Care Home: Saxonwood

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What the care home does well The majority of people who live at the service and are relatively able enjoy a good quality of service; they tell us that: "made to feel welcome" "provides good care" "I am very satisfied" asked what the home does well residents reported: "The care provided" many things", everything" "happy with everything "Carers are wonderful do their best under difficult circumstances very helpful when they have the time" "generally very satisfactory" Health professionals who were surveyed have responded positively to most questions asked commenting that : "always found staff and management very helpful in supporting their residents with any exercise programme I have put in place" well organised staff - staff know if I am due to visit and are helpful" The home is well maintained, and people enjoy living in a clean, comfortable and homely environment. People we surveyed and spoke with said that they enjoyed the variety and quality of the meals provided. There is an activities programme which is more suited to those more able people who live in the home, people said they enjoyed the trips out. People who come to live at the home are encouraged to bring their own personal possessions, and welcome the opportunity to personalise their own space and help them settle into the home. A low staff turnover means that people in the home benefit from continuity in the staff who support them and know them well. Staff tell us that they enjoy working at the home and are proud of the quality of service offered, asked what the home does well they tell us: "I am proud to work at Saxonwood." "management is very approachable and always makes time to listen" "palliative care, laundry service, catering, respecting people as individuals" "Saxonwood has some very dedicated staff who work hard to meet the needs of residents" "Overall Saxonwood is a very nice home for residents and staff" "We always try to put the resident first, we try to keep them happy and active" What has improved since the last inspection? Since the last inspection all outstanding requirements have been fully addressed or we are satisfied that there is clear evidence of the intention to address the requirement. The AQAA informs us that in the last twelve months the home has commenced a programme of redecorating corridors and rooms,some furniture has been upgraded in lounges. Storage of medication has been improved to include air conditioning and more secure lockable facilities. A change of Pharmacy has also taken place to provide improved service to the home. The AQAA tells us that improvements have been made to the recruitment training and supervision of staff, we are satisfied with progress made in recruitment and training but have failed to find sufficient evidence that staff practise and performace is routnely monitored or formally supervised. The home has handled adult safeguarding alerts well and the senior staff have a better understanding and awareness of safeguarding issues. The review and updating of policies and procedures is progressing and the home has made literature about the service more readily available. The activities programme has been improved to include some new activities and more trips out, more able people in the home welcome this. Menus have been reviewed to offer a better range of dishes to those with diabetes What the care home could do better: We are concerned that those less able people living in the home who generally lack capacity to engage well with staff, may have their needs over looked. Improvements to care plans and risk information have been superficial and not sustained to aid staff knowledge and practise when working with individual people. Plans do not accurately reflect the needs of individuals and are not routinely reviewed, people living in the home have less involvement in their support plans which are not person centred. Risk information is not always in place in regard to moving and handling, pressure care and nutrition, where risks are identified information is minimal and fails to reflect the risk reduction measures that need to be implemented. New Care staff are not being provided with the necessary common induction standards to ensure they have the initial skills and knowledge to support people in the home effectively, staff performance and practise is not routinely monitored or formally supervised We have issued requirements for the home to address these shortfalls. We have also made some recommendations for improved practise. Key inspection report Care homes for older people Name: Address: Saxonwood Saxonwood Road Battle East Sussex TN33 0EY     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: Michele Etherton     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Saxonwood Saxonwood Road Battle East Sussex TN33 0EY 01424774336 01424774336 manager@saxonwood.org.uk www.sxhousing.org.uk Sussex Housing and Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Saxonwood is registered to provide accommodation for up to 36 older people and admits residents with low to medium dependencies. It is owned by a housing association, Sussex Housing and Care. The registered manager post is currently vacant. The deputy manager has taken on the acting manager role, overseeing the day to day operations of the home, until a new manager is appointed. 