Care Home: Severn Heights Nursing Home

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What the care home does well The atmosphere of the home is friendly, warm and welcoming. People using the service appear relaxed and were seen interacting well with all the staff. There is a good choice of food available in the home, and the food is well presented. The home can cater for any special diets, including individual preferences, dietary and cultural needs which, means people living at Severn Heights should receive food that they like. Accommodation for people is on two floors and a passenger lift assists people with mobility problems to access all areas of the home. People are encouraged to personalise their rooms with items that are familiar to them so that they live in an environment, with things they recognise. There is a committed staff team some of who have worked at the home for many years so people have people they know looking after them. A varied range of activities are provided for the people living at the home and the home arranges transport for individuals wishing to maintain links with the local community. People told us: `the home gives very good care and support to all the people` `the atmosphere in the home is warm and caring` `I just knew the minute I walked into the home that this was the one for ----` `my ----- is so happy here` What has improved since the last inspection? There is an ongoing maintenance programme in respect of decorating and purchasing new furniture and equipment. Some carpets have been replaced which has improved the appearance of these areas. A small conservatory is being built off the lounge for the people to use, and allow people to see the gardens if they don`t wish to go outside. What the care home could do better: The recruitment procedure must be robust to ensure that people are safeguarded from harm. The home is badly in need of storage space for large equipment. Without it these items are stored in corridors and bathrooms and this impeded the residents and staff each day and makes the full use of facilities difficult. The management of housekeeping and infection control processes needs to be reviewed so that the people are able to live in a clean house and be protected from infection. Monitor staff training and development, and provide regular supervision. This willensure staff fulfill the aims of the home and meet the changing needs of people using the service. Develop effective quality assurance audits and include the views of people using the service and professionals. The programme to improve the internal and external condition of the home needs to be speeded up. For example the building of the conservatory has been ongoing for many months and relatives commented about the length of time that had been taken up. Review bathing facilities to ensure that they are suitable for the peoples` needs who live in the home and they have a choice between a bath or shower. The home should provide a good range of suitable chairs in the dining room, lounges and individuals bedrooms to ensure that they are safe for the individual to use. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Severn Heights Nursing Home Old Hills Callow End Nr Worcester Worcestershire WR2 4TQ     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: Christine Potter     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Severn Heights Nursing Home Old Hills Callow End Nr Worcester Worcestershire WR2 4TQ 01905831199 02089029611 susan.stock2@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ablegrange Severn Heights Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Severn Heights Nursing Home, previously known as St Clouds Nursing Home, is a former country home set in six acres of mature grounds with views across the River Severn. The home is registered to provide accommodation, personal and nursing care for a maximum of 30 people of either sex over the age of sixty-five years. All bedrooms are for single occupancy and eleven rooms have en suite facilities. People are accommodated on two floors with a passenger lift providing access to first floor rooms assisting people with mobility problems to access all areas of the home. Other areas of the home used by people include, lounges, dining areas, toilets and bathrooms. Handrails are appropriately fitted to assist people to walk around the home. Ramps are fitted to assist people in wheelchairs to use the gardens, and outside Care Homes for Older People Page 4 of 31 Brief description of the care home furniture is provided. The registered manager for the home is Mrs Susan Jones who is a registered nurse with many years experience in caring for older people. The home is owned by a company known as Ablegrange Severn Heights Limited who have other care homes. A varied range of activities are provided for the people living at the home and the home arranges transport for individuals wishing to maintain links with the local community. Information regarding the home can be obtained from the Statement of Purpose and Service Users Guide, which are available from the home. Information about the fees are not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for hairdressing, daily newspapers and chiropody. Care Homes for Older People Page 5 of 31 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 focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. We visited the service during the day on the 10th June 2009 the last Key inspection was the 12th June 2007 and this rated the home as good. We did an annual service review in June 2008 followed by a random inspection because the service had failed to provide sufficient information in their Annual Quality Assurance Assessment. During this inspection we spent time observing daily life, and we met with people and relatives Care Homes for Older People Page 6 of 31 who use the service. We spoke to the manager, administrator and many staff who were present throughout the inspection. We looked at care files and records completed by the service which must be kept by the home to show that it is being run properly. Before we visited the service we looked at the information we had about the service since the last inspection. This included an annual service review, random inspection, notifications of incidents sent to us by the service, surveys sent to us by people using the service and the Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment is completed by the manager and informs us how well the home think they are performing and provide us some information about the home, staff and people who live there, improvements and plans for improvement which we would take into consideration. What the care home does well: What has improved since the last inspection? What they could do better: The recruitment procedure must be robust to ensure that people are safeguarded from harm. The home is badly in need of storage space for large equipment. Without it these items are stored in corridors and bathrooms and this impeded the residents and staff each day and makes the full use of facilities difficult. The management of housekeeping and infection control processes needs to be reviewed so that the people are able to live in a clean house and be protected from infection. Monitor staff training and development, and provide regular supervision. This will Care Homes for Older People Page 8 of 31 ensure staff fulfill the aims of the home and meet the changing needs of people using the service. Develop effective quality assurance audits and include the views of people using the service and professionals. The programme to improve the internal and external condition of the home needs to be speeded up. For example the building of the conservatory has been ongoing for many months and relatives commented about the length of time that had been taken up. Review bathing facilities to ensure that they are suitable for the peoples needs who live in the home and they have a choice between a bath or shower. The home should provide a good range of suitable chairs in the dining room, lounges and individuals bedrooms to ensure that they are safe for the individual to use. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. There is sufficient information available for people to decide whether Severn Heights is right for them. There are opportunities for people to visit the home before making up their minds. The home carries out assessments of peoples needs before they move in, so that staff can provide the care that is needed. Evidence: The certificate of registration was clearly displayed in the reception area of the home along with the insurance certificates. A coloured brochure containing photographs of the home is displayed in the reception area of the home with copies of the service user guide. Visitors who arrived to view the home were provided with copies of the information to take away and look at. Feedback from surveys and people using the service confirmed that they had been provided with sufficient information to assist them with their choice. It was Care Homes for Older People Page 11 of 31 Evidence: recommended that the service user guide is produced in alternate formats to assist people with sensory impairments to understand the information more easily. The statement of purpose reviewed at this inspection did not include all the information as required to meet the relevant standard. People visiting the home still says St. Clouds, and this is changed to reflect emergency services who during the day commented that the sign from the main road this had been confusing for them. It is recommended that the name of the home. This could cause confusion for were not aware of the change of name. We looked at the pre admission assessments for three people who had recently moved into the home. The assessments provided sufficient information for the service to decide whether they would be able to meet the persons needs if they chose to move into the home. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. Comments and feedback about the home included: family caring atmosphere good value staff cheerful there is a welcoming atmosphere Severn heights nursing home is second to none The Annual Quality Assurance Assessment accurately reflected how the service was meeting these standards. It provided us with basis details of the homes improvements in the last 12 months which included: Updating statement of purpose. Redecoration of rooms The homes plans for improvement over the next 12 months include updating their brochure, and having photographs of the staff displayed in the home so visitors and people using the home are aware of who staff are and can . Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: We looked at the experiences of three people using the service in detail. This included looking at their care files, meeting them, and speaking to relatives where possible. This is to establish their views about the home. We found that the individual care files contain a range of information relating to the health and care needs personalised to the individual. The care plan format detailed the actions and interventions needed to meet the continuing needs of each person. For some people information from relatives had been included in the care plan as part of the assessment process. The care plans clearly represented information gained through the homes pre admission assessment process. The care plans showed that they were being regularly reviewed and updated by the staff, and take account of changing needs and circumstances. It was recommended that staff complete a care Care Homes for Older People Page 13 of 31 Evidence: plan for any individuals acute health need an example being chest infection or unary tract infection. This will assist in ensuring that all staff are fully aware of the persons health needs and follow the directives in the care plan so that the persons care is not at risk of being compromised. Comments received from people using the service were positive and included: the home is very good, they provide good care to all people living here and support the staff who work here. It is a warm and friendly atmosphere in homely surroundings.it is well run and as adequate equipment. my ----- health and well being has improved beyond belief. the nursing care is excellent. all staff are caring and helpful. Risk assessments are completed for individuals which include a range of health and care needs. The assessments are used by the staff to assist in promoting the safety and welfare of the individual. It was recommended that all people that move into the home are weighed on admission to establish a baseline record and assist in monitoring the persons nutritional assessment. People using the service are registered with a range of local community health services that are appropriate to their needs. Systems are in place to ensure that all health appointments and arrangements are monitored and completed. Liaison between the home staff and visiting health and social care professionals is good. The home is able to access a range of advice and guidance that may be needed about matters relating to individuals health and well-being. Comments received from visiting health professionals included: staff are always available informative and helpful. Severn Heights nursing home has appropriate policies and procedures in place for the receipt, administration and disposal