Care Home: Russell Court

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What the care home does well There is a warm and friendly atmosphere, so people feel welcomed to the home when moving in or visiting. There is an open visiting policy enabling people to visit at a time that suits them, so relationships are maintained. Comments received included; "It has always been homely here". "They always ask me if I want a drink when I come; visitors can go and make drinks also". Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Pre-admission assessments are completed, so that the home and people who are considering living in the home are confident that their individual needs can be met appropriately. People have access to a varied range of health care professionals so that they can be reassured that their health care needs are met in a timely fashion. People are cared for in a respectful manner by staff working in the home, so that people`s self-esteem and dignity are upheld at all times. The medication systems were generally of a good standard, ensuring people receive the medication prescribed for them. The home is maintained to a good standard; there is a pleasant area to sit outside, so people have a pleasant and homely environment to live. The food was of a good standard with a choice, so people received varied and nutritious meals to meet their needs and preferences. There are generally good staffing levels and staff receive a range of training, so they have the skills and knowledge to meet people`s needs. The home responds to complaints and people feel they are listened to, so they can be assured any concerns are addressed. People can be confident that the registered manager has good leadership skills and abilities to maintain a good standard of care for people living in the home. Comments included; "I have confidence in the manager". What has improved since the last inspection? There has been an improvement in the arrangements for activities on offer should people choose to participate, so they have opportunities of stimulation and social contact. Staff are in the process of developing a "Life history" of people living in the home to record their diverse lifestyles, enhance knowledge and aid communication, so that outcomes can be improved. The manager has commenced a relatives forum where he meets with relatives on a regular basis to improve communication and provide them with support where appropriate. The falls procedure has been updated to ensure appropriate action is taken in the event of anyone living in the home sustaining a fall. Night staff recording has been improved, so that aspects of care and concerns can be followed up effectively. Staff have been provided with summary care plans on each unit, so they have the relevant information to support people and ensure their needs are met. Staff are taking responsibility for various aspects within the home, so the take ownership and improve systems. Two of the units have been re-decorated, the patio has been steam cleaned and shrubs around the home have been pruned to enhance the environment and improve the natural light in the home. New castors have been purchased for beds so they can be moved more easily and the manger is currently trialling some new beds to determine if they would be suitable to meet the needs of people living in the home. The manger sends out surveys regularly to people who live in the home and relatives in order to gain feedback about the home, so that improvements can be made. The manager is now registered with us and is showing a commitment to her role within the home to make further improvements to add quality to the lives of the people who live there. The home has worked towards meeting the previous requirements and recommendations. This suggests that the providers and registered manager are keen to ensure that people who live in the home experience quality outcomes. What the care home could do better: The manager stated he was in the process of improving the service user guide to include pictures, so that people would be provided with more comprehensive information to assist people with making a decision about moving into the home. Plans are also in place for senior staff to spend more time on the units with staff and people living in the home to improve communication and support. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes, demonstrating people`s needs are met effectively. Staff must ensure a record of the amount of medication at the beginning of each month, so that medication can be audited effectively. The minimum/maximum and current temperature of the medication fridge should be recorded to ensure medication is stored at the correct temperature over the 24 hour period. The manager should liaise with the district nursing team where people are unable to mobilise about appropriate strategies for pressure relief, so the risk of pressure sores are reduced. Also consideration should be given to providing staff with training in respect of tissue viability, so they have the appropriate skills and knowledge to care for people who are at risk. Records of health professionals visits should provide details of the reason for the visit and outcome. Also the manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure etc. to ensure people`s well being. Tippex must not be used on legal documents. People should be consulted about having lockable facilities, where these are not in place, so they have the option of the facility to store valuables. A risk assessment should be undertaken on windows where restrictors are not in place and appropriate action taken to ensure safety and security in the home. A system for recording informal complaints should be developed to demonstrate continuous development. The gas safety check must be undertaken to ensure the equipment is fit to use. Key inspection report Care homes for older people Name: Address: Russell Court Overfield Road Russell Hall Estate Dudley West Midlands DY1 2NY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Farrell     Date: 1 7 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Russell Court Overfield Road Russell Hall Estate Dudley West Midlands DY1 2NY 01384813375 01384813377 tony.cooksey@dudley.gov.uk N/K Dudley Metropolitan Borough Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 