1 5 0 1 2 0 0 9 0 Over 65 36 Care Homes for Older People Page 4 of 34 Brief description of the care home The premise is a detached property situated in a quiet cul de sac in Battle. There are 36 single bedrooms situated on three floors. There are two shaft lifts to enable access to all floors. Eighteen bedrooms have ensuite facilities and 18 have a wash hand basin. There are four bathrooms one of which is assisted and another has a shower. The home has a large dining room, lounge with views across the gardens and activities room. The home is non-smoking. There are 3.5 acres of garden which are well maintained, accessible to residents and include lawns with some bench seating, established borders, a fish pond, patio area with seating, greenhouses, vegetable patches and fruit trees. There is a good-sized car park to the rear of the property. The home is situated within walking distance of the town centre, its shops and access to bus and rail routes. The staffing compliment consists of the manager, carers and ancillary staff. There is two staff on a wake night duty. The fees range from £340 - £533 per week. Additional charges are made for hairdressing, newspaper/magazines, telephone, transport and chiropody. Previous inspection reports are available from the Provider or can be viewed and downloaded from www.cqc.org.uk Care Homes for Older People Page 5 of 34 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: A key inspection of this service has been undertaken and all key standards assessed, including progress made by the home in addressing outstanding requirements. Where we have become aware of outcomes for additional standards we have included these in our assessment. Our inspection has taken account of information received about the service and from the service since the last inspection, this includes a completed Annual Quality Assurance Assessment (AQAA) which was returned when we asked for it. The AQAA has been completed to a reasonable standard and tells us only some of the information we needed to know. The AQAA would benefit from additional content to illustrate the day to day operation of the service, its strengths and weaknesses and how identified shortfalls have been addressed and proposed improvements. We have discussed these omissions ans Care Homes for Older People Page 6 of 34 suggestions for improvement with the acting manager. We have surveyed a sample of people living in the home and staff who support them, to obtain their views about service quality; this has been helpful in planning the inspection and informing our judgements about the service. Our inspection has also included an unannounced site visit to the service on 30th September 2009 between 09:50 am and 16:40 pm. During which we were able to spend time talking with people living in the home, observe and speak with staff and examine a range of documentation. We have also been able to spend time with the acting manager and the area manager. We have been proportionate in our judgement of this service considering compliance with regulation and outcomes for all the people living in the service alongside the overall risks and impacts of identified shortfalls. Care Homes for Older People Page 7 of 34 What the care home does well: The majority of people who live at the service and are relatively able enjoy a good quality of service; they tell us that: made to feel welcome provides good care I am very satisfied asked what the home does well residents reported: The care provided many things, everything happy with everything Carers are wonderful do their best under difficult circumstances very helpful when they have the time generally very satisfactory Health professionals who were surveyed have responded positively to most questions asked commenting that : always found staff and management very helpful in supporting their residents with any exercise programme I have put in place well organised staff - staff know if I am due to visit and are helpful The home is well maintained, and people enjoy living in a clean, comfortable and homely environment. People we surveyed and spoke with said that they enjoyed the variety and quality of the meals provided. There is an activities programme which is more suited to those more able people who live in the home, people said they enjoyed the trips out. People who come to live at the home are encouraged to bring their own personal possessions, and welcome the opportunity to personalise their own space and help them settle into the home. A low staff turnover means that people in the home benefit from continuity in the staff who support them and know them well. Staff tell us that they enjoy working at the home and are proud of the quality of service offered, asked what the home does well they tell us: I am proud to work at Saxonwood. management is very approachable and always makes time to listen palliative care, laundry service, catering, respecting people as individuals Care Homes for Older People Page 8 of 34 Saxonwood has some very dedicated staff who work hard to meet the needs of residents Overall Saxonwood is a very nice home for residents and staff We always try to put the resident first, we try to keep them happy and active What has improved since the last inspection? What they could do better: We are concerned that those less able people living in the home who generally lack capacity to engage well with staff, may have their needs over looked. Improvements to care plans and risk information have been superficial and not sustained to aid staff knowledge and practise when working with individual people. Plans do not accurately reflect the needs of individuals and are not routinely reviewed, people living in the home have less involvement in their support plans which are not person centred. Risk information is not always in place in regard to moving and handling, pressure care and nutrition, where risks are identified information is minimal and fails to reflect the risk reduction measures that need to be implemented. New Care staff are not being provided with the necessary common induction standards to ensure they have the initial skills and knowledge to support people in the home effectively, staff performance and practise is not routinely monitored or formally supervised Care Homes for Older People Page 9 of 34 We have issued requirements for the home to address these shortfalls. We have also made some recommendations for improved practise. