Care Home: Sea Breezes Residential Care Home

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What the care home does well People live in a comfortable home, where they can choose the decoration and furniture they want. They are supported to make decisions, and have as much control over their lives as they are able to have. They are involved in planning their own care and risk assessing their needs. They know how to make complaints if they need to, and they have lots of opportunity to say what they think about the care they receive. People are treated with respect, and their privacy and dignity is maintained well. Staff are cheerful and friendly, and know how to meet people`s needs and wishes. They are trained in how to protect people, and they are recruited in a way that helps to keep people safe. What has improved since the last inspection? Since the last inspection there have been lots of improvements made to the way the care and support is provided. For example, assessments now record people`s wishes for their end of life arrangements, so that things can be dealt with in the right way. There is a new key worker system in place that helps people to be more involved in planning and reviewing their care. People are also now asked for their views about how personal risks could be managed, and this is recorded. At the last inspection we suggested that staff rotas show surnames of staff so that they can be better identified. This has now been done. Some areas of the home have been redecorated and people where involved in choosing colour schemes. People are now asked how they want their bedrooms decorated before they move into the home What the care home could do better: At this inspection we did not make any requirements, which are things the home must do to meet regulations. However we did make some recommendations, which are suggestions that may help to improve the service. Firstly, we said that that the reports of care plan reviews should contain more information about how the review was carried out and what issues were looked at. This will help the home to show that the review process is thorough. Although people are able to join in some activities, we suggested that there should be an identified member of staff to make sure that there is a more regular and varied programme. This is so that everyone`s needs and wishes are taken into account. The manager currently plans staff training events a few months in advance, however we suggested that she introduce an annual plan, so that the frequency and appropriateness of training can be monitored more effectively. Lastly, we made a recommendation in the previous inspection report for including information about new laws relating to decision making, in care plans. Although care plans currently show how people make decisions for themselves, we have brought the recommendation forward to this report, so that care plans include what to do if aperson is unable to make a decision about an issue. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sea Breezes Residential Care Home 41 Scarborough Avenue Skegness Lincolnshire PE25 2TD     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: Wendy Taylor     Date: 0 7 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 27 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Sea Breezes Residential Care Home 41 Scarborough Avenue Skegness Lincolnshire PE25 2TD 01754760596 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kerry Ellen Beeston Type of registration: Number of places registered: Sea Breezes Residential Homes Limited care home 21 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 people who can be accommodated is 21. The registered person may provide the following categories of service only: Care home only - Code PC To people 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 - Code OP Date of last inspection Brief description of the care home Sea Breezes is situated in the seaside resort of Skegness, and is close to the seafront and the local amenities. It is a detached, three storey building with car parking to the rear and a patio area to the front of the building. The home is registered to provide personal care and support for up to twenty-one residents. The town centre is within approximately 200 metres from the home. Transport is provided by the home for residents to access local facilities and to attend hospital appointments. Public transport Care Homes for Older People Page 4 of 27 Over 65 21 0 Brief description of the care home is readily available and the town is well served by rail and road links. The current provider is Mrs Ambika Devi Bumma, and she visits regularly to support the registered manager. The registered manager is Mrs Kerry Beeston, who has worked at the home for several years, latterly as the deputy manager. The manager told us that the current fees charged for placement at the home range from 372.32 to 458.64 pounds per week, depending on the assessed needs of the resident. Information about the costs and the day to day operation of the home, including a copy of the latest inspection report, is available at the main office of the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that the people who use the service receive good quality outcomes. This key unannounced inspection took place over one day in November 2008, and lasted for approximately 7 hours. The care and support received by four people was followed in detail, using a method called case tracking. This method involves talking to people, observing the care and support they receive, and looking at things like their care plans, medical records, and daily notes. It also involves looking at staff records and general house records, as well as talking to the manager and staff. Some of the information we use for the inspection has already been sent to us such as a self assessment and notifications of anything that happens in the service. Care Homes for Older People Page 6 of 27 At this visit we also used another way of working, where an Expert by Experience was an important part of the inspection team, and they helped the inspector to get a picture of what it is like to live in the home. They spent time talking to people who live in the home, and to the staff who look after them. They also had the opportunity to look around the home. The term expert used in this report describes a person whos experience comes from using services for themselves or the people they care for. What the care home does well: What has improved since the last inspection? What they could do better: At this inspection we did not make any requirements, which are things the home must do to meet regulations. However we did make some recommendations, which are suggestions that may help to improve the service. Firstly, we said that that the reports of care plan reviews should contain more information about how the review was carried out and what issues were looked at. This will help the home to show that the review process is thorough. Although people are able to join in some activities, we suggested that there should be an identified member of staff to make sure that there is a more regular and varied programme. This is so that everyones needs and wishes are taken into account. The manager currently plans staff training events a few months in advance, however we suggested that she introduce an annual plan, so that the frequency and appropriateness of training can be monitored more effectively. Lastly, we made a recommendation in the previous inspection report for including information about new laws relating to decision making, in care plans. Although care plans currently show how people make decisions for themselves, we have brought the recommendation forward to this report, so that care plans include what to do if a Care Homes for Older People Page 8 of 27 person is unable to make a decision about an issue. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 10 of 27 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. Peoples needs are identified and understood by the home, because there is a good assessment process. Evidence: We looked at the files of four people who live at the home. The files contained lots of information about peoples needs and wishes that the manager had gathered before the person moved in. We know from information we received before going to visit the home, that the manager looks at all of the information gathered in the assessment process and decides whether the home can meet the persons needs. Files also contain letters that the manager writes to people to tell them if the home can meet their needs. Assessments look at things like relationships, communication, advocacy, risk taking, personal care, culture, and religion. In the last inspection report we suggested that the Care Homes for Older People Page 11 of 27 Evidence: home gather information about peoples end of life arrangements and wishes. The home have now started to do this. The manager also told us that they now also ask people to choose how they want their room decorating before they move in. People told the expert that they had chosen to live at the home, and some of these people had lived in the local area before the moved in. They also said that they had recommended the home to other family members. The home does not provide intermediate care at present. Care Homes for Older People Page 12 of 27 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. Care plans ensure that peoples needs and wishes are met, and they are cared for in an individualised and respectful way. Evidence: In the last inspection report we suggested that care plans show how peoples privacy and dignity is met. We saw that this is now done. We also saw that staff were friendly and respectful towards people who live at the home and their relatives. They were helping people in private where necessary, and they did things in a relaxed and timely way. The expert saw that staff were cheerful and spent lots of time talking to the people who lived there. The expert also saw that the moving and handling practises were generally good, but one comment was made about the positioning of a sling. We talked to the manager about this who took action straight away. There are details in peoples files such as who is their GP, social worker, and next of kin; and care plans show how to meet needs such as medication, religion, culture, communication and relationships. They also show how people make decisions for Care Homes for Older People Page 13 of 27 Evidence: themselves. In the last report we suggested that care plans include reference to new laws about decision making, and we have decided to bring the suggestion forward into this report, so that the home can clearly show how they have responded to the new laws. The manager has recently introduced a new keyworker system, and records show that keyworkers now carry out the monthly care plan reviews. However the reports of the reviews are not very detailed so we made a recommendation about this. We saw that people sign their care plans and review records where they are able to. We also saw that they sign their risk assessments to show that they have been involved in developing them. In the last inspection report we recommended that risk assessments were more personalised. This has now been done, and the assessment also shows the persons own view of how the risk should be managed. There is a record in each persons file showing when they have seen their GP or other health professional, and if they have visited the hospital. There are also records for medication administration, which were completed satisfactorily in most cases. A signature was missing from one record and the manager dealt with this appropriately. Risk assessments are in place for those people who want to take their own medication, and the latest report from the local pharmacy visit did not highlight any issues. In our last inspection report we said that medication records must have photographs on them so that medication is given to the right person. This has now been done, and the manager said that they are also in the process of putting photographs onto peoples care plan files. Care Homes for Older People Page 14 of 27 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 supported to have as much control over their lives as they are able. They enjoy a range of activities, however the frequency and variety of the activities may not meet everyones wishes. Evidence: Information we received prior to the inspection indicated that the homes activity plan has had some improvements following discussions with the people who live there. Records of meetings held with the residents show they have discussed things like having bar-be-ques and trips out. The events file shows that activities such as sing-a long sessions, bingo, church visits, coffee mornings, and quizzes are organised and attendance is recorded. The manager also described the plans for Christmas, which include local community support. However the expert felt that even though specific events were being organised there was not enough stimulation for people during the day, such as crafts. People also told us that they would like activities to be more regular, and to be more varied. We spoke to the manager about this during the visit, and we made a recommendation. There is lots of information around the home about new laws to help people with Care Homes for Older People Page 15 of 27 Evidence: decision making. The manager told us that she is currently organising formal training for staff about the new laws, and there is also a training video for them to watch in the meantime. We made a recommendation at the last visit for care plans to show how the new laws affect peoples lives (see Standards 7 to 10). The manager said that they are in the process of doing this. Care plans show staff how people make their own decisions, and people who live at the home told us that they can make their own decisions and choices about everything, for example where they eat their meals, where they spend their time, and who they want to see. They told us that they can receive visitors whenever they want and staff make them feel very welcome. People told us that they get good quality food, and they have a good choice. They told us that the cook asks them what they want to eat at least a day before, but they can change their minds whenever they wish. We saw that there is a menu guide set for a period of six weeks, which helps people to make their choices. We also saw that people can ask for specific food that is not in the menu guide, and staff make sure that it is provided. Records of peoples likes, dislikes, special needs and allergies in relation to food and drink are kept in their files, and staff showed us that they have a good understanding of theses wishes and needs. The expert spoke to people about the food in the home, and they said that it was good. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are clear systems to protect people from harm, and for peoples complaints to be dealt with in the right way. Evidence: Records show us that since the last inspection visit, the home has not received any complaints. We saw that the complaints policy is displayed in the downstairs hallway. It is also in the service user guide and statement of purpose, both of which are available at the reception desk. People told us in surveys and when we spoke to them that they know how to make a complaint, and they feel confident to do this. There is an up to date copy of the Local Authority guidelines about protecting people in the home, and staff showed us that they understand what to do if they saw or suspected abuse of any kind. They told us that they have been trained in how to protect people, and we saw training certificates on staff files. Records show us that there have been no referrals to the local Safeguarding Adults team since the last inspection visit. Information we received before we visited the home told us that there are also policies in place for things like whistle-blowing, acceptance of gifts by staff, and managing service users money. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 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 enjoy a comfortable and well maintained environment. Evidence: When we visited the home, we found that it was clean and tidy, with a comfortable atmosphere. The expert commented that the lounge was a pleasant room, however people told her that it was rather warm with the heating on. The manager took action about this straight away. We saw that things like cleaning materials and wheelchairs we stored properly, and there were hand washes, gloves and aprons available around the building to help with hygiene. There were also signs in bathrooms and toilet areas, to show people how to wash their hands properly. Records show us that staff have had training about infection control. Risk assessments are in place for things like using stair gates, and for the hand washes that are available around the home. There is a maintenance book that shows repairs are carried out quickly, and people told us that they were able to choose things like curtains and paint colours for parts of the home that have been recently decorated. They also told us that they liked their bedrooms and they could bring whatever furniture they wanted into their rooms. People also told the expert that Care Homes for Older People Page 19 of 27 Evidence: having their own things around them made them feel like it was their home. The manager told us that the electrical systems have recently been checked and they are waiting for a certificate to show this. Reports for inspections of kitchen hygiene show that good standards are maintained, and there are up to date records for kitchen cleaning rotas, meat temperatures and fridge/freezer temperatures. Care Homes for Older People Page 20 of 27 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 are protected by recruitment procedures, and they benefit from a well trained and supported staff team. Evidence: We looked at four staff files during our visit. They contained information such as two written references, criminal record bureau checks, identification, and application forms. Staff told us that they were given a good induction to the home when they first started work, and the training records show this. We saw that a nationally recognised induction programme is now used for new staff. Staff told us they they have had training about things like dementia care, heath and safety practises, moving and handling, and first aid. Again training records show this. The manager told us that training is booked when courses become available through their training provider, and this is done a few months in advance. We made a recommendation about this. We know from information we had before we visited that some staff hold or are working towards nationally recognised care qualifications. People who live at the home, and staff, told us that there are usually enough staff to meet needs. During the visit we saw that staff were busy but they did things in a calm, relaxed and organised way. We made a recommendation at our last visit that staff rotas should show surnames, and this has now been done. We saw records of staff Care Homes for Older People Page 21 of 27 Evidence: meetings were they could talk about things like appraisals, health and safety, and general work patterns. The records also show where the manager and providers highlight good work and commitment from the team members. Staff told us that they have regular supervision, and records of the sessions were contained in their files. They said that there is good team work in the home, and it is a lovely place to work. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there, and systems are in place to promote their health, safety and welfare. Evidence: The manager has shown us that since the last inspection she has attended training courses that help her to keep up to date with care issues, and she continues to study towards a nationally recognised management qualification. She also showed us that she maintains a clear working relationship with the owners of the home. Staff, and the people who live at the home told us that they have a good level of support from the manager, and she is very approachable. Records are in place to show that audits are carried out regularly for things like staff files, and care plans. We also saw records of annual surveys, where people are asked for their views about the service they receive. They made comments such as were satisfied with what we have, I feel very safe here, and my privacy is respected at all Care Homes for Older People Page 23 of 27 Evidence: times. People also told us that they are consulted about whatever happens in the home, for example decorating or purchasing furniture. The manager also showed us how she is working towards recommendations made at the latest Local Authority quality assurance visit. Information we had before we visited the home told us that there is a policy about how to manage peoples money on their behalf. We checked the records for money kept by the home on behalf of people who we case tracked. The records were satisfactory, and they included monthly audits carried out by the manager. Staff told us that they received regular fire safety training and their training records support this. They demonstrated that they know what to do in the event of a fire. Records show that fire drills are carried out regularly, and there is an up to date certificate to show that fire safety equipment has been checked. The manager said that recently fire alarm checks have not always been carried out weekly, and records confirmed this. During the visit, the manager allocated a member of staff to carry out routine weekly fire alarm checks, including emergency lighting. Environmental risk assessments are in place for things like infection control, portable electrical equipment, and moving and handling equipment. The manager said that the assessments are due for review in the near future and this would be done. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 It is recommended that care plan review records contain more detail about how the review was conducted, and what issues were focused on. This is so that it can be demonstrated that the process is thorough. It is recommended that care plans contain information about the Mental Capacity Act, 2005 and the effects it has upon peoples lives. This is to ensure that their rights and choices are protected. It is recommended that that a staff member should be identified/employed to co-ordinate regular and more varied activities. This is so that peoples individual needs and wishes are met. It is recommended that an annual training plan is put into place. This is so that the frequency and appropriateness of training can be monitored and reviewed more effectively. 2 7 3 12 4 30 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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). 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. 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