Care Home: Silvanna Court

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What the care home does well The feedback received about Silvanna Court has been positive. People made favourable comments about the service and staff such as, "I can`t praise them highly enough," "This care home is very good," and "I have been very happy with everything." When people are considering moving into Silvanna Court they know that through assessment and discussion they will be helped to decide if it is the right place and suitable for them. When people move into the home management and staff will continue to make every effort to find out about people`s needs and preferences so that these can be identified, planned for and met. People can feel confident that aspects of their care needs such as medical care, and the management of their medicines will be well and safely managed. People living at the home told us that they were always treated with respect and dignity. People will always able to welcome their visitors so that they can maintain contact with friends and family. If people wish to raise any concerns about the service they can feel confident that their concerns will be listened to and dealt with. People said that they enjoyed the food provided by the home. They are offered choice and their individual needs and preferences are respected. What has improved since the last inspection? Since we last visited Silvanna Court there have been some changes in the management of the home. The home has also experienced a significant turnover of staff. From information received it appeared that this situation had led to a loss of staff morale and a reduction in the quality of the service. The provider has taken steps to address this and an experienced manager has taken up the post at Silvanna Court. They have been in post for about three months and are working hard to re-establish good care and practices. The home is now fully recruited to so people should receive care and support from people that they are familiar with. Activities have developed well providing people for more opportunities for occupation and stimulation. Many more plans are in hand to encourage staff in offering people a fulfilling lifestyle. Relatives involvement is being encouraged through newsletters, opportunities to volunteer, meetings, and the Alzheimer`s support group. The premises have continued to be well maintained, so that people live in a pleasant home. What the care home could do better: The manager and their team have done well in addressing issues and encouraging staff to take a different approach. This needs to continue so that good practices are thoroughly established as part of the homes culture. Care planning needs continued monitoring to ensure that staff are aware of people`s current care needs and can meet them in an individual and person centered way. Staff should receive timely and good quality training in dementia care to ensure that they are equipped with up to date knowledge and have good skills to undertake their role. Key inspection report Care homes for older people Name: Address: Silvanna Court Silvanna Court 84 Runwell Road Wickford Essex SS11 7HR     The quality rating for this care home is:   two star good 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: Vicky Dutton     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Silvanna Court Silvanna Court 84 Runwell Road Wickford Essex SS11 7HR 01268767384 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): silvanna.court@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Name of registered manager (if applicable) Pauline Brenda Kelly Type of registration: Number of places registered: care home 83 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 83 The registered person may provide the following category of service only: Care Home Code 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Silvanna Court is a large purpose built care home registered for 83 older people who may also have dementia. The home is comprised of three floors and is divided into suites along the theme of flowers. There are bedrooms and a number of lounges on each floor. The lounges also incorporate a dining area and a small kitchenette for the Care Homes for Older People Page 4 of 31 Over 65 0 83 83 0 Brief description of the care home purpose of making drinks. The home has been decorated to a good standard. It benefits from a large rear courtyard area, which is planted. There are tables and chairs available for people to sit outside. Some of the bedrooms within the home have access doors to the courtyard area. The home is situated close to Wickford town centre, where there are shops and public transport. The current fees at the home £550.00 to £721.00. Fees charged will vary according to level of need, type of room and funding arrangements. There are additional charges for chiropody, hairdressing and other personal requirements. There is a statement of purpose and service users guide available. People can access a copy of the most recent inspection report. 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: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent nine and a half hours at Silvanna Court. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to relatives, management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the Care Homes for Older People Page 6 of 31 National Minimum Standards and how they can evidence this. The AQAA for Silvanna Court was completed by the manager. It was adequately completed, gave us all the information we asked for and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from four people living in the home, four relatives and one visiting professional. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, deputy manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 31 The manager and their team have done well in addressing issues and encouraging staff to take a different approach. This needs to continue so that good practices are thoroughly established as part of the homes culture. Care planning needs continued monitoring to ensure that staff are aware of peoples current care needs and can meet them in an individual and person centered way. Staff should receive timely and good quality training in dementia care to ensure that they are equipped with up to date knowledge and have good skills to undertake their role. 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 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. People can feel confident that they will be given assistance and information, and have their needs assessed to ensure that the home will be suitable for them. