Care Home: Salmonsbury House

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What the care home does well Prior to this visit we received five questionnaires back from people living in the care home. All confirmed that they `always` get the support they need, when they require it. The also all confirmed that they `always` receive the medical support they need. All confirmed that they knew how to make a complaint if needed and that they knew who to speak to if they were unhappy about something. All agreed that the care home is kept clean and fresh at all times. Specific comments included `everyone is treated with care and compassion`, `some of the staff are the best in the county`, `the home does most things well`. What the care home could do better: Although the care plans were very comprehensive, none of the care plans we inspected had been signed by the individual who was receiving the care, in order to show their agreement and consent. We spoke to the manager about this and said that this should either be completed by the person receiving the care or, if not possible, by the person`s representative.During the recruitment process the care home must make sure that all recruitment criteria is met before someone starts work. The safeguarding adults/abuse training would appear not to be giving staff enough information and knowledge of the local county`s wider protocols. Random inspection report Care homes for older people Name: Address: Salmonsbury House Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 2 9 0 4 2 0 1 0 Information about the care home Name of care home: Address: Salmonsbury House Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ 01451820821 01451822517 manager.salmonsbury@osjctglos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Beryl Ann Ratcliffe Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Orders of St John Care Trust care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Salmonsbury House is a purpose built care home located close to the centre of Bourton on the Water. It is registered to provide nursing and personal care to forty residents predominantly over the age of 65 years. The Home is managed by The Orders of St John Care Trust. Salmonsbury House has thirty five single rooms on the ground floor and a further five bedrooms on the first floor; four of the rooms have en suite facilities. A shaft lift has been installed to provide access to the upper floor. The residents have Care Homes for Older People Page 2 of 10 Brief description of the care home the benefit of large comfortable communal areas and attractive private gardens. There is ample off road parking. Information about the home is available to prospective residents and interested parties in the printed Service User Guide, and a copy of the Commissions recent report is available in the home for anyone to read. The charges for Salmonsbury House range from six hundred and forty eight pounds for personal care only to eight hundred and forty five pounds for nursing care (this figure is inclusive of the free nursing care contribution). Hairdressing, chiropody, toiletries, magazines and newspapers, transport and holidays are extra costs. Care Homes for Older People Page 3 of 10 What we found: This care home was full at the time of this inspection. This inspection was carried out by one inspector between the hours of 8.50am and 2.20pm. Each person has a comprehensive assessment of their needs before their admission. This is usually completed by the manager who will, where possible, visit the person either in their own home, in hospital or in another care home. We saw evidence that this process had been completed for the last two people to be admitted to the home prior to our inspection. Each assessment was comprehensive and additional information had been gathered from appropriate sources, such as the funding authority and hospital staff. For both of these people, comprehensive care plans had been devised giving guidance to staff on how each individual need should be met. The requirement made in relation to this in the last Key Inspection in 2007 has therefore been met. The care plans also demonstrated that peoples individual beliefs and rights had been considered. Both sets of care records told us that the care was being reviewed and amended as needed. There were records confirming input and support from external health care professionals such as experts in skin and wound care, local Community Nurses, General Practitioners (GPs), Community Dietitians, Chiropodist and Opticians. All helping to ensure the persons health care needs were being met. We inspected the stock of controlled medicines held within the home and their associated records. We also inspected a selection of medicine administration records (MARs) including those of the last two people to be admitted. These records told us that people were receiving their medicines appropriately and that there are safe arrangements in place for the storage and monitoring of medicines. We spoke to the nurse on duty about several peoples pain control and the information she gave us, along with the written records, told us that peoples pain control is regularly reviewed and altered as required. This nurse was also over heard by us reviewing someones medication with the GP surgery and local Pharmacy. During this inspection a Community Nurse visited and a GP. There were appropriate arrangements in place for the signing of the application of topical medicines such as creams and ointments. The previous requirement in relation to this has therefore been removed. Records told us that people were receiving appropriate care in relation to wound care and pressure relief. The same went for people who were nutritionally at risk. We spoke to the cook who was knowledgeable in the dietary needs of the older person and who was able to explain what she does when people require additional support. The manager and cook explained to us the adjustments that had been made with breakfast. This had been in response to staff realising that due to peoples care needs taking longer to meet, that some people were having their breakfast quite late. The new arrangements have now resolved that. We spoke to some people whilst they were having breakfast and they all agreed that the food was good. The kitchen has maintained its award of five stars from the Food Safety Officer which means that the kitchens standard of cleanliness and record keeping is very high. Care Homes for Older People Page 4 of 10 There are arrangements in place for people to be able to make a complaint or raise a concern. The procedures for this were accessible to read by people visiting the home. The home has had one complaint in the last twelve months which the manager investigated and did not uphold. We (the Care Quality Commission, CQC) have not received any complaints or concerns about the home in the last twelve months. Staff receive training in safeguarding adults and abuse but for most staff this is delivered by the in house training coordinator using a video on the subject. We spoke to two members