Care Home: Sandhall Park Care Home

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What the care home does well People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People who answered our surveys are satisfied with the care they receive, they told us `we are well looked after by caring and friendly staff`, and `I enjoy living in this home, my health has improved and I want for nothing`. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The manager and the staff have worked hard in the last 12 months to meet the requirements of the last report (April 2008). They have been sucessful in moving the service forward and improvements have been made in the care plans, staff training, staff supervision and the numbers of staff on duty. Staff morale is good and individuals told us they work as a team to provide a consistently high standard of care. What the care home could do better: The home has worked hard to meet the standards within this report. We have made a small number of requirements and recommendations around good working practices and these will be followed up at the next visit to the home. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sandhall Park Care Home Sandhall Drive Fairfields Goole DN14 5HY     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Sandhall Park Care Home Sandhall Drive Fairfields Goole DN14 5HY 01405765132 01405765133 sandhall@mimosahealthcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mimosa Healthcare (No4) Limited care home 50 Number of places (if applicable): Under 65 Over 65 0 50 0 dementia old age, not falling within any other category physical disability Additional conditions: 50 0 50 The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Dementia - code DE Physical Disability Code PD Date of last inspection Brief description of the care home Sandhall Park Nursing and Residential Home is situated on a residential estate on the outskirts of Goole. The home is registered to provide residential and nursing care for older people including those with dementia and/or physical disabilities. The home is a purpose built building with enclosed well-kept garden areas for people who use the service. All rooms are on ground floor level. Mimosa Healthcare Limited has produced a welcome pack which people are given before they are admitted to the home. This Care Homes for Older People Page 4 of 33 Brief description of the care home includes a service user guide, which explains what the home provides. Information given by the manager during this visit (28 April 2009) indicates the home charges fees from 312.04 GBP to 604.64 GBP week. The level of fee is dependent on the type of care required and the source of funding. There is a weekly third party top up charge of 25.00 GBP.People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. 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: 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 home does not have a registered manager at the moment and for the purposes of this report the acting manager is referred to as the manager throughout the text. Information has been gathered from a number of different sources over the past 12 months since the service was last inspected (29 April 2008), this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal chats with a number of people living in the home took place during this visit; their Care Homes for Older People Page 6 of 33 comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was adequate. We received 2 from staff (20 ) and 8 from people using the service (80 ). The manager is in the process of completing an Annual Quality Assurance Assessment; the timescale for its return, given by the Care Quality Commission, is the 6 May 2009. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: 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 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 8 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 9 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. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. At our last visit in April 2008 a requirement was made that The registered person must make sure that each person is provided with a written plan of care for daily living, and longer term outcomes, based on the care management assessment/care plan or the homes own needs assessment. This must be in place within 5 days of admission. Checks at this visit showed that the home has made improvements to their Care Homes for Older People Page 10 of 33 Evidence: admission process and this requirement is now met. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Discussion with three people showed that they were satisfied with the care they receive and have a good relationship with the staff. One person told us I am very happy here, the staff look after me and I have everything that I need. At our last visit to the home in April 2008 a requirement was made that The registered person must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. We have looked at the staff training files during this visit and found that staff have attended training and development sessions over the past year and this requirement is now met. Information from the training files and training matrix indicates that the uptake of staff training from April 2008 to April 2009 has improved with more staff attending mandatory sessions. The manager is aware of the need to promote more specialised training as a number of people using the service have conditions relating to dementia, diabetes, heart disease, depression, strokes, arthritis and other problems linked to old age. Information from the manager and discussion with the people living in the home indicates that all of the people using the service are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Checks of the staffing rotas and observation of the service showed that the home employs three staff from different countries and cultures. The home is able to offer a limited choice of staff gender to people who express preferences about care delivery, as they employ two male care staff. The information about peoples preferences should Care Homes for Older People Page 11 of 33 Evidence: be recorded onto the care plans. The home does not have any intermediate care beds and therefore standard six does not apply to this service. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living in the home are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. Evidence: Information from the surveys indicates that the people who responded are satisfied that the staff give appropriate support and care to those living in the home. People spoken to said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. At our last visit in April 2008 a requirement was made that The registered provider must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. The plans must be regularly updated and show evidence of regular monitoring and have a system in place to identify any deterioration in a persons mental health. The plans should meet relevant Care Homes for Older People Page 13 of 33 Evidence: clinical guidelines produced by professional bodies concerned with the care of older people and those with dementia. Checks at this visit found that the requirement has been partly met; further work is required to ensure the plans are person centred. The care of four people was looked at in depth during this visit and included checking of their personal care plans. Improvements have been made to the reviewing and monitoring of the information within the care plans and staff are amending the care plans when the needs of individuals change. There is clear input (where needed) from the Community Psychiatric Nurses for those with mental health problems. Management plans for aggression and challenging behaviour are in place and up to date for specific individuals and 17 of the staff attended training around Dementia Care in 2008 and further training dates have been arranged by the manager for 2009. Equality and diversity information about people is not clear on the care plan format. We found that information about religious beliefs, sexuality, ethnicity and peoples preferences regarding staff gender for personal care was not included in all plans. The manager should make sure this aspect of the care plan is developed. Information about the social needs of individuals is not recorded in detail within the care plans. There is a personal history sheet completed for each person, but little has been done with the information captured within this process. The manager must ensure that the care plans are developed to show each persons wishes and choices around their care, to identify their likes and dislikes, hobbies, interests and personal goals, and document their involvement with family and friends. There is a yearly formal review process for the care of people using the service with the funding authorities and family (where the person receiving care consents to this). This process has been reviewed and brought up to date by the manager to ensure that in the past year, everyone has had the opportunity to discuss their care and ongoing needs with the home and, where appropriate, the funding authority. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from people indicate that on the whole they are satisfied with the level of medical support given to them. One person told us my health has improved greatly since I came into this home, the staff cannot do enough for you and I have put on weight and feel wonderful. Entries in the care plans specify where individuals have dietary needs, including PEG feeds, supplement drinks and specialist diets. The staff weighs everyone on a regular Care Homes for Older People Page 14 of 33 Evidence: basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the people we spoke to prefer to have staff administer their medication. At the last visit in April 2008 a requirement was made that Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. The registered provider must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. Checks at this visit found the requirement was met. The home is using Lloyds Pharmacy to supply their medications. Checks of the medication records showed that there are a few missing signatures where staff have forgotten to sign when giving medication, but over all the records show much improvement from a year ago. We recommend that the manager completes a medication audit weekly to ensure staff are following the medication policy and procedures. Looking around the medication room we found a persons medication on the side of the counter instead of in the locked medication cabinet and checks of the controlled drug cabinet found a build up of medication waiting to be destroyed using the kits provided by the pharmacy waste disposal company. We discussed these issues with the manager and the nurse on duty ensured the medication was stored correctly and others disposed of by the end of our visit. We discussed the need to ensure that diabetics in the home had their own lancet devices for testing blood sugars as recommended in the latest medical alert sent to care homes. The manager said she would ensure that each person had their own device and that these were labelled with their names. At the last visit a requirement was made that The registered person must ensure that any medication training received by the staff is accredited. Checks at this visit found the requirement was met. Care Homes for Older People Page 15 of 33 Evidence: Discussion with the manager indicated that qualified nurses gave out medication to people receiving nursing care and that senior care staff gave out medication to people receiving residential care. Lloyds pharmacy have developed three, distance learning medication units, for staff to complete as part of an accredited training scheme. At the time of our visit 5 senior care staff were in the process of completing these units as part of their self development/training. Peoples comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. We spoke to four people during our visit who told us the staff are vey good, they listen to me and give me the care I need, and if it was not for the marvellous care that I receive from the staff, I dont know where I would be. Nothing is too much trouble and they are always there when I need them. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home employs an activities organiser for 30 hours a week and she works Mondays to Fridays from 9.30am to 3.30pm. Information about the weekly programme of events and forthcoming attractions is on display in the entrance hall of the home. The activity co-ordinator sends out a quarterly newsletter that details this information and includes, quizzes, poems and other items of interest for those living in the home. The newsletter is available to anyone expressing an interest. Outside entertainers are booked twice a month and on the day of our visit there was a singer coming to entertain people during the afternoon. The mobile library visits every 6 weeks and the home has a stock of large print and talking books for those who have difficulty reading. Over half the people who answered our surveys said that there was usually something Care Homes for Older People Page 17 of 33 Evidence: for them to take part in, although the views from those we spoke to varied from the activities are good to there is not a lot that I can do and I am not interested in most things. Discussion with the activity co-ordinator indicated that it was difficult to keep everyone motivated to join in with activities; the majority of events are group activities although the activity person does spend some 1-1 time with people who are restricted to their bedrooms due to their physical conditions. The four care plans we looked at have brief records of activities that people have taken part in, but these are mainly in the form of a sheet with code numbers entered onto it for different activities. It does not say if people have enjoyed what they have done, nor do the care plans include information of each persons likes and dislikes around social events, interests and hobbies. The manager is aware that this aspect of the care plan should be developed and much more could be done to make the care plans person centred. Information on display in the home and comments from people we spoke to, indicate that individuals are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. People have access to the local churches and weekly visits by the Church of England minister and Catholic priest are arranged on an individual basis. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display in the home. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. The manager said that herself, the deputy manager and the assistant residential manager have all attended training on Equality and Diversity relating to the care home setting. We were told that it is the managers intention to cascade this training to staff through meetings and supervision sessions, although this has yet to be started. We found that the manager had obtained a number of leaflets about the Mental Capacity Act and the Deprivation of Liberty Legislation, these were available to people using the service and staff, Care Homes for Older People Page 18 of 33 Evidence: The home has two dining rooms and offers people a choice of eating facilities. One dining room has more people requiring assistance with eating and drinking than the other, and staff were seen to be sat helping individuals with their lunch time meal. One person told us the meals are very good, I have put on weight since coming into the home and I am well looked after. Another person said I dont always like the meals in the home as they are too bland for my taste. However, I am looking forward to todays meal as it is one of my favourites. Other people commented that it depended on which cook was on duty as to whether they liked the food or not. Observation of the lunchtime meal showed that there were at least two different options of meals given out to people, including soft diets and those for diabetics. Staff told us that if someone did not like what was on the menu then there were always alternatives that they could have. Presentation of the meal was acceptable and specialist cutlery and plate guards were available. We spent some time talking to people and staff about what was on the menu for lunchtime; no-one we spoke to could say what was being served for lunch and staff had to go ask in the kitchen. No menus were seen on display although laminated copies were found on the cabinets in each dining room; these were not helpful as they were not put into different weeks and staff did not know which menu was in use. People told us the staff took round a tea list and they could choose their meal options, but few could remember what they had ordered for lunch. We recommended that each dining room is provided with a menu board that displays the days selections on it, so both staff and people using the service could see what meals were being served. Care Homes for Older People Page 19 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. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. People using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Evidence: Checks of the records in the home showed that there have been two formal complaints made to the service since the last inspection. The manager has investigated each problem and taken appropriate action to resolve the matters. The written responses to the complainants are kept on file. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard, and people who spoke to us were confident of using the complaints procedure should they have need to. One person said I would talk to the staff or the manager, they have been very good in the past about sorting out any little issues I have had and I believe they would deal with anything major in the same way. Safeguarding issues and outcomes areas such as health care, staff supervision, staff Care Homes for Older People Page 20 of 33 Evidence: training, complaints and safeguarding of adults have been looked at as part of this visit. There have been no safeguarding allegations made in the 12 months since our last visit (April 2008), and the staff we spoke to displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. At the last visit in April 2008 a requirement was made that The responsible individual must make sure that the staff attend appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. Checks of the staffing matrix showed that this requirement has been met. The staff training matrix given to us on 28 April 2009 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training, and sessions were held in July, October and December 2008 with a total of 14 staff attending (26 ). The staffing matrix also showed 7 members of staff (13 ) attended dementia care training in September and December 2008. Discussions with the manager indicated she is aware of the need to continue with these training sessions to ensure all staff have attended and are up to date with their skills and knowledge around these areas of care. Care Homes for Older People Page 21 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. The standard of environment within the home is good, providing people with a comfortable and homely place to live. Evidence: Walking around the home it is clear that the environment is spacious, welcoming and decorated/furnished to a good standard. People have access to a number of communal facilities including four lounges, two dining areas and two secure courtyard areas provided with seating and plants. The manager said the maintenance man is responsible for the upkeep of the courtyard areas, and we recommended that the manager look at replacing the benches in these sectors as they are in a state of disrepair and may not be safe for people to sit on. We found that work has taken place to provide a storage room for paperwork generated by the business, to keep information safe and confidential. This was a recommendation in the last report (April 2008). Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The Care Homes for Older People Page 22 of 33 Evidence: home is single storey and has flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, bath hoists, stand aids and handrails. There are a number of specialist nursing beds provided, to aid staff in caring for the people using the service and make life more comfortable for individuals who spend a lot of time in bed. Bed rails are used in some rooms where individuals have been perceived as being at risk of falling out of bed. The staff and the maintenance man do checks of the rails weekly to ensure they are fitted correctly and in working order, and risk assessments are signed by the person or their family and kept in the individuals care plan. We observed that on this visit all bed rails were in the down position whilst people were out of bed and bumpers are available to cushion the rails when in use. At the last visit in April 2008 an ongoing requirement was that A plan must be put into place to address the inadequacies of the call bell system and the front door bell. Checks at this visit showed that the noise from the nurse call system and front door bell remains loud, however no-one we spoke to made any complaints about this and no comments were received on this issue within the surveys returned. We are aware that the provider has tried to improve the system with little success. We have decided to move this requirement to a recommendation as the issue appears to be having less impact on the quality of peoples lives. Discussions during this visit indicate that people using the service find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. At our last visit in April 2008 a requirement was made that The registered person must make sure that staff receive appropriate training on the control of spread of infection in accordance with relevant legislation and published professional guidance. Checks at this visit found the requirement has been met. Information from the staffing matrix supplied to us on 28 April 2009 indicates that 23 staff members (44 ) have attended infection control training in the past year with courses being held in December 2008 and February 2009. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff induction, training and recruitment practices have got better, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive and we enjoy life in the home and the staff are a great bunch of people who look after us well. At the time of this visit there were 46 people in residence (15 with nursing needs and 31 with personal care needs) and the staffing rota showed that the following staffing levels are in use 7.15am to 2.30pm - 1 nurse and 7 care staff on duty, plus a general assistant (this individual does not do personal care), 2.30pm to 9.15pm - 1 nurse and 6 care staff on duty, plus a person working 12 noon to 7pm and 9.15pm to 7.15am - 1 nurse and 3 care staff on duty. Care Homes for Older People Page 24 of 33 Evidence: At our last visit in April 2008 a requirement was made that The registered provider must ensure there are sufficient staffing numbers and skill mix of staff to meet the assessed needs of the people, the size, layout and purpose of the home at all times, and additional staff are on duty at peak times of activity during the day. Checks at this visit show this requirement has been met. Information from the manager at this visit, about the number of care staffing hours provided (1064), and the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidance. We found that staff morale in the home has improved since our last visit in April 2008, care practises have improved and there have been less complaints and no safeguarding allegations made in the past year. Staff told us that they have noticed a positive difference since the new manager came into post and staff feel that the service is getting better. At the last visit in April 2008 a requirement was made that The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age and dementia must be included in the training programme, and the registered person must make sure that staff have an individual training and development assessment and profile in place. Checks at this visit found the requirement was partly met. There is an induction course for new members of staff, and over 50 of the care staff have achieved an NVQ 2 or 3, with 2 working towards this award. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge around pressure care, dementia awareness and continence promotion. Information from the staff training files and training matrix indicates that the staff uptake of training has improved from last year, but this needs to progress further to ensure everyone is up to date. Figures taken from the staffing matrix given to us on 28 April 2009 show that staff have achieved the following statistics in the past year - basic fire safety training (56 ), food hygiene (54 ), moving and handling (46 ), COSHH safe working practice training (0 ), health and safety (25 ), safe guarding of adults (26 ) and infection control (44 ). Staff-training files hold the certificates of achievement but staff do not have their own personal training plans in place, showing each person what training they must attend each year. The manager must ensure these are developed and discussed with staff during supervision. Care Homes for Older People Page 25 of 33 Evidence: The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Care Homes for Older People Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: At our last visit in April 2008 a requirement was made that The registered person must advertise for and recruit a permanent manager. Checks at this visit found this requirement has been met. The acting manager is in the process of applying to be registered with the Care Quality Commission and this should be completed by August 2009. The acting manager is a Registered Learning Disabilities Nurse and has completed her Registered Managers Award. She has experience of working with older people both in nursing homes and in a hospital setting. The manager told us that she keeps her skills and knowledge up to date with regular training sessions pertinent to her role. Care Homes for Older People Page 27 of 33 Evidence: The home has an up to date quality award from Investors in People and is working towards achieving the local councils quality award (QDS) part one. Meetings for people using the service and their families/friends are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. At the last visit in April 2008 a requirement was made that The registered person must make sure there is an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for people using the service. Checks at this visit found that the manager is in the process of doing this work. The requirement will be moved to a recommendation in this report. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires. The manager is aware that this information must be analysed and put together into an annual development plan (ADP) as part of this process, to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The manager told us she is working on the ADP for 2009. Checks of the finance systems within the home found that computerised records are kept for peoples personal allowances; the administrator on a daily basis up dates these. Information from the manager and administrator indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Care Homes for Older People Page 28 of 33 Evidence: At the last visit in April 2008 a requirement was made that The registered person must ensure that staff receive formal supervision at least six times a year. The supervision must cover all aspects of practice, philosophy of care in the home and career development needs. Checks at this visit found the requirement has been met. The manager is carrying out formal staff supervision and has completed a matrix for this process in 2009. Supervision records were seen in the three staff files we looked at during this visit and these are satisfactory. At our last visit in April 2008 a requirement was made that The registered person must ensure that the fire risk assessment for the home is up to date and that generic risk assessments are completed. Checks at this visit found the requirement has been met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. The home recieved a visit from the Environmental Health Department in March 2009 and a number of problems were found in the kitchen. We were given evidence on our visit (28 April 2009) that the home has drawn up an action plan to address all the issues in the Environmental Health report and at the time of our visit the majority had been completed. The local Fire Officer visited the home in February 2009 and everything was found to be satisfactory. 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 7 15 The registered provider 30/07/2009 must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. This will make sure that staff have the appropriate knowledge to provide person centred care and support to people using the service. 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 manager should ensure that equality and diversity information such as religious beliefs, sexuality, ethnicity and peoples preferences regarding staff gender for personal care is included in all plans The manager should consider how the social side of the Page 31 of 33 2 12 Care Homes for Older People care plans can be developed to ensure that peoples interests are recorded in detail and demonstrate how the home is meeting the social and emotional needs of people with physical and mental health conditions. 3 15 The manager should ensure that a menu board is put up in the dining rooms so people and staff know what meal options are available each day. The manager should ensure that the benches in the courtyard areas are replaced as those seen during this visit (April 2008) are in a state of disrepair and may not be safe for people to sit on. The manager should consider how the noise of the call bell system and the front door bell can be reduced so that people can be satisfied that they are able to attract the attention of staff in a dignified way, whilst enjoying a peaceful environment. The manager should register with the Care Quality Commission by the end of August 2009. The manager should ensure that there is an Annual Development Plan produced from the feedback of stakeholders, as part of the homes Quality Assurance process. 4 19 5 22 6 7 31 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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