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 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. Prospective residents of the home are provided with opportunities to visit if they wish and are given information about what the service offers. People who come to live in the home dependent on their financial status receive contracts or terms and conditions information. Evidence: The Housing trust has recently updated policy and procedure information including the development of a general statement of Purpose across all homes, the acting manager is aware that this must reflect the specific service offered by the home and this is being attended to. The AQAA informs us that the home has actively made more literature available and this is displayed in the reception area. The home operates an admission procedure, that monitors that Prospective residents are provided with necessary information to inform them about the service offered by the home. Most people we spoke with commented that they had not personally visited Care Homes for Older People Page 12 of 34 Evidence: the home but had taken on trust the views of their representatives or knew of the home through word of mouth. All said they were happy in their choice. Contractual or terms and conditions information is provided to people who come to live in the home so that they know how much they have to pay and what this covers. Some concerns have been expressed through survey feedback from one or two people living in the home and a few staff, about the perceived trend of the home taking people with higher needs who are straining the resources of the home. When we visited we met a number of people living in the home who said they had noticed no change in the service received from staff and were unaware of anyone who might be considered as inappropriately placed. From observations made during our visit particularly of some of the people who may be considered as having increased needs, we do not consider these to be outside those normally to be found in residential care homes; in all likelihood these will form the majority of referrals in future, and this will require a cultural change within the staff team to work effectively with a more needy resident group. Whilst the home is able to offer some respite it does not provide an intermediate care service. Care Homes for Older People Page 13 of 34 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. Some people living in the home may have their needs overlooked, by a failure to monitor changes in needs routinely and the impact of any associated risks from this.The majority of more able people living in the home enjoy a good lifestyle. Medication arrangements are improved. Evidence: The majority of people living in the home currently need minimal support from staff and enjoy a good quality of life, Survey feedback and direct interviews with more able people who live in the home confirms that they feel well supported and cared for. Their ability to vocalise their needs and relate well with staff, means that the lack of updated information in support plans has less impact on them and their day to day quality of life than on those who are less able through lack of capacity or disability. When we spoke with people they were unfamiliar with their support plans, although examination of plans indicates some signatures, they are not routinely involved in updating plans,and do not take an active role in discussions about their needs and how these should be supported by staff. Care Homes for Older People Page 14 of 34 Evidence: The acting manager is keen to re-introduce the key work system, and is confident this will enable staff to build closer working relationships with people they are allocated to,involving them more routinely in discussions about their support. The management team recognise that operating both a computerised and hard copy system of support plans is not working and will be reviewing these arrangements. When we looked at a sample of four care plans, we found three were out of date, one by more than one year, others had not been updated since february and May 2009.Only one plan of someone admitted in Spetember 2009 was found to be up to date in this sample. We noted the plan for an individual with dementia failed to reflect the changes which have occurred to their ability to self mobilise and also occupy themselves by using television and newspapers and how staff are supporting them with this. We found that support plans which should be used as a working tool by staff to ensure they provide the agreed level of support in a consistent manner,are not being routinely maintained. Whilst staff have an awareness of the general changes to individuals, there remains an over reliance on this information being communicated verbally with little guarantee of a consistent level of support being offered. Our observations of an individual with dementia indicated that whilst their physical needs may be well attended to, there was little understanding within the plan of care of the need for staff to take a proactive role to try and engage the individual in activities to provide stimulation and exercise where they now lack the capacity to do this for themselves. There has been some improvement to the