of medication. We looked at how the home managed peoples medication and we checked the medication for the three people being followed. The medication records seen were well documented either with a signature for administration or a code to explain why the medication was not administered. People seen were appropriately dressed for the temperature of the home, and in keeping with their gender and personal preferences. We observed staff respecting peoples privacy and dignity for example, knocking on doors before entering private rooms, and speaking to them courteously. We were told by people using the service and relatives that all staff are respectful and courteous when addressing them. There was a good atmosphere between the staff, people using the service and relatives, we were told by a relative: all the staff are all wonderful from the manager to the housekeeper you cant fault them Care Homes for Older People Page 14 of 31 Evidence: The Annual Quality Assurance Assessment received form the home for this inspection stated: For what they could do better, they could provide privacy locks on the ensuite bathrooms. For how they have improved in the last 12 months they told us staff had extra training sessions in a community bereavement seminar that incorporated dignity in death. An end of life wishes form has been added to the care plans for resident and their families on admission. The homes plans for the next 12 months stated that they were going to provide privacy locks. Care Homes for Older People Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have the opportunities to be involved in a wide of interesting activities and access the gardens. The dietary needs of the people are well catered for with a balanced diet and a varied selection of foods. Evidence: We spoke to the activities person who is clearly committed and enthusiastic about her role. This was evident given the amount of activities and fundraising completed in the few hours allocated for this to be completed. We were told that if additional hours were available more social events could be organised for weekends and evenings which would further benefit the people living in the home. The activities person stated that they do everything with the individual which they are able to participate in, they also commented that the manager and care staff were supportive and gave up their own time to assist with outings for people. A record of all activities is then maintained within the persons care records and updated monthly. We received positive comments from people about the planned activities and this included: Activities are constantly being arranged to stimulate and encourage social enjoyment activities are provided and I am always asked if I want to join in outings which my ------- enjoys Care Homes for Older People Page 16 of 31 Evidence: entertainment, musicians are organised and much appreciated Photographs are displayed in the entrance area of the home showing the various activities that people have participated in. It is recommended that the hours allocated for activities and funding towards activities is reviewed. We spoke to the chef who explained the arrangements with food for people living in the home. Prior to admission the dietary needs of individuals is discussed, on admission to the home the chef visits and goes through a food information chart a copy of which is kept in the persons care records. Comments on these included --- is a good eater likes most foods, likes all puddings. ---likes most food, uses sweeteners, and enjoys fish, meat, veg, fruit, bacon and sausage.is not keen on eggs. The people confirmed that the home were providing food from this information. The chef confirmed that they have full authority for selecting the food supplier for the home, and can change suppliers if they are not happy with the quality of food. It was confirmed that all equipment is working and the dishwasher has just been replaced. The home work a four week menu rota and this includes a full cooked breakfast, cereals, toast, or whatever the individual requests for breakfast. Two choices are available at lunch time for example fish pie or spaghetti carbonara, and we were told if they dont like this can have an alternative which might include omelettes. The food records maintained by the chef showed what people had received for the day. The choice of meals for the day of the inspection was roast lamb or pork chops with pancakes for dessert. People who prefer can have an alcoholic drink with their meal and staff were asking people at lunch time. The dining room was attractive for people to use who wished to, however it was recommended that the home look at more suitable chairs appropriate for the needs of the people using the service. Comments received about the food included: excellent food the food is really lovely here. During the day we saw people in the lounges with the television and radio on, some people were in their bedrooms watching television, or enjoying visits from relatives. We saw visitors coming and going throughout the day and we were told that the home make them welcome at whatever time they visit. The Annual Quality Assurance Assessment received May 2009 states that people are encouraged to participate in a variety of activities provided by the home ranging from one to one to group activities, in house entertainment and day outings. It stated that they are pro active in holding special events for religious festivals. Under the homes improvements in the last 12 months the home told us that they were awarded a highly commended certificate in the Breath of Fresh Air competition. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 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 who use the service are able to express their concerns and have access to the homes complaints procedure, and are confident that their views will be listened to and acted upon. Evidence: Following the last Key inspection in 2007 and the Annual Service Review in 2008 the home have received no complaints form people using the service. The manager feels that this is because she has an open door policy and encourages people to discuss any issues with her before they become a problem. People using the service and staff confirmed that the manager was always approachable and made time to listen. The home keep a suggestion box is in the reception area of the home for people to make comments if they wish to do so and they can remain anonymous. The home maintains a register of any complaint made and this shows details of past complaints and shows how the service investigated the complaint and the outcome of the investigation. We were told by people using the service and relatives