32, Old age, not falling within any other category (OP) 32 Date of last inspection Brief description of the care home Russell Court is a purpose built home, owned and managed by Dudley Local Authority. The home is registered to provide care to a maximum of 32 service users at any one time. Registration categories approved are primarily for older people with nine places Care Homes for Older People Page 4 of 32 Over 65 0 32 32 0 Brief description of the care home for older people who have a diagnosis of dementia. The home offers 32 single occupancy bedrooms, all have en-suite facilities which comprise of a hand washbasin, walk in shower and toilet. The accommodation is divided into four units. Two units are situated on each of the two floors. Each unit provides eight bedrooms and has a comfortable lounge/ dining area and a joining kitchenette. A passenger lift is available to enable access to both floors. Ramped access to and from the home is available. The home has one assisted bath on the ground floor and a number of assisted toilets. Russell Court overall, is maintained in terms of flooring and furniture to a good standard. The home has a generous size garden and a number of car parking spaces. Russell Court offers open visiting times between 7AM and 11PM. The service user guide, statment of purpose and our report were available in reception providing people with information about the services and facilities in the home. Arrangments for fees should be discussed at the time of making enquiries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet peoples needs and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 20th June 2007 when it was given a two star rating. An annual Service Review (ASR) was undertaken on 31st July 2008. This is a process where we collect information from various sources and if no changes are identified a report is produced based on the information received, without a visit to the home. This inspection found the home continues to provide good outcomes for people living there. However, some areas of improvement were identified which are outlined in Care Homes for Older People Page 6 of 32 the area What the home could do better. As a result of the findings of this inspection a further key inspection will be undertaken by 20th June 2010. However, we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies. An Annual Quality Assurance Assessment (AQAA), which is a questionnaire that is completed by the manager, was forwarded to the home. The manager was completing it at the time of inspection, but we had not received it at the time of writing the report. The inspection was undertaken over one day by one inspector. The Manager was available for the duration of the inspection. The home did not know that we were visiting. At the time of inspection the home was full and information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection four people who live in the home, two visitors and four staff were spoken with in order to gain comments. Surveys were sent out before the inspection in order to gain feedback. We received one completed survey from one person living in the home, one relative and two health professionals. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? There has been an improvement in the arrangements for activities on offer should people choose to participate, so they have opportunities of stimulation and social contact. Staff are in the process of developing a Life history of people living in the home to record their diverse lifestyles, enhance knowledge and aid communication, so that outcomes can be improved. Care Homes for Older People Page 8 of 32 The manager has commenced a relatives forum where he meets with relatives on a regular basis to improve communication and provide them with support where appropriate. The falls procedure has been updated to ensure appropriate action is taken in the event of anyone living in the home sustaining a fall. Night staff recording has been improved, so that aspects of care and concerns can be followed up effectively. Staff have been provided with summary care plans on each unit, so they have the relevant information to support people and ensure their needs are met. Staff are taking responsibility for various aspects within the home, so the take ownership and improve systems. Two of the units have been re-decorated, the patio has been steam cleaned and shrubs around the home have been pruned to enhance the environment and improve the natural light in the home. New castors have been purchased for beds so they can be moved more easily and the manger is currently trialling some new beds to determine if they would be suitable to meet the needs of people living in the home. The manger sends out surveys regularly to people who live in the home and relatives in order to gain feedback about the home, so that improvements can be made. The manager is now registered with us and is showing a commitment to her role within the home to make further improvements to add quality to the lives of the people who live there. The home has worked towards meeting the previous requirements and recommendations. This suggests that the providers and registered manager are keen to ensure that people who live in the home experience quality outcomes. What they could do better: The manager stated he was in the process of improving the service user guide to include pictures, so that people would be provided with more comprehensive information to assist people with making a decision about moving into the home. Plans are also in place for senior staff to spend more time on the units with staff and people living in the home to improve communication and support. The care plans and systems for recording monthly reviews of peoples condition/care need to be developed further in order to provide a comprehensive plan of care and record of changes, demonstrating peoples needs are met effectively. Staff must ensure a record of the amount of medication at the beginning of each month, so that medication can be audited effectively. The minimum/maximum and current temperature of the medication fridge should be recorded to ensure medication is stored at the correct temperature over the 24 hour period. Care Homes for Older People Page 9 of 32 The manager should liaise with the district nursing team where