content of support plans but they in general lack person centred information and are inconsistent in the level of detail that they may contain. People we spoke with told us that they are supported by staff to shower or bathe and that this is often enough for them. When we examined daily log entries for the files sampled of more vulnerable people we found inconsistencies in the frequencies of baths and showers recorded. When we looked at a file for someone with continence issues we were unable to evidence within daily lof entries that they had received either a shower or a bath within a two week period.When we asked a senior carer about this we were advised the person had at that time been unable to bathe for medical reasons, this however, Care Homes for Older People Page 15 of 34 Evidence: could not be supported by entries either in the daily log or in the presence of an emergency care plan. We were able to highlight similar inconsistencies in the freuency of bathing provided to other people whose files we sampled and we have brought these concerns to the attention of the acting manager. Whilst survey feedback indicated a split between how people in the home perceived service quality, many of the more able people in the home expereince good quality outcomes for themselves and are vocal in their appreciation of the service, here are some of the comments we have received: made to feel welcome provides good care I am very satisfied asked what the home does well residents reported: The care provided many things, everything happy with everything Carers are wonderful do their best under difficult circumstances very helpful when they have the time generally very satisfactory Asked what they could do better residents told us More staff, staff are friendly but need more, Health professionals who were surveyed have responded positively to most questions asked commenting that : always found staff and management very helpful in supporting their residents with any exercise programme I have put in place well organised staff - staff know if I am due to visit and are helpful When we spoke with people in the home they confirmed that they are well supported to access routine health care and specialist appointments, and they welcome the escort of staff to these. Examination of individual files confirmed that the home is Care Homes for Older People Page 16 of 34 Evidence: proactive in ensuring people in the home access health appointments and referrals for health care are made on their behalf. Weights are recorded regularly. Some support plans viewed indicated those people in the home with dietary issues, some of which need food supplements. Care plan information failed to reflect how dietary issues impacts on the day to day routine and well being of individuals, and how this is to be supported. Nutrional risks are not assessed, and staff are therefore unaware of the importance of nutritional supplements or maintaining a good diet for effected individuals. People who are experiencing decreased mobility do not routinely have pressure care risk assessments developed,we are advised that currently no one in the home has pressure areas, but there is no indication as to who may be deemed to be at risk and the measures implemented to reduce this risk. Appropriate systems have been developed to aid the risk assessment of individual people in the home but these are not consistently used or updated, moving and handling assessments are not in place for everyone and yet the majority of people in the home have some moving and handling needs however minimal. General risk assessment information is basic and lacks detail as to risk reduction methods implemented to minimise risk, these are not routinely reviewed along with care plan information. Whilst there are some individuals in the home who self administer and the home has put appropriate risk assessments in place for this, there is generally a culture that staff will administer medications. Most people we spoke with were satisfied with this decision and chose not to take charge of their own medications, consents to medication by staff are not recorded within support plan information, where individuals lack capacity to self administer capacity assessments to support these judgements are not in place. Since the last inspection the home has taken on board some of the shortfalls highlighted and have changed pharmacist. Medication storage has been reviewed and improved, regular audits are undertaken and the most recent by OPUS commented positively on overall medication management within the home; some recommendations for improvements were made which we would support. Staff would benefit from individual PRN guidelines and medication profiles to aid their understanding of individuals medication needs and aid consistency in administration and is a recommendaiton. Care Homes for Older People Page 17 of 34 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. The majority of able people in the home enjoy the lifestyle they lead and are able to make decisions and choices for themselves,there is a lack of stimulation for less able people who lack capacity to participate or occupy themselves. The home is supportive of people in the home maintaining important relationships and friendships. People in the home benefit from a well prepared varied and nutritious diet. Evidence: An activities programme is in place and a part time co-ordinator is available to facilitate some of the activities on offer, the majority of people we spoke with make an active choice to participate or not in the activities and most thought the range and frequency of activities are enough, people in the home particularly appreciate the trips out. The