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. The Service Users Guide had been updated in September 2009 and provided up to date information including fees. It was explained that when people are thinking about moving into Silvanna Court they are given a copy of the homes brochure, and time is spent explaining about the home and answering any queries. A copy of the Service Users Guide is given on request. On surveys people felt that they had received enough information about the home. Relatives spoken with confirmed that they visited the home and felt that they had been given good information. We looked at the files of two people who had recently moved into the home and saw that pre-admission assessments had been undertaken that provided a good basis for Care Homes for Older People Page 11 of 31 Evidence: understanding peoples care and other needs, and begin planning their care. 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. People can feel confident that they will receive good and consistent care that meets their individual needs. Evidence: People living in the home and their relatives seemed happy with the care and support offered at Silvanna Court. They made comments such as, They look after me very well and I am quite happy, My family and I are very happy with the quality of care given to my relative, They have coped with [relatives] changing needs very well, and, I visit at all different times and have never seen the staff be anything other than caring and patient. Staff spoken with had a good awareness of peoples individual needs, and were observed to support people in their preferred individual routines. People generally looked relaxed, comfortable and well cared for. Whilst meeting minutes and discussion indicate that there have been issues with consistency and quality of care, the new management team have and continue to work hard to address this. A key worker system is in place and again this is being promoted to improve the individual care and support for residents. Care Homes for Older People Page 13 of 31 Evidence: To see how well peoples care is planned for and arranged so that staff are aware of peoples needs, and meet them in an individual way we looked at eight peoples care records, spoke to staff and observed practice. We found care plans to be comprehensive and to cover the issues identified in the pre-admission assessments. Care plans provided staff with good information to enable them to care for people in individual ways that they prefer. Care files contained assessments, risk assessments, care plans and daily records. We saw that where possible the person or a relative had signed to agree to the care planning process, and had assisted the home by providing background information and a social history of the resident. Care plans were in place relating to different aspects of peoples needs such as personal care, mobility, diet, medication, and activities. The quality of care plans was generally satisfactory, but we did discuss with the manager some aspects that could be improved. While some care plans provided a good level of detail others were not so good and could provide more person centered detail. Other care plans were good at describing things, for example someones behaviour but did not really give staff guidance as to how this was to be managed. Care plans are kept under regular review, however sometimes the review highlighted changes that had not then been carried forward onto the care plan. The language used in care planning needs to be monitored as reference to temper outbursts on two care plans viewed is not person centered. The new manager said that they are gradually reviewing all care plans to ensure that they are of an acceptable standard. From discussion and records looked at, people receive good health care at Silvanna Court. On four residents surveys returned people told us that they always received the medical care that they need. A visiting professional made fully positive responses on our survey. They said, Very caring and clean environment. Residents are very well cared for. The home asks for advice and are willing to take advice to improve their skills. They also said, We have no concerns at all with the care they provide at this time. People told us that they were always able to see a doctor when they needed to. Relatives spoken with felt that they were kept well informed of events and peoples wellbeing. We saw that assessments had been undertaken in relation to key areas such as tissue viability, nutrition and falls. Ongoing monitoring through nutrition records, weight recording and clear documentation relating to falls was in place. Areas of risk such as the use of bed rails and moving and handling had also been assessed. Where assessments indicated high risk care plans were put in place relating to this. We also saw that appropriate equipment such as air mattresses and cushions were in place to assist in peoples safe care. Records showed that people access appropriate health care professionals such as community psychiatric nurses, physiotherapists, general practitioners, opticians, chiropodists and other specialisms to meet their individual needs. A relative told us, Staff have liaised with other professionals to find Care Homes for Older People Page 14 of 31 Evidence: ways of ensuring they are comfortable, provided with appropriate resources and safe. Where residents have been diagnosed with specific conditions we saw that their care files contained information about this to educate and guide staff. The manager told us that some senior staff have recently undertaken training in stoma care, and that the district nurses were going to supply other training for staff relevant to residents individual needs. This will increase staffs knowledge and understanding enabling them to deliver good care. One person had recently raised concerns with us, (CQC) about the management of medication in the home. These concerns were looked into and addressed by the provider. One concern recently recorded in the homes complaints records also related to the safe management of medicines. Minutes of a Care Team Managers meeting in January this year also indicated that there had been ongoing issues with medication management. The manager told us that the deputy manager had worked hard to ensure that all expected procedures and practices were being applied to a good standard. We looked at medication systems in place on the ground and second floor on this visit to