all staff have the necessary knowledge and understanding to ensure residents who may be at risk are protected. Care Homes for Older People Page 21 of 33 Evidence: On this occasion we were shown records of staff training. This demonstrated that the responsible individual has planned further sessions to ensure newly appointed staff receive training and that, should it be necessary, existing staff receive further training to refresh their knowledge and understanding. We spoke to group of staff who were on duty. They confirmed the training they had received. They were also able to describe the different types of abuse that residents might be subject to and what they would do if they witnessed such an event taking place. Care Homes for Older People Page 22 of 33 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. Residents live in a safe, well maintained environment. The home is clean, pleasant and hygienic Evidence: During a previous visit we expressed concern that residents did not live in a well maintained environment. Standards of cleanliness at Royston were not sufficient to ensure it was pleasant and hygienic for residents. On this occasion we visited most of the bedrooms and all of the communal areas including the dining room and lounge. We noted that the majority of the bedrooms had been redecorated and refurbished with new curtains and bedding. Several rooms had also been re carpeted. The overall impression was that the environment was cleaner and fresher than was previously the case. Following discussion, the responsible individual informed us that he had programme in place to ensure that all areas of the home will be redecorated and re carpeted. The programme also included replacing and refitting two bathrooms. We also visited the kitchen area. We were informed that a new floor covering had been laid, the ceiling had been repaired and that further improvements had been Care Homes for Older People Page 23 of 33 Evidence: made to meet requirements made by the local Environmental Health Department. We were shown the most recent environmental health report, following a visit made on 12th February 2010. This confirmed that work carried out was to the necessary standard and that requirements made had been met. We also visited the laundry area. Improvements had been made to floor and wall surfaces to ensure they are easily cleaned to reduce the risk of cross infections. The overall standard of cleanliness to this area had also been improved. The responsible individual informed us of his intention to replace the washing machine in the near future. We were shown records of cleaning schedules for the kitchen and for the laundry area. We were informed that staff are expected to clean these areas regularly. The manager is responsible for monitoring cleanliness to ensure it is maintained at the required level. We also examined maintenance records. This demonstrated that there is a system in place for staff to report any defects or small repair jobs. We were informed that repairs are carried out by a handyman employed at the home, or if necessary, by outside contractors. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not been provided in sufficient numbers, particularly at mealtimes, to meet the current needs of residents. It was not clear how the registered manager calculates the numbers and skills level required should current residents needs increase or when new residents are admitted. Residents are supported and protected by the homes recruitment policy and practices. Staff have been trained to do their jobs. Evidence: Following our previous visit to the care home we expressed concern that there were insufficient staff on duty to meet the needs of residents accommodated. During this visit we were given a selection of staff rotas to examine. They demonstrated that, a trained nurse is on duty from 8am to 8pm each day supported by at least two care assistants. This meant that, since our last visit, there had been an increase of at least one care assistant between these hours each day. Each night a trained nurse and a care assistant are on duty and awake to provide for the needs of residents. In addition there is a cook on duty seven days a week to provide meals for Care Homes for Older People Page 25 of 33 Evidence: residents and a house keeper on duty five days a week to ensure the premises is kept clean. The expert by experience noted, I observed only two carers who were looking after the three residents in their rooms as well as the six residents in the lounge. Their absence was very noticeable at lunchtime when they had to provide assistance in feeding for the three room bound residents as well as serving the six other residents, This resulted in delays in helping residents into the dining room and serving them causing agitation in some of the residents left seated at the table. The resident left in the lounge was upset when I rejoined her as she had asked to be taken to the toilet and had to wait. I havent been able to provide quotations from the residents as they had very little to comment on. I only received responses when talking to them about their past life and even then one of the residents kept falling asleep. From direct observations, discussions with the manager and examining care records we found that there is still insufficient staff available to meet current residents care needs, particularly at key times of the day such as meal times. Following discussion we asked the responsible individual how they determine that staffing levels are sufficient to meet the needs of residents. We were informed that, whilst there is not one at present, they intend to use an assessment tool in future to calculate how many staff are required to meet the needs of residents. Following our previous visit to Royston Nursing Home we made a