AQAA informs us that in response to requests from people in the home they are now enabled to undertake light gardening tasks if they wish to. At present activities are provided for those who have capacity to participate. Some thought will need to be given to the type and range of activities offered in future. Increasing numbers of people with sensory deprivation and mental capacity issues, Care Homes for Older People Page 18 of 34 Evidence: will require staff to be more knowledgeable about how to support them and to be proactive in engaging with them to participate in activities to promote mental and physical stimulation and improve their overall quality of life in the home. There has not previously been a culture of staff having to be proactive in working with individual people in the home who may be unable to initiate stimulation and activities for themselves, there is a need for greater intervention and involvement by staff, some thought needs to be given as to how staff time could be more effectively used and clearly this will have resource implications which the home management will need to consider. When we spoke with those people in the home who are able to make decisions and choices for themselves, they indicated they are very satisfied with the lifestyle they currently experience and are complimentary of the home and staff. People we spoke with indicated regular visits from families and friends where these relationships exist and it is clear there are no restrictions to this. All survey and direct feedback from people in the home indicated good levels of satisfaction in regard to the quality and range of food offered in the home. There is a pleasant dining area and people we spoke with commented positively on the standard of food within the home, one person reported that what I like is that you get all the trimmings with your meal just like at home. Special diets are catered for and people we spoke with said they could have alternatives, and feel able to influence the menu. When we spoke with one of the cooks they confirmed that attention is paid to what meals people seem to prefer and when new dishes are introduced whether these prove popular or not. The AQAA informs us that menus have been reviewed to offer a wider range of dishes to people with diabetes, when we spoke with a cook they confirmed that they are trying to improve the range of desserts offered to people with diabetes, so that they are not missing out on puddings offered to everyone else. Care Homes for Older People Page 19 of 34 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. People in the home feel listened to but some people need reassurance to express their concerns and how this is undertaken. Systems are in place to safeguard people in the home but staff need to ensure that what they learn is applied to their everyday practise Evidence: Since the last inspection feedback from people living in the home through surveys and direct interviews suggest an improvement to how they feel about the management of the home and how they engage with them. People generally find the acting manager approachable and feel listened to. Whilst the majority surveyed and spoken with stated they had a satisfactory experience of the home and had little to complain of , they were confident of being able to raise issues with staff and that these would be dealt with. Some people surveyed said they did not know how to complain and one person we spoke with stated that they would probably tolerate some level of poor service rather than jeopardise their place at the home, this has been discussed with the acting manager who has agreed to work with people in the home to make clear to them that their feedback is valued and in no way compromises their placement within the home. The home has managed adult alerts appropriately and there are no current open alerts. The management team are currently dealing with some negative behaviour Care Homes for Older People Page 20 of 34 Evidence: from some existing people in the home toward a newer resident, this has also precipitated concerns from some staff about the admission of more needy people to the home. From our own observations during our visit, discussions with other people in the home, and examination of records we are not aware of anyone within the home who is not suitably placed, but recognise that there has not been until now a culture of admitting people who needed more than minimal personal care needs at point of admission and this will require a different way of working for all staff. We are satisfied that the home management are tackling this issue appropriately. Staff are receiving adult safeguarding training Care Homes for Older People Page 21 of 34 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 in the home enjoy living in a safe, clean, comfortable and homely environment, that benefits from routine maintenance and upgrading programmes. Evidence: When we last visited the call bell system had been identified by the then manager and staff as in need of replacement and a requirement issued for this to be progressed. Although the system has not yet been replaced, we are satisfied with the arrangements in hand to do so within the next few months. Improvements to the exterior of the building have been completed ensuring broken tiling has been replaced and a pathway to the front door relaid and hazards removed. The AQAA tells us that a programme of redecorating of corridors and rooms is underway, lights have been installed along the front path to aid visibility. Storage of important equipment used for care of people in the home has been relocated to more appropriate areas around the home. Equipment used to support