see if this aspect of peoples care was managed in a safe and effective way. No one living at Silvanna Court currently manages their own medication. Each floor of the home manages their medication separately and to a different schedule. We saw that the medication areas were clean and well organised. All expected records and procedures were in place. Good records were maintained. Medication systems have recently started to be audited on a weekly basis to pick up any issues. No anomalies or errors were noted on the records sampled. Staff told us that they had completed medication training provided by the supplying pharmacist on a regular basis. Some staff had also completed a distance learning course in relation to medication management. Medication training did not appear on the homes training martix, it was not therefore clear what training had been undertaken. Minutes of a recent meeting said in relation to medication that, The deputy manager will be implementing training so that everyone is doing the same thing. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. One person told us, The care in this home is very good, they show each person love and respect. Another person said, My relative has always been treated with respect and their dignity preserved as much as possible. Although not fully inspected we saw that the home seek to address peoples end of life needs. One care file viewed contained and End of Life Preferred Place of Care plan in place. and a care plan relating to pain control. The same was being set up for another resident. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to have a fulfilling lifestyle, maintain contact with friends and family and enjoy good food. Evidence: During the site visit we spoke to many residents and a number of visitors. People felt that they made choices in their daily lives. One person told us, Im happy as staff let me stay in my room if I want and come out when I want. We saw that a number of people choose to keep their rooms locked. During the day we heard staff offer people choices in relation to routines and food. Care plans viewed identified to a degree peoples choices and preferences such as rising/retiring times and food. People are able to go where they wish and bring in personal possessions to make them feel at home. The home employs three activity co-ordinators who each cover one floor and work for twenty hours each week. People felt that the level of activity had improved in recent times. One person said, The activities have improved greatly since the new activities lady began working here, and another that, I am pleased to see that activities is an area being addressed by the new manager, and new members of staff have been employed as activity co-ordinators. A weekly activities programme is produced for each floor. The home has a lively feel and during the site visit on different floors and at different times people enjoyed making cakes, making Easter Care Homes for Older People Page 16 of 31 Evidence: bonnets, doing word games and board games, having their nails done, going to take Communion, going out with relatives and being occupied with various books and items. Care staff interacted well and undertook activities with people. A number of people at Silvanna Court prefer to remain in their rooms or are cared for in bed. We saw from records and observations that these people are offered company and activity. Where appropriate care plans indicated that people should be left with radio, music or the television on according to their personal choice. This was noted to be being adhered to. Most care files viewed included a social history sheet that provided details of peoples history and interests. As at the previous inspection the home are still hoping to develop life story work with people to provide a point of interest and contact for people who have dementia. In most cases care plans were in place relating to activity. Held separately to care files and maintained by the activities co-ordinators are activities assessments and records. This practice was discussed with the manager as it will not help in providing a joined up approach to care. The AQAA completed by the manager and discussion on the day highlighted the many activities and developments that have taken place and are planned for the future. The home now have access to a minibus so trips out will be planned. For people with dementia items such as rummage boxes and sensory equipment is available. A local sweet shop visits the home to sell their wares. There are plans to set up a coffee shop. To keep people in touch with what is going on a regular newsletter is starting to be produced. Families, particularly those who may be living abroad, are being encouraged to provide their email addresses to make keeping in touch easier. The home is starting to feel part of the local community. There are links to the local British Legion and local schools. The local Alzheimers group meet monthly at the home to provide information, guest speakers and support for relatives and people living with dementia. One relative told us that they had found this support most helpful. People have opportunities to fulfil their spiritual needs through fortnightly church visits and the opportunity to take Communion on an individual basis. People spoken with seemed happy with the level and range of activity offered. People are able to enjoy having visitors at any time. We saw that people were made welcome, offered refreshment and that they had a good relationship with management and staff. One person told us, The staff are always very welcoming. Feedback on the food provided at the home was mostly positive. People said, The choice of menu is excellent, and, The choice of food has improved. The home operate a four weekly rotating menu, with a choice being offered for each meal. In dining areas we saw that the days menu had been clearly written up for people. People said, and we saw that residents were asked what they would like and given a choice. The manager said that work was starting on taking pictures of meals. This is Care Homes for Older People Page 17 of 31 Evidence: so that eventually people with dementia, who may be unable to verbalise their choices, may be assisted in selecting what they wish to eat. On the day of the site visit people were seen to enjoy their lunch. When people needed assistance staff offered them appropriate help. 