of staff about their knowledge of safeguarding adults. Both clearly explained that they would not tolerate any abuse toward the people in the home and if they were concerned that this was taking place or had happened, they would report their concerns to the manager. Both however had limited knowledge of what the County Councils responsibilities were and of the involvement of other interested parties such as us and the police. We would strongly advise the company to access the County Councils Alerters training for more of its staff to help them have a broader understanding of the processes that they are involved in. We were informed that the manager and training coordinator are the only two who have attended training on this outside of the care home. We walked around the care home, internally, which looked well maintained, well decorated and clean. The manager explained that many areas had been refurbished since the last inspection in 2007. Several bedrooms were very personalised and we spoke to one person who had furnished her bedroom with all of her own furniture, She liked to spend most of her time in her room so enjoyed having her own things around her. Several other bedrooms had been redecorated and fitted with new bedroom furniture. Most bedrooms had profiling beds in order to help the person be more comfortable when in bed, for example the top end raises and helps the person sit upright. There are three mobile hoists that can be used by staff for the safe handling of people who cannot stand or walk. We visited bathrooms which had individual decor and matching soft furnishings to help make the bathing experience more enjoyable. These baths can also be used by people who need assistance to bathe. We spoke to the housekeeper and complimented her on the cleanliness of the home. There are set cleaning schedules in place and an infection control policy. On the day of this inspection the outside windows were also being cleaned by her staff. We observed in place protective gloves, aprons, wipes, appropriate waste bags and soiled linen bags which all help to maintain good infection control. There were alcohol gel dispensers along the corridors for rubbing in to hands in between hand washing. Staff were wearing protective tabbards/aprons when carrying out certain tasks and when feeding or serving people their food. We inspected the recruitment files of the last two people to be recruited. Contracts of employment were seen for both people and where one member of staff had altered their working hours, an amended contract had been issued. Both had submitted application forms with no unexplained gaps of employment. Both had started work in the care home following appropriate safeguarding adult checks and receipt of a Criminal Records Bureau (CRB) clearance. One had started following satisfactory receipt of two references but the other had been started before receipt of either reference. Although the request for these had been initially followed up, this was not for over two weeks after the person had started. Written references were seen in the file but with dates of nearly two months after employment. Both staff members had received training in most mandatory subjects, although one person had still not received first aid awareness training many months in to Care Homes for Older People Page 5 of 10 employment. The other had no certificate for safe moving and handling training but a date was entered in the training coordinators record as having been provided. The trainings records seemed a little disorganised as we needed to cross reference three different record locations to confirm if trainings had actually taken place. Some staff have done training in dementia care and death, dying and bereavement. Questionnaires received back from staff confirm that the manager is very supportive but that they would like more training, particularly in dementia care. Although the people living in the home commented that staff were either always or usually available when they were needed, staff felt they were struggling at times to meet peoples needs. We spoke to the manager about this who agreed that the dependency levels of the people in the home have risen. She had already identified that the home now required two nurses to be on duty each morning. The manager explained that some adjustments had already been made to some staffs working hours but the nurses time is taken up with medication administration, wound care, giving staff guidance, answering telephone inquiries that are relevant to peoples health, liaising with other health care professionals and record keeping. This is therefore leaving the care staff short of staff and the necessary supervision. We were informed that an extra nurse has been agreed in principle by senior company managers, meaning the home can go ahead and advertise. We receive notifications from the home reporting various events as is required of them. There had been one recent medication error which had been appropriately reported to us and the correct action had been taken by the service to ensure this did not occur again. The manager also confirmed that the company carrys out visits to the home, once monthly as is required in Regulation 26 of the Care Home Regulations 2001. What the care home does well: What they could do better: Although the care plans were very comprehensive, none of the care plans we inspected had been signed by the individual who was receiving the care, in order to show their agreement and consent. We spoke to the manager about this and said that this should either be completed by the person receiving the care or, if not possible, by the persons representative. Care Homes for Older People Page 6 of 10 During the recruitment process the care home must make sure that all recruitment criteria is met before someone starts work. The safeguarding adults/abuse training would appear not to be giving staff enough information and knowledge of the local countys wider protocols. 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 set out on page 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 29 19 Potential members of staff 24/06/2010 must not start work within the home before all the required recruitment criteria has been received and found to be satisfactory. In this case this refers to one staff members non return of references. This is so that the home can satisfy itself that a person is suitable to work in the home with vulnerable adults. 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 7 The person receiving the care should sign the written care plan that outlines what care is going to be delivered and how, thereby indicating that they agree with the the plan of care and give their consent for it to be carried out. All staff should attend the local County Councils Alerters training on safeguarding adults and abuse as well as receive further supportive training on the subject, in house. 2 18 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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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