judgement that residents were protected by the homes recruitment procedures and practices. On this occasion we examined the recruitment records of two care staff who had been appointed since our last visit. We found that on each member of staff had commenced employment before all necessary checks had been obtained. We asked the responsible individual about this and were informed that each member of staff received induction training during this period and were not directly involved in providing personal care to residents. The responsible individual also confirmed that staff who receiving induction training had been appropriately supervised to ensure residents were safe. Following the previous visit, we expressed concerns that staff had not received training, including induction training, to ensure they were competent to do the work expected of them. Since this visit the responsible individual has provided us with information that demonstrated a programme of training has been set up so that staff have the knowledge and skills they need to meet residents needs. On this occasion we examined staff training records. They demonstrated that the staff training programme included mandatory training such as fire safety, health and Care Homes for Older People Page 26 of 33 Evidence: safety, identifying abusive practices and how to report them and manual handling. We also spoke to a group of staff who were on duty. Following discussion, they told us about their role in the care home, the training they have undertaken, their understanding of the needs of identified residents and the action they are expected to take to ensure residents needs have been met. Care Homes for Older People Page 27 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge their responsibilities fully. Work is needed by the management of the home to embedded improvements made so that they become part of every day care practices. This will mean care practices will continue to improve to ensure the care home is run in the best interests of residents. The health, safety and welfare of residents and staff have been promoted and protected. Evidence: Since our previous visit Mrs Margaret Malumo has become registered with us as the manager. Mrs Malumo has demonstrated to us that she has the necessary skills, knowledge and experience to manage Royston Nursing Home. There has also been a change to the responsible individual. Mr Lance Herbert is now responsible for supervising the management of the care home. Care Homes for Older People Page 28 of 33 Evidence: Mr Herbert informed us that he has set up regular staff meetings and regular sessions for supervising the staff. We were shown documentation which demonstrated that since November 2009, there have been three staff meetings. Minutes seen provided evidence that meetings are used by the registered manager and the responsible individual to communicate relevant information regarding the day to day running of the care home to the staff. Records of supervision sessions indicated they have taken place every three months and have been used to discuss practice issues and to identify training needs of individual staff. Mr Herbert demonstrated he had conducted monthly visits to the home in accordance with current legislation. Reports of each visit were available to us for examination. Mr Herbert also showed us documentary evidence that satisfaction questionnaires had been sent out to residents, their families, visiting GPs, social workers, district nurses and other visitors with an interest in the care home. However, there was no evidence that Mr Herbert had reviewed the information in questionnaires and put together an action plan to address any shortfalls identified. Following discussion, Mr Herbert confirmed that this would be the next step he would be taking as part of the process of quality assurance. During this visit we found evidence that a great deal of work has been done to make improvements that were required. However there is still work to be done by the management to monitor and supervise staff to ensure the improvements that have been made become embedded within care practices so that residents will receive better quality care. We shared our observations with the registered manager and the responsible individual when feeding back our findings at the completion of our visit. Information supplied in the AQAA confirmed the registered provider has taken appropriate steps to ensure the premises and equipment within the care home is safe for use. For example, gas and electrical appliances have been checked and maintained regularly. We found evidence that a programme of training provided to all staff includes health and safety issues, fire prevention, manual handling and first aid. Care Homes for Older People Page 29 of 33 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 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Care plans must include clear directions to staff with regard to when and why medication prescribed on as required basis is administered. This will ensure medication is administered safely to residents and as prescribed by the residents GP 26/06/2010 2 10 12 Care plans must include 26/06/2010 information about the wishes and preferences of residents with regard to how their needs are provided for. This will ensure staff are clear about how they should provide care to individual residents to ensure their dignity and rights of choice and privacy is maintained 3 27 18 There must be sufficient staff on duty at times of peak demand such as meal times 26/06/2010 Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will ensure the needs of individual residents can be met without compromising their wellbeing and dignity. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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