that they were aware of the complaints procedure and who to talk to if they had a concern. One person who had recently moved into the home told us that the complaints procedure was explained to them on admission to the home. Comments included: I am aware of how to make a complaint, but have never needed to Care Homes for Older People Page 19 of 31 Evidence: We were told by staff that they had received safeguarding training and were aware of the homes whistle blowing policy. Staff also confirmed that they would have no hesitation in reporting any concerns to the manager. The manager shows a good understanding of recent developments concerning deprivation of liberty and safeguarding, it is important that staff are trained in this area so that they are able to keep the people they support safe from abuse or neglect. On the day of the inspection staff stated that they were not aware of the changes. The Annual Quality Assurance Assessment received May 2009 states under what we could do better continue to provide effective lines of communication for everyone involved in the care of people. Under improvement for the next 12 months states that they plan to ensure all staff are fully aware and understand the implications of deprivation of liberty. Care Homes for Older People Page 20 of 31 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 adequate 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 spacious and elegant house, which has been adapted for them. Some areas are still in need of updating to ensure that people live in a clean, safe attractive environment. Evidence: The home has been adapted to meet the needs of the people who use the service without losing its character. There are homely touches, such as ornaments, pictures and plants. There are two sitting rooms with comfortable armchairs and a small dining area. Accommodation for people using the service is available in single and shared bedrooms. Since the last Key inspection the home has replaced some carpets which have helped in improving the homes appearance. A conservatory has been built off the lounge, a visitor told us that this had been ongoing for many months and felt that the timescale for this had been unreasonable. Some parts of the home look decoratively tired and some carpets remain badly stained. In addition it is recommended that chairs are reviewed and a variety of armchairs are provided which are assessed as suitable for the individual. One person told us that the chair was most uncomfortable and they could not wait to return to bed Care Homes for Older People Page 21 of 31 Evidence: to be comfortable. The home does not have modern baths and it is recommended as part of the upgrade baths are replaced with ones more suitable for the people needs living in the home. Outstanding from the last inspection report in June 2007 is the bathrooms and toilets are not all fitted with appropriate locks. The manager told us that they were in the process of having quotes for the outstanding work. A sample of bedrooms seen were generally personalised for the individual with small ornaments and photographs which provides some familiarity for people using them. The home is surrounded by picturesque well maintained gardens which provide a pleasant outlook for the people living in the home. However due to the construction of the conservatory off the lounge the path outside is not wide enough for people in wheelchairs to go all around the home to the front of the building. Some areas of the home were odourous it was appreciated only one domestic was working, but given the size of the home it is recommended that the hours allocated for domestic work is reviewed. Domestic cover should be available for the seven days and ensure that sufficient time is provided so people can be assured that they live in a clean home.. The annual quality assurance assessment returned to us from the home told us that the storage facilities for the home remain an issue for them. Under the section on how the home have improved in the last 12 months included that they have done general re-carpeting and decorating all around the home, purchased a further hoist, another new dishwasher, a secondary tumble dryer has been purchased, a conservatory, has been added to the lounge and is in the final stages of completion. Trees have been planted around the home. Recorded under improvements for the next 12 months included to review storage facilities in the home, they are applying for planning permission to build a pagoda type construction over the area where a huge tree used to stand. Care Homes for Older People Page 22 of 31 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. Peoples needs are being met by nurses and carers who are trained and in sufficient numbers to provide the care that people need. By not following the recruitment procedure properly may compromise the safety of the people living in the home Evidence: We looked at the staffing rotas on the day of the inspection, these showed that for the 25 people living at the home there were sufficient staff on duty throughout the 24 hour day. In addition to the nurses and carers the home provides administration cover, catering staff, housekeeping staff, activities, and maintenance staff. We talked to members of the staff team, and they told us that they enjoy working at Severn Heights and this is reflected by the number of years many staff have remained with the home. Some staff told us they were disappointed that they had not received a pay review in the last two years, and felt that senior staff were not given any financial recognition for additional training. Staff confirmed that they felt that the number of staff allocated to the shifts was sufficient to ensure the care needs of the people living in the home was being met. We received many positive comments about the staff from people who use the service, these included: staff are good at their job the staff team are very caring staff pop in Care Homes for Older People Page 23 of 31 Evidence: and see how I am help is always at hand if necessary thank you most sincerely for giving me a splendid quality of life the nursing care is excellent. Three staff personnel files were reviewed at the time of the inspection for staff recently employed. Generally the home has a thorough recruitment procedure in place. However there appears to be some slight confusion between the manager and administrator in sending for references and criminal records checks. The home needs to ensure that references are obtained from the applicants most recent employer and if not a clear explanation recorded within the staff file. A record should be kept on the application form for any unexplained gaps in the