people are unable to mobilise about appropriate strategies for pressure relief, so the risk of pressure sores are reduced. Also consideration should be given to providing staff with training in respect of tissue viability, so they have the appropriate skills and knowledge to care for people who are at risk. Records of health professionals visits should provide details of the reason for the visit and outcome. Also the manager should liaise with the GP surgery about the follow up of chronic diseases such and diabetes, high blood pressure etc. to ensure peoples well being. Tippex must not be used on legal documents. People should be consulted about having lockable facilities, where these are not in place, so they have the option of the facility to store valuables. A risk assessment should be undertaken on windows where restrictors are not in place and appropriate action taken to ensure safety and security in the home. A system for recording informal complaints should be developed to demonstrate continuous development. The gas safety check must be undertaken to ensure the equipment is fit to use. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for people moving into the home to assist them in making a decision about moving into the home. An assessment is completed prior to admission, so staff can determine if peoples needs can be met upon moving into the home. Evidence: The home had a service user guide, statement of purpose and our last report available in the reception area on entering the home. Also a copy of the complaints procedure was available, but this requires updating with our details to ensure it is up to date. These documents provide people with information about the services and facilities to assist them in making a decision about moving into the home. The manager is currently working on the service user guide to include pictures, so that it is more informative for people considering moving into the home. Care Homes for Older People Page 12 of 32 Evidence: The home provides residential care for people who require long term or respite care. The manager stated they go out to assess people before they move into the home to determine if the home is able to meet their needs. One file was looked at for a person who had recently moved into the home. The assessment was satisfactory and a letter had been forwarded to them advising them they could move into the home. This process gives people the confidence that their needs will be met when they move into the home. People can visit the home before moving in so they can have lunch, view the facilities, meet staff and other people who live there, in order to sample what it would be like to live there. On discussion with one person they stated they did not visit, but relatives had visited on their behalf and they told him about the home. The survey returned indicated they had received enough information to help them make a decision about moving into the home. The manager stated following admission to the home there is a trial period of one month and a review is held at the end of a month. This provides further opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place for planning peoples care and meeting health care needs ensure a person centred approach where needs are met. The medication systems were satisfactory ensuring people receive the medication that is prescribed for them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling, tissue viability, nutrition and falls. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being is promoted. Some people had bed rails to protect them from falls when they were in bed and the Care Homes for Older People Page 14 of 32 Evidence: occupational therapist had undertaken risk assessments in respect of them. Generally it was found that care plans lacked detail and did not provide staff with the information required to meet peoples needs. However, the manager and senior staff have developed summaries of care plans and copies were available on each unit providing staff with the details they required to support people, so their needs were met. These were generally found to be comprehensive and of a good standard in most cases. The manager stated that when the process is complete they will review all care plans and ensure they are updated to provide detailed information about the support people require. The records in respect of peoples care were being reviewed monthly, but the comments were very brief and it was not always possible to identify when changes had occurred in peoples care or treatment. It is recommended that this process be reviewed. Staff had liaised with the district nursing team, who visited regularly to renew dressings and support staff where there was a risk of pressure sores. There was evidence of pressure relieving equipment in place and risk assessments had been completed. The risk assessment for one person had not indicated they were at risk. However, they did not move independently and there was no evidence of pressure relieving equipment or other strategies in place. Although the person had no pressure sores it was recommended that where people are unable to mobilise advice should be sought from the district nurses to ensure appropriate measures are put in place to reduce the risks of sores developing. The manager should also consider arranging training for staff about pressure area care to ensure they have the appropriate knowledge and skills to care for people who are unable to mobilise independently. Staff were recording food/fluid intake and regular weights of people, so they could monitor their well being. They also had separate charts to record the application of creams and where they should be applied, so that people received the care required. Staff recorded daily records and areas of concern were passed on to the senior staff who had a separate recording system. On some occasions it was found that areas of concern highlighted by care staff had not been recorded by the senior staff to demonstrate follow up. On discussion with the manager he stated that they were in the process of arranging for senior staff to spend more time on the individual units to improve monitoring and communication and reduce the risk of this occurring in the future. Also it was noted that tippex was used in records on some occasions. This should not be used on legal documents. If a mistake is made it should be crossed Care Homes for Older People Page 15 of 32 Evidence: through and error recorded. Feedback from the survey from people living in the home indicated staff listened to them and always acted upon what they said and they usually received the care and support they required. Feedback at the time of inspection from people living in the home and their relatives was positive with comments such; Staff doing above and beyond. Kept updated with any changes etc. It is really nice here. They will call the doctor if I am not well. If you ask them anything they will do it - they are good workers. I am satisfied, I like it here. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP was in agreement). People had access to other health and Social Care professionals and records demonstrated visits were undertaken by social workers, district nurse, chiropodist and optician. This ensures peoples health care needs are being met. Records suggested that checks in respect of diabetes were undertaken, although it was not clear, but there was no evidence of checks in respect of other chronic diseases such as high blood pressure, asthma, etc. The manager will need to ensure records of visits by health professionals clearly state the reason for the visit and outcome of visits. Also he should liaise with the GP surgery about follow up of chronic diseases to ensure peoples well being is maintained. Feedback from surveys indicated people always received the medical care they needed. Feedback from health professionals was good indicating staff sought advice appropriately and acted upon it. Comments included; A well run home with a welcoming environment. Clients needs are well met, carers are receptive to any changes of care planning to maintain well being of any individual. The home is very clean; clients talk favorably about staff and anyone who stays for respite are always happy to return. Care Homes for Older People Page 16 of 32 Evidence: The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. All medication was stored safely in a locked room in locked cupboards. On inspection of the medication for the current month audits were found to be correct indicting people receive the medication prescribed for them. However, some of the audits for boxed medication could not be completed, as there was no record of the amount of medication entering the home at the beginning of the month. The manager stated they do not use homely remedies. Staff record the temperature of the fridge regularly to ensure it is within safe limits. It is recommended the minimum, maximum and current temperatures are recorded, so that staff can monitor the temperature over the 24 hour period. Staff were observed to assist people in a sensitive manner and were seen to be giving people choices about the food they ate and what they would like to drink. Observations indicated that people living in the home respond to staff in an easy relaxed style. People seemed to be well supported by staff to choose clothing appropriate for the time of year which reflected their individual culture, gender and personal preferences. Also staff were seen to knock on peoples bedroom doors before entering. The home is divided into four units and each has a lounge. In addition there were seating areas leading onto each unit and a separate smoking room, so people have a choice of areas to sit and meet visitors. The manager stated people could use the office telephone if they wished to make calls in private and some people had their own mobile telephones. Bedroom doors had locks and people could have the keys to them if they wished to enhance privacy. There were no lockable facilities in some bedrooms to store valuables/medication and people should be consulted about their wishes in respect of this facility. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home were flexible, so people are able to maintain important relationships. People are consulted about their wishes and a range of activities are available if they choose to join in enhancing peoples well being. There is a choice of healthy meals that meets peoples dietary requirements. Evidence: There was no evidence of any rigid rules or routines in the home and people who live there can go outside on their own or with friends and family as they choose, depending on their abilities. On discussion with people living in the home they stated they could get up/go to bed when they wanted and spend time as they wished. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. One member of staff had recently taken over responsibility for activities and the manager stated she currently spends three mornings per week devoted to activities. Activities to date have included celebration of one persons 40th Wedding anniversary, a trip to the theatre, television, a visit to the pub, a coffee morning and sing song, Care Homes for Older People Page 18 of 32 Evidence: exercise to music and drawing. On the day of inspection a singer attended in the afternoon and some belly dancers were arriving to provide a show that evening. Feedback from the survey was positive with the comment, Has made good efforts with activities. There is a day centre on the site that has activities and people can access them if they wish. People can also continue visiting any centres they were visiting before moving into the home if they wish. The library visit and the manager stated that they did utilise talking books in the past for some people. He also stated two staff were hoping to set up a gardening group, so that people who have an interest in gardening can get involved and they were planning a fete for later in the year. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met and a religious service is held in the home regularly. One person visits church and people can have communion if they wish. Feedback from people included; I get up and go to bed when I want. I have made friends here; I go to things in the day centre. I can visit at any time. They always ask me if I want a drink when I come; visitors can go and make drinks also. They have a bit of entertainment. There is a four week rotating menu, based on peoples preferences with a cooked breakfast Monday to Friday morning and the main meal in the evening. At week ends there is a light breakfast and the main meal is served in the middle of the day. The menu demonstrated a variety of nutritious meals with a choice at each meal time and people living in the home confirmed that they are offered a choice each day. Special diets can be arranged for reasons of health, taste and cultural/religious preferences and these were being provided. Drinks and snacks were available between meals with a fruit platter in the middle of the afternoon and sandwiches for supper in the evening. On discussion with catering staff they were aware of peoples dietary needs. The kitchen was clean and very orderly. Care Homes for Older People Page 19 of 32 Evidence: Comments received included; I like the food. The food is good. She is asked about what she would like for her meals. The food is marvellous. There is a dining room on each unit with a small kitchen facility. The dining tables at breakfast and lunchtime were well presented with table cloth, condiments, cutlery etc. Staff had also obtained specialised equipment where necessary to enable people to maintain their independence. Meals were nicely presented and staff provided assistance appropriately where necessary. Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate systems in place so people are protected from harm. Evidence: A complaints procedure was on display in reception, but it requires updating with our current contact details, so that people can contact us with concerns if they wish. Some people were not aware of the procedure, but stated they would go to the office or speak to the manager if they had any concerns. I have confidence in the manager. We have not received any complaints about the home and their complaints record demonstrated one formal complaint had been received. The manager provided us with a copy of a response to the complaint, which covered all the areas raised by the complainant. There was no record of informal concerns/complaints in the home, which could suggest the staff only record formal written complaints and concerns are not recorded. It is recommended that suitable systems be developed to record informal complaints and concerns and the action taken in order to demonstrate a pro active approach and continuous improvement. We received information about one safeguarding meeting that was held by Social Services following one persons fall. They made recommendations for the home and the manager advised us of the action they had taken to address the recommendations, so that people are safeguarded. Care Homes for Older People Page 21 of 32 Evidence: Records indicated that most care staff had undertaken training in respect of safeguarding and on discussion with a member of staff they had a satisfactory knowledge of the procedure within the home. The manager has received training in respect of the Mental Capacity Act and Deprivation of Liberty safeguards. He stated it had been discussed with staff at staff meetings and records were available to demonstrate this. This should provide staff with the knowledge about the Mental Capacity Act, commensurate with their position, to ensure they are aware of the procedures for supporting people who lack capacity to make decisions. Care Homes for Older People Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and comfortable environment that meets their needs. Evidence: The building is a large, detached, two storey purpose built home for older people. It is located in a residential area close to Russell Hall hospital, a number of shops and other public amenities. There is off road parking to the front side of the building. The exterior is fairly well maintained with level access to the building for wheelchair users and seating outside for use when the weather permits. Internally it is divided into four separate units with a maximum of eight people residing on each unit. A partial tour of the home was undertaken and it was found to be warm, clean and maintained to a good standard. The atmosphere was calm, relaxed and friendly and there were no unpleasant odours. Comments received included; Its always been homely here. The home is always very clean . Each unit has a lounge/dining area and kitchen plus eight bedrooms with en-suite facilities. Bathrooms and toilets were strategically placed around the home and were provided with liquid soap and paper towels. Bedrooms had en-suite facilities consisting of toilet, shower and wash hand basin. A call bell facility was available in each bedroom so people can call for assistance if required. Lockable facilities were available in some bedrooms, so people could store medication/ valuables and bedroom doors Care Homes for Older People Page 23 of 32 Evidence: had locks to enhance privacy. It was noted that some windows in bedrooms did not have restrictors in place for safety and security purposes. The manager should review this area. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their bedrooms more homely. A passenger lift enables people to access all areas of the home and they have a range of equipment to assist people with reduced mobility e.g. portable hoists, cricket aid, hand rails etc. The main kitchen was clean, well organised and adequately equipped for its purpose. The laundry was spacious and has processes to prevent cross infection. Laundry equipment was adequate to allow sluice and pre-wash cycles. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate staff on duty, who are trained to meet peoples needs appropriately. Evidence: On the day of inspection there was a manager, senior carer and six care staff on duty. The duty rota indicated there were six care staff on duty during the day and two overnight and this was usually achieved except if there was sickness at short notice. A senior carer is on duty during the day and on call at other times. The home does use some agency staff and it was stated they had been working in the home for some time, so they were aware of peoples needs and the routine of the home to provide continuity. Ancillary staff such as domestic, laundry, catering, administration, and maintenance staff support care staff. Comments received from people living in the home and visitors included; No problems with staff, home, care, attention; struggling at times due to being short staffed There is nothing to grumble about, the staff are nice. They are