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 are cared for safely through practice in the home. Evidence: The home has a clear complaints procedure in place that is easy to understand. The complaints procedure is on display for people. On surveys and in discussion people said that they knew how to raise any concerns. One person said, I have always been confident that any concerns or questions would be listened to, taken seriously and acted upon. The AQAA said that eighteen complaints had been made over the previous year. When we looked at records we saw that these had been well recorded and responded to. There were no particular common factors or themes. The home encourages staff to raise any issues of concern. Two complaints recorded had been submitted by staff using a staff concerns form. Staff training records and staff spoken with confirmed that training in safeguarding had been undertaken. We saw that good information was available so that staff have access to the appropriate forms to use if an incident occurred. The staff room had information on display relating to whistleblowing and copies of No Secrets were available. The home have their own policies and procedures in place relating to safeguarding vulnerable adults. Some people living at Silvanna Court can be challenging in their behaviours. We saw that care plans reflected these needs and that behaviours were monitored to try and Care Homes for Older People Page 19 of 31 Evidence: establish any patterns. During the day staff reacted appropriately to peoples behaviours and provided gentle encouragement and support. Although the training matrix available did not show that training in this area had been undertaken the manager confirmed that in house training had taken place. They said that more was planned to be delivered by a senior person in the organisation. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and well maintained home. Evidence: Silvanna Court is a purpose built home that has been open since 2007. It provides people with a spacious and well maintained environment. A handy person is employed to ensure that minor repairs and decorations are dealt with in a timely manner. There is an ongoing programme of redecoration and renewal. For example the manager told us that it was currently planned to replace some of the chairs in the home and redecorate the lobby area. People have pleasant rooms which they are able to personalise to their own taste. All rooms are single and have an en-suite facility. Accommodation is provided over three floors with a number of lounge/dining areas available. The home are currently working to make corridor and lounge areas more interesting, and hope to provide tactile and other features to provide interest and stimulation for people who have dementia. There are a range of assisted bath/shower facilities avaialble to meet peoples needs. Staff at the home are currently working to make these areas bright and interesting for residents. Equipment such as hoists are provided to meet residents needs. The home is large and had been divided up into units with flower names to make it feel smaller and more homely. However this is not really noticeable, the names are Care Homes for Older People Page 21 of 31 Evidence: not commonly used, and signage does not make it obvious what unit you are entering. The manager hopes to address this. Minutes of a recent staff meeting said, We are no longer describing the home as top, middle and bottom. All the units have names and we will be decorating the units to encompass these names and make it less impersonal. On the day of the site visit there were isolated areas of odour that persisted past the morning routines and cleaning. These seemed to relate to specific individual needs. The manager said that staff are encouraged to flag up any rooms where carpets need cleaning so that this is attended to. Minutes of a domestic staff meeting in February indicated that odour control and inadequate cleaning routines had been an issue that the new manager is addressing. An evening domestic had been appointed as part of this process to provide cleaning availability across the day. In spite of difficulties people told us that they are happy with this aspect of the home. They felt that the home was always kept clean and said, The residents rooms are always kept clean and tidy, and, The cleaning is very good. The home has a suitable laundry area. The person working in there confirmed that they had received training but could not confirm that this included infection control training. They did however have an awareness of appropriate procedures. We saw that there was information available relating to infection control, and observed good staff practice during the day. However the training matrix available did not include infection control training. The manager confirmed that this was due to take place in April this year. 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. People are supported for by caring and well trained staff. Evidence: We received positive comments about staff working at Silvanna Court. People said, The staff are very friendly kind and caring, and, The staff are very friendly and helpful. Surveys, discussion and observation showed that staff are positive about their role. The home has been through an unsettled period with changes in management. Staff turnover at the home has been quite high with 21 staff having left over the last year. This has not helped to provide people with consistent care from people that they know. However the manager said that the home is now fully recruited to and agency staff are not used. This was confirmed by the AQAA which indicated that no agency staff had been used in the home for the previous three months. On the day of inspection eighty people were being accommodated. Different staffing levels are maintained on each floor. The second floor have three care staff and a Care Team Manager (CTM) during the day. The first floor a CTM with five care staff during the morning and four in the afternoon/evening. One the ground floor a CTM and four care staff are on duty during the day. To cover the home at night there are six care staff and one CTM. Rotas sampled indicated that these levels are maintained. The managers hours are supernumerary, and the deputy manager also has some supernumerary time to complete monitoring and supervising tasks. Additional staff are Care Homes for Older People Page 23 of 31 Evidence: provided for administrative, domestic, laundry, catering, maintenance and residents activities. During the site visit there were generally staff around in the communal areas to monitor, interact with, and assist people. When we used a call bell on two occasions to gain assistance for a resident this was responded to reasonably promptly. People spoken with felt that staffing was usually sufficient to meet their needs. Two people on surveys however said, In order that residents can always be supervised, I believe that one extra member of staff on each floor would ensure that the service would be delivered better as the residents are going to be needing greater care as their symptoms progress, and, If there were more staff they would have more time to give individual attention to the residents. Staff and management spoken with said that they felt staffing levels were adequate to meet peoples current level of needs. We did however discuss with the manager that the system used to determine residents level of needs and consequently staffing levels was flawed. The system does not take into sufficient account the needs presented by peoples level of dementia or behavioural needs. The manager agreed to look into this. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the AQAA and discussed at the site visit indicated that out of 50 care staff ten currently hold an NVQ. The manager confirmed that all senior staff have recently been signed up to commence their NVQ at level three. Care staff will soon be starting NVQs at level two. The previous inspection found that recruitment procedures and practice at Silvanna Court were satisfactory and protected residents. We looked at the files of two members of staff who had been most recently started work at Silvanna Court to ensure that good practice was being maintained. Staff files were well organised so it was easy to find the information we needed. We saw that all proper checks had been undertaken. Independent Safeguards Authority (ISA) first, and Criminal Records Bureau checks had been undertaken, references taken up and proof of identification sought. We pointed out to the manager that one persons references had not been entirely satisfactory, and that gaps in employment history were not fully documented. However explanations given were sufficient to establish that good recruitment practice that protects residents is continuing. A fairly new member of staff spoken with said that their induction had been very good and that all management and staff had been extremely supportive. However, there was no evidence in staff files that a robust initial induction had taken place. We could see that some core training had been undertaken, and that one person had signed for the receipt of their Skills for Care Common Induction Standards workbook. The Care Homes for Older People Page 24 of 31 Evidence: manager said that the induction paperwork might still be on the units having been completed with the member of staff by the CTM, even when they had started some time ago. Following the inspection the manager confirmed that all induction records had been collected from the units and were now in place on peoples individual files. In discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. Staff records sampled and a training matrix viewed indicated that staff have undertaken a basic range of training including dementia care. From information given the training course for dementia care lasts for two and a half hours. Given our observations on the day of peoples dementia care needs, this basic level of training may not be sufficient to give staff the skills that they need. More in depth training should be looked at. The manager confirmed that further dementia training will be delivered in time through the organisation, and that external courses are also being looked at. Care Homes for Older People Page 25 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 live in a safe and well managed home. Evidence: The new manager at Silvanna Court has been in post for about three months. They are experienced and have appropriate qualifications. The manager is in the process of registering with us (CQC) and is awaiting their fit persons interview. The manager is supported by the deputy manager and CTM team. People made positive comments about the management of the home and felt that they were friendly and approachable. One person said, The new manager is approachable; seems very competent and experienced and explained their vision/ethos they wished to create at a meeting with relatives in February. I felt assured that their wish was to manage the home in the best interests of the residents. Another person said, The new manager seems good, and I think things are changing for the better. Information received about the service since the previous inspection, discussion and information viewed at this inspection indicated that the home has been through an Care Homes for Older People Page 26 of 31 Evidence: unsettled period where standards of service and staff morale had dropped. However the provider had recognised this and taken steps to address the situation. Although there is still work to do in bedding down new practices and maintaining good care, the home now seems to be making good progress again. Information viewed showed that many areas of improvement are being worked on to improve the experience of residents and their families. When we visited the home was well organised, and most of the information needed to undertake the inspection was readily available. Discussion and information viewed at this inspection showed that the manager is aware of things happening in the home and proactive in dealing with issues when they arise. The provider has strategies in place to ensure that the quality of the service is kept under review and that people have the opportunity to express their views about the service. We saw that regular staff meetings for all designations take place. One relatives meeting has been held and further meetings are planned. The manager said that residents meetings have not been held as it is difficult to get people interested. They felt that a one to one approach worked better. Suggestions boxes are available and staff are also encouraged to express their views and contribute to making the service better. The provider undertakes regular quality reviews of the service. A full quality audit was last undertaken at Silvanna Court in November last year. Surveys were sent out as part of this process. The audit was very thorough and raised many issues that needed to be addressed. The manager said that the agenda for action produced has been worked through and will soon be fully addressed. Regular monthly visits are required by Regulation to be undertaken by a senior person in the organisation