applicants employment history, the manager and administrator knew the reason for gaps but had not made a written statement on the application form. Staff should not start work without a pova first or criminal records check being received this is to further safeguard the people living in the home. Staffing records were seen, and eight staff are currently completing a NVQ level three qualification in health at a local college. Other staff have completed NVQ level two and three. Staff told us about the training that they had completed and stated that they felt appropriately trained to meet the needs of the people living in the home. Carers informed us that they were provided with sufficient information about the individuals living in the home, and received regular daily handovers to keep up to date with the changing needs of people living there. The Annual Quality Assurance Assessment informs us that they employ full and part time staff providing a range of flexibility and availability to meet the needs of the people. Recorded in the section what we could do better to identify and organise gaps in training needs. Find time to hold more regular staff meetings rather than discussions at handover. Recorded in the improvement section they have recorded that a deputy manager has been appointed and is a asset to the home. Recorded in the plans for improvement the home recorded to encourage new members of staff to complete NVQ level 3, to retain the existing staff. Continue to update and review staff files. Care Homes for Older People Page 24 of 31 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. People using the service have confidence in the management and organisation of the care home Evidence: Since the last key inspection there has been no change with the manager, and residents, staff, and relatives told us that she is approachable, supportive and always listens to new ideas. A deputy manager has been recruited since the last key inspection and the manager and staff confirmed the benefits of having a deputy in place. We looked at the fire records and these showed that the regular checks were being completed, so that in the event of a fire, people are protected by living in a home where smoke detection systems and evacuation procedures are regularly reviewed and tested. Care Homes for Older People Page 25 of 31 Evidence: Staff keep a written record for all accidental occurrences that occur within the home, so it is easy to audit accidents that have occurred in the home to see whether there are any patterns developing. Nursing staff and care staff are supervised informally at the moment. It is recommended the service formalise their supervision program for the staff to assist in monitoring performance and ensuring that staff have the opportunity to voice their opinions. Staff confirmed that they did have an annual appraisal with the manager every year. The home holds residents meetings and had completed quality assurance questionnaires in the past the home needs to review this and establish the views of people using the service and other professionals at least annually. Some of the comments made to the home and us using the surveys related to the poor television picture. The manager confirmed this was a problem and they were looking at quotes for a digital aerial for the home to improve the picture quality. Other comments received were about the slow progress with the building of the conservatory, and the poor signage to the home which refers to St Clouds Nursing Home. The home has a system in place for peoples personal finances. The administrator explained the procedure, any residents monies are kept secure and receipts for purchases are maintained for example hairdressing. Maintenance cover is allocated to the home for 18 hours per week, it is recommended that this is reviewed so that additional audits can be carried out to assist in ensuring the health and safety of people living in the home is not being compromised. For example a window restrictor was broken on the day of the inspection and there is no routine checks completed to ensure that they are maintained in good working order. The wheelchairs appeared dirty, and in need of having tyres and footrests checked. The Annual Quality Assurance Assessment for the home told us that they provide a high quality of care for people. The manager is supported by the administration manager. Included in what the home could do better develop a more formal quality assurance annual development. In how the home as improved the home stated that they have improved the frequency of staff supervision and with recruitment of new staff have alleviated the need for agency staff. Plans for improvement in the next 12 months include consulting with the Directors with regard to preparing a business and financial plan. Care Homes for Older People Page 26 of 31 Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 The service user guide is produced in alternate formats to assist people with sensory impairments to understand the information. The statement of purpose should include all the relevant information to meet the standard fully. A care plan is developed for acute health problems to ensure that individuals care needs are fully met. The home should ensure that there is access for people in wheelchairs to use them in the grounds. As part of the upgrade to the home consideration should be given to the type of baths, so that all people living in the home have a choice of either a bath or shower. The home should reveiw the chairs in the dining room, lounges, residents bedrooms, and the grounds there should be a varied range of chairs available to meet the assessed needs of the residents. The home should provide suitable storage for the equipment in use so to avoid health and safety risks of this being stored inappropriately around the home. The home should reveiw the number of hours allocated to Page 29 of 31 2 3 4 5 1 7 19 21 6 22 7 22 8 26 Care Homes for Older People housekeeping to ensure that there is cover for the seven days and staff have sufficient time to clean the home to a satisfactory standard. 9 33 The homes quality assurance assessment should be reviewed and the information received should be included in the homes annual development plan for example television aerials. The frequency of carers formal supervision should be reviewed to ensure that their needs are being met. The maintenance hours should be reviewed to ensure that audits are in place to assist in reducing any compromise to the residents health and safety. 10 11 36 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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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