Care Home: Santralla

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What the care home does well This home provides a comfortable and homely environment for people to live in. Staff are available in good numbers so that there are always enough on duty to provide the care people need, to chat, engage in activities and to take people out. The staff and manager know the people at the home well and understand their needs and preferences. Staff treat people kindly and with respect. The food is good. One person said,` I enjoy the meals here, they`ll do something different for you if you ask.` People have their complaints listened to and acted on. One person said `I can always speak with Jan and she`d help.` The home is pleasantly decorated, safe and well maintained. Staff all have NVQ level 2 in care, to ensure they have the skills necessary to offer good care. The manager and staff actively solicit feedback about the quality of the service on offer and act to improve when people make suggestions. Staff are well recruited. What has improved since the last inspection? The last inspection report had no requirements and was rated as good. The service has been dormant for a period of time and reopened last year. There have been no key improvements since this time. However, there are a number of positive outcomes for the people living at the home as the previous paragraph shows. What the care home could do better: People could have more consistently detailed care plans , with more specific and individual risk assessments in place to make sure they are kept safe and that the care offered is what they need. Medication could be recorded more accurately to make sure people are kept safe from the risk of medication error. A controlled medication storage facility is required so that the home could store controlled medication when required. Staff must have structured safeguarding of adults training so that they are more aware of what constitutes abuse and what the referral procedure is if they suspect abuse. Staff must complete foundation level training to complement the NVQ training they already have and so that they can offer the best care for people. The service should have a manager registered with CQC. The home must have a gas safety certificate to ensure the home is safe for people to live in. Key inspection report Care homes for older people Name: Address: Santralla 8 The Crescent Scarborough North Yorkshire YO11 2PW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Ritson     Date: 1 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Santralla 8 The Crescent Scarborough North Yorkshire YO11 2PW 01274487207 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): basson@pcslimited.net Pennine Care Services Ltd. Name of registered manager (if applicable) Mrs Linda Jane Lunn Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 22 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 category: Old age, not falling within any other category - Code OP, maximum number of places 22 Date of last inspection Brief description of the care home The service is registered to care for up to twenty- two service users of either sex who are over the age of 65. It is situated in a large terraced house set in The Crescent in Scarborough and is conveniently placed for the main town shopping area, local and national transport including the mainline railway station and is a short walk from the `cliff lift service to the sea front. 0 2 0 6 2 0 0 9 0 Over 65 22 Care Homes for Older People Page 4 of 26 Brief description of the care home The home has steps to the front of the building where a ramp has been installed. There is a garden area where residents can sit out in the warmer weather. The home has a passenger lift to some levels and stair lifts have been fitted to allow access to all other levels. The provider has produced a statement of purpose, which gives information about the home and the services offered. The current inspection report is available on request at the office. Additional charges are made for chiropody, hairdressing, newspapers and trips out. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection for this service took twelve hours. This includes time spent gathering information and examining documentation before and after a site visit and in writing the report. The home was visited on 9th and 12th March 2010. The manager was not on duty on the day of the first visit. This service is one star, which means people living at this home receive an adequate service. Information for this inspection was gathered from the following: Considering information submitted to CQC in an Annual Quality Assurance Assessment (AQAA). A tour of the premises. Care Homes for Older People Page 6 of 26 Observations of care throughout the day of the site visit. Speaking with people. Case tracking people on the day of the site visit. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CQC. Considering comments made by relatives, health care and social services staff. 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. All key standards were looked at during this inspection. The manager and area manager were available at the close of the site visit for feedback. Care Homes for Older People Page 7 of 26 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 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 26 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 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed, but assessments should be more consistent to provide sufficient knowledge of each persons care needs. Evidence: The assessment documentation for all people living at the home was looked at. Each person has an assessment of needs on file, however, the detail and quality of these varies. The home is bringing in a new assessment form which, when completed for all people living at the home will be a useful and comprehensive document. Some people have an admission checklist filled in, which gives good information, but this was not present for all people. Some people also have a personal history document which provides good background information and gives staff a basis for conversation and to gain an understanding of each person. Risk assessments have been competed for areas of care such as moving and handling. Separate assessments for other areas of risk should be considered so that each persons vulnerabilities can be assessed individually. Strategies should then be put into place to show that risk has been Care Homes for Older People Page 10 of 26 Evidence: considered and that people are enabled to live their lives safely whilst acknowledging an acceptable level of risk. The involvement of the person, any relevent interested parties such as relatives or friends and specialists in health care should be clearly indicated to show that a wide range of appropriate people have been consulted over the assessment to ensure the home has the best information. In this way each person can be offered good care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is mostly based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: A care plan is available for each person living at the home. These care plans are variable in quality and detail. Some contain good detail and are supported by advice given by health and social care professionals, others are very brief and do not contain enough information to give confidence that good care is being given. Daily report records are completed in good detail and there are separate records for weight, social activities, medication, intake of food and health care professional visits. If such records are to be useful they need to be used consistently and this was not always the case. Sometimes the record of social activities was not filled in adequately, but activities were recorded in daily notes instead. A new care plan proforma was seen and this will provide good detail. There was some evidence of risk assessments being carried out but these were not always sufficiently specific for each individual. Each person should be assessed for risk, both in terms of daily living and the environment they live in, and strategies put in place to ensure people live their lives according to Care Homes for Older People Page 12 of 26 Evidence: their wishes whilst staying as safe as possible. Care plans are sometimes reviewed, but sometimes not. Care plans need to be kept under review to ensure that people receive the most appropriate care for their needs. People have access to health care services both within the home and in the local community. They are able to choose their own GP and attend local dentists, opticians and other community services. People unable to access local services are supported by visits to the home by health care professionals. Staff are able to think in a person centred way and were able to give a verbal update about needs. Staff said they encouraged individuals to be independent and to take responsibility for their own care whenever possible. They also said the views of residents are sought about the way personal care is delivered. This is good practice. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs. However, there were a small number of gaps in recording. On the morning of the inspection medication had been administered but the record had not been filled in for some people. In some cases, staff had recorded an X which had no explanation written by it. Staff understood this to mean that the GP had instructed the drug must nolonger be administered. This should be made clear on the reverse of the MAR chart. Staff must record all medication at the time of administration to avoid errors and the risk of harm to people living at the home. All staff who administer medication have received appropriate training to do so. The home must install a facility for the storage of controlled medication. This is to comply with the guidelines laid down by the Royal Pharmaceutical Society, so that facilites are available should any person living at the home be prescribed controlled medication in the future. People living at the home said they were happy with the way that most staff deliver their care and respect their dignity and rights. One person said: I think they are all very good. They are all kind and respectful. Another person said The manager is a really kind person. They do alright. Care Homes for Older People Page 13 of 26 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 are able to make choices about their life style. Social, cultural and recreational activities meet individuals expectations. Evidence: It was clear from speaking with the manager and staff that they knew each individual very well, including their likes, dislikes, interests and hobbies. The location of the home close to the centre of town, supports easy access to the facilites of cafes, pubs and shops. Some of the people living at the home go out unaided or with family or friends, others go out sometimes with members of staff. Staff understood the importance of each person having a full and interesting life and said they had time to sit and chat with people or to do such activities as each individual preferred. All activities were recorded either in activity logs or in daily notes. The new care planning documentation which has been used for some people at the home, includes a personal history with interests and hobbies. This should be available for all people living at the home so that recording is consistent and written evidence supports the good practice that was observed. People are encouraged to have visitors and the home has a visiting policy. Care Homes for Older People Page 14 of 26 Evidence: The manager and staff showed they had a good understanding of each persons food likes and dislikes. Specialist diets are catered for when required and the home has a food intake chart for each person where daily choices for meals are recorded. This helps the staff understand preferences and is also useful to share with health care professionals if a person has a period of ill health. At present the manager is acting as cook. This is because the home only has seven people living there. When the home increases occupancy, a designated cook will be recruited. Care Homes for Older People Page 15 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure. The home could better protect people from abuse through staff training. Evidence: The home has a complaints policy and procedure. People said they knew who they would speak to if they had a complaint and appeared confident that something would be done about any concerns they had. Staff have received abuse awareness training in their induction but none of the staff have received external safeguarding of adults training. The manager has good links with local care managers from social services and knew who she would contact if she needed to refer a safeguarding issue. The staff knew they would speak to the manager, but there was not always an understanding of safeguarding procedures and how they work. All staff should have safeguarding of adults training to ensure they understand the procedure to keep people safe. Staff should also have training in Mental Capacity and Deprivation of Liberty to ensure that people are being treated in line with best practice and current legislation. Care Homes for Older People Page 16 of 26 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 well