individual people in the home is well maintained within appropriate servicing frequencies. We found the home to be well maintained. Cleanliness is good with systems in place Care Homes for Older People Page 22 of 34 Evidence: for the promotion of improved hand washing and personal hygiene routines. An ancillary staff are in place to ensure domestic and maintenance tasks are undertaken. Communal areas provide comfortable and homely environments for people to spend time in. Individual bedrooms are personalised and people we spoke with welcomed the opportunity to bring personal possessions into the home to aid their settling in. People generally felt laundry is managed well within the home. Care Homes for Older People Page 23 of 34 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. People living in the home are better safeguarded by Improvements to the recruitment and training of staff. Further areas for development are suggested. Evidence: Feedback from people using the service through survey and direct discussion indicates that in general they think there are enough staff always available to support them. More than 50 percent of staff have achieved NVQ2, but there is still a limited understanding of the person centred way of delivering care and support. Some staff survey and interview feedback has highlighted growing concerns as to the staffing resource implications of admitting people to the home with higher needs. Our visit, however, highlighted no one within the present resident group who could be considered inappropriately placed and might substantiate these concerns. It is clear that staff have been unused in general to working with less able residents at the point of admission, their experience lies in working with people who become less able over a period of time and who have sometimes needed palliative care and they have responded well in these situations. There is a need for staffing levels to be routinely reviewed to ensure needs irrespective of numbers of residents can be appropriately supported, and for staff time to be used more effectively. Care Homes for Older People Page 24 of 34 Evidence: The acting manager has worked hard to develop staff files and address shortfalls in documentation identified previously. When we visited we sampled three staff files and found all the necessary checks and references in place to assure the fitness of individuals, a lack of current photographs and clarity of start dates were highlighted as further improvements that can be made. The implementation of interview notes which provide opportunities to clarify gaps in employment histories and reasons for leaving previous care roles needs to be applied consistently within recruitment practise. A programme of staff training and development has been implemented to address previously identified shortfalls and gaps in staff mandatory training. We noted bookings for further training, staff have also received sensory awareness training. A review of computerised training records currently held highlights a lack of clarity as to what training staff have already achieved and what dates refreshers are due, this has been discussed with the acting manager who has agreed to amend the present spread sheet. Suggested improvements should enable the acting manager an improved overview of what the trainings needs are within the staff team. Individual training profiles have not been developed and we are unable to judge whether staff have completed all the necessary training they should in a timely manner. When we looked at new staff files we noted that each undertakes a basic orientation and induction to the service, but, for care staff this does not also include the skills for care induction programme. The common induction standards programme has been implemented elsewhere in the housing trust homes but not in Saxonwood and we require this to be progressed. Care Homes for Older People Page 25 of 34 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. Actions have been taken to comply with regulatory requirements, but overall improvements within the service have not been sustained in some key areas, such shortfalls could compromise the well being of more vulnerable people living in the home. Evidence: Following the departure of the previous registered manager, the deputy manager has taken on the role of acting manager to oversee improvements in the service and address outstanding requirements. Her appointment as acting manager has been a popular choice within the staff team and the people who live in the home. When we spoke with staff and people in the home they all spoke positively about the acting manager and how approachable and friendly they find her. We have expressed our concerns during our visit at the delays in appointing to the manager post, and whilst there has clearly been some actions taken to address Care Homes for Older People Page 26 of 34 Evidence: identified shortfalls, improvements elsewhere in the service have not been sustained. The acting manager understands the principles of person centred planning but this has not been translated into the way in which support plans are developed or in the way that more vulnerable people living in the home experience care delivery.There is an awareness of mental capacity legislation but this is not routinely applied in determining whether individuals have capacity to undertake aspects of their own care or judgements recorded around this. We have received a completed AQAA to inform our inspection of this service and this has been completed to a reasonable standard, and tells us only some of the information we needed. The AQAA information would benefit from additional content to illustrate the