great. Care Homes for Older People Page 25 of 32 Evidence: Carers are as good as gold. All the regular staff are very nice. Feedback from the survey indicated they could do better by recruiting more permanent staff. The comment to support it was; The units are quite isolated due to the layout of the building and sometimes if the carer on the unit is perhaps dealing with a resident in their bedroom for example, the other residents can be left alone for a time. The home has not employed any new staff since 2005 and at previous inspections the recruitment process was found to be satisfactory. There is a rolling programme of staff training and records indicated the majority of staff had completed training in respect of fire safety, manual handling, food hygiene, health and safety, safeguarding, first aid and all senior staff had completed training in respect of medication. Currently a number of staff are undertaking a distance learning course in respect of caring for people with dementia. The manager has also arranged updated training in respect of manual handling and food hygiene for the near future. Twenty of the twenty eight staff have completed National Vocational Qualification (NVQ) level 2 in care, three are in the process of undertaking the training and five are waiting to commence the training. The manager has almost completed the Registered Managers Award. Training provides staff with the appropriate skills and knowledge to care for people living in the home. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people living there. Systems are in place to ensure the health, safety and protection of people living in the home. Evidence: The manager works on a full time basis, is registered with us and has almost completed the Registered Managers Award. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The home does not act as appointee/agent for people in the home, but assists with personal allowances. Individual records were maintained for people where the home holds money on thier behalf and receipts were available to confirm all expenditure on the accounts sampled. The balance of monies checked was found to be correct. This should ensure that peoples monies are held safely. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home, which gives us information about the home, staff, people who Care Homes for Older People Page 27 of 32 Evidence: live there and the improvements over the past year and the plans for the future of the home. The manager was completing it at the time of inspection, but we had not received it at the time of writing the report. The manager took up the permanent post last year and stated the quality assurance process consisted of an annual satisfaction survey by the organisation. There was evidence that this had occurred before he had taken up the post, but there was no action plan to address the areas of improvement identified. He was also sending out surveys to people living in the home quarterly and thier relatives six monthly in order to gain feedback and these demonstrated good feedback about the services in the home. The manager stated they were also using an auditing tool to assess the home against the National Minimum Standards. This was last completed in 2007/2008 and he stated it would be undertaken by a manager from another home later in the year. Consideration should be given to gaining feedback from other stakeholders to enhance the quality assurance process. Staff meetings were held intermittently over the past year and staff supervision had not been undertaken regularly over the same period of time. The manager stated two full time senior care staff had moved to other homes and this had affected the regularity of such meetings, but hoped to address this in the future. The manager has recently commenced relative forum meetings to improve communication and provide support where necessary. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and full working order with the exception of the gas safety certificate. Checks were completed on the fire system and equipment so that people should be safe in the event of a fire occurring. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must record the amount of medication at the beginning of each month. So that auditing of medication can take place to ensure robust medication systems 17/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 7 Tippex must not be used on documents. Records must clearly indicate follow up of concerns and when changes occur in treatments/care etc, so that peoples conditions can be monitored effectively. All care plans should be updated and outline in detail the action required by staff to meet peoples needs so care is individualised and peoples needs are met in a consistent manner. The manager should liaise with the GP practice about monitoring of chronic diseases to ensure peoples well being is maintained. 3 7 4 8 Care Homes for Older People Page 30 of 32 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 5 8 Records of health professionals visits should state the reason for the visit and outcome so that care can be monitored effectively. Consideration should be given to providing staff with training in respect of tissue viability and health conditions to enhance their knowledge and understanding of peoples needs and ensure they are met effectively. The minimum, maximum and record temperature of the fridge should be recorded daily to ensure medications stored at the correct temperatures. Retain a record of activities undertaken within the home to demonstrate people are appropriately stimulated. Systems be implemented to record informal concerns/complaints and the action taken to address them to demonstrate continuus improvement. Ensure the complaint procedure is updated with our current details, so people can contact us if they wish. Consult people about their preferences in respect of lockable facilities and provide appropriate facilities if they request them. Undertake a review of windows; risk assess and take action where necessary to ensure the safety and security of people living in the home. The gas equipment should be checked on a regular basis to ensure it is fit for use. 6 8 7 9 8 9 12 16 10 11 16 19 12 19 13 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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