maintained, safe environment. Evidence: The home is pleasantly decorated, light and well maintained for people to live in. The home has an infection control policy and procedure to ensure people are kept safe from the risk of infection. There are two lounge areas, so that people can have visitors in the quiet lounge if they prefer. The laundry is situated away from the kitchen and is not easily accessible to the people living at the home. People said they had no complaints about the way the laundry was handled. Care Homes for Older People Page 17 of 26 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. Staff in the home are in sufficient numbers to support the people who use the service and to support the smooth running of the service. They are well recruited and training is generally good, though improvements woud mean staff were even better equiped to offer good care. Evidence: There are sufficient staff rotad to be on duty at all times to ensure people receive the care they need. Staff all receive induction training and some have received full foundation training, though there is some inconsistency here. The manager is aware there are gaps in training and plans to remedy this, with some training being planned for the near future. However all staff have acheived NVQ level 2 in care which covers many of the foundation subjects in detail. Staff should also have training in specialist health care subjects relevent to the people in their care. The incomplete training is due to the reduced number of people living at the home and consequent budgeting restraints rather than a blinkered or negative approach. It was clear that the manager wanted to give her staff the best opportunity to offer good care. Foundation training for all staff needs to be completed so ensure this can be achieved. Staff are well recruited with two references being followed up for each person, a Protection of Vulnerable Adults(POVA) check and an Independent Safeguarding Authority (ISA) check. This ensures that people living at the home are kept safe from Care Homes for Older People Page 18 of 26 Evidence: staff who are known to be unsuitable to work with vulnerable people. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a registered manager. Staff are well managed but some recording could be better to ensure people receive the care they need. Practice is based on the views and opinions of those receiving the service. People are generally kept safe by the policies and procedures and safe working practices of the home. Evidence: The person managing the home at present, Jan Hudson, has a long history of working at the home. She has acted as deputy for a number of years, supporting other managers. At the moment she is managing the home but has not yet submitted her application to be the registered manager. Her skills lie in caring for people in a compassionate and enabling way, and in managing staff well. She has less confidence in keeping good records and care plans up to date, but she intends to do this with the assistance of the area manager. Some of the shortfalls found during the inspection were due to limited recording of essential information. However, the care observed throughout the two days of the inspection was consistently high. Staff spoke highly of their manager and confirmed she was a very good carer who would be happy to work Care Homes for Older People Page 20 of 26 Evidence: alongside any of them, and would also tell them if they were not doing a job to her high standard. They all agreed she was a fair but firm person to work for. The manager needs to decide if she is going to apply to be the registered manager for the home or if she feels most comfortable in a supporting role. The manager and staff ask for feedback from service users and family on a constant basis and there was evidence for this during the inspection. A full quality assurance system will be developed when the home has a higher occupancy. However, people said they felt their wishes and feelings were taken into consideration and they had confidence that the manager would act on suggestions if it was in her power to do so. Several health and safety documents were examined. The home has an up to date fire risk assessment and all staff have received fire training. The fire alarm is tested on a weekly basis. The home has an up to date electrical wiring certificate, but the gas safety certificate was dated 27th March 2007. The manager believed there was an up to date certificate but could not find it. The home must have this to ensure that the premises is safe for people to live in. Care Homes for Older People Page 21 of 26 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 22 of 26 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 3 14 The needs of the service user must be assessed appropriately. So that correct care can be given. 31/05/2010 2 7 24 Care plans must be kept under review. To ensure people receive the care they need. 29/04/2010 3 7 13 Care plans must consistently 29/04/2010 include all information necessary to offer good care, including risk assessments for all areas of risk for each individual. To ensure people receive the care they need. 4 9 12 A controlled drugs storage facility must be provided. To ensure people receive the medication they require in a timely way. 02/04/2010 Care Homes for Older People Page 23 of 26 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 5 9 12 All medication must be recorded at the time of administration. To protect people from errors of medication administration. 02/04/2010 6 9 9 Any code used on the MAR 02/04/2010 sheet must be explained in writing on the reverse of the MAR sheet. To protect people from the risk of error in medication administration. 7 18 13 Staff must have safeguarding of adults training. To ensure people are protected from risk of harm. 30/06/2010 8 29 18 Staff must all have foundation level training To ensure they have the skills necessary to offer good care. 30/06/2010 9 38 12 A gas safety certificate must 23/04/2010 be available for the home. To ensure the home is safe for people to live in. Care Homes for Older People Page 24 of 26 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 8 Care plans should contain more information from health care professionals and other sources to show that a wide variety of people have been consulted over the care of each individual. Staff should have training in The Deprivation of Liberty and Mental Capacity to ensure people are cared for in a way which respects their rights. There should be a registered manager for this service. 2 18 3 31 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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