day to day operation of the home its weaknesses and strengths and how things are being improved, including previously identified shortfalls. At present the service has a number of stand a alone audits to monitor service quality in specific areas, a monthly monitoring of this is conducted by the area manager and quarterly board meetings assess the information gathered. People who live in the home are provided with resident forums and opportunities to express their views through these and through survey feedback which is also analysed. A report of quality assurance findings is completed and made accessible to people in the home. A service development plan has been produced for the service and we have requested a copy of this. In view of the shortfalls we have identified during this inspection, particularly in regard to the maintenance of important documentation e.g care plans, risk information, we are concerned that current audit systems may not be sufficiently robust. We have discussed these concerns with the area and acting home manager indicating some review of quality audit systems is needed. Appropriate systems are in place to safeguard residents monies although we have not assessed these again on this occasion. Whilst staff report that they do have opportunities informally to meet and speak with the acting manager and that staff meetings are being held, formal supervision of staff has slipped. Examination of staff files indicates that in most cases only one supervision has been held since the departure of the previous manager. It is important that staff practise and performance is formally monitored and that staff have opportunities in private to raise issues which concern them in regard to the work they are undertaking and this is a requirement. Care Homes for Older People Page 27 of 34 Evidence: The AQAA informs us that all policies and procedures have now been reviewed and updated. Health and safety serving and checks have been undertaken routinely and are in date. When we looked at accident and incident information we noted that there is a lack of clarity in regard to what constitutes an accident, as some falls are clearly being recorded as incidents and not accidents. This confusion could lead to an under reporting of accidents and an inaccurate assessment of falls occurrence, and we would recommend that staff are given clarity to determine and differentiate one from another. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 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 Care plans should be person centred and must be reviewed a minimum of monthly with active involvement of the resident concerned where possible. 15(1) Unless it is impracticable to carry out such consultation, the registered person shall after consultation with the service user, or a representative of is, prepare a written plan as to how the service users needs in respect of health and welfare are to be met. The plan of care should accurately reflect the current needs of each service user and how these are to be supported by staff 30/12/2009 2 9 13 Risk assessment information 30/12/2009 must be routinely reviewed and should in addition to highlighted risks reflect the Page 30 of 34 Care Homes for Older People 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 risk reduction measures implemented 13(4)(c) The registered person shall ensure that(c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated so that people in the home are protected from harm 3 30 18 Care Staff must receive skills for care induction training to ensure they have the necessary skills and knowledge to fulfil their role Regulation 18(1)(c) The Registered person shall, having regard to the size of the care home, the statement of Purpose and the number and needs of service users (c) ensure that the persons employed by the registered person to work at the care home receive(i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further 30/12/2009 Care Homes for Older People Page 31 of 34 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 qualifications appropriate to such work. 4 36 18 The registered provider 30/12/2009 must ensure that systems are in place for the routine and formal supervision and monitoring of staff practise and performance and element of which should be observational 18(1) The Registered person shall having regard to the size of the care Home, the statement of purpose and the number and needs of service users(2) The registered person shall ensure that persons working at the care home are appropriately supervised. 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 9 Individualised PRN guidelines should be developed to aid consistency in administration Individual medication profiles that take account of individual preferences and diversity in respect of medication would also inform staff better about the medications administered and what they are for. Staff files would benefit from a current photograph and clarity in respect to the date employment commences. Documentation should be able to evidence that gaps in 2 29 Care Homes for Older People Page 32 of 34 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 employment and verifications of reasons for leaving previous care roles have been pursued with applicants routinely. 3 30 Development of individual staff traiing profiles would inform the Manager of gaps in knowledge and skills that need to be supported through training. A review of audit systems is needed to ensure these are sufficiently robust to identify shortfalls in service delivery. 4 33 Care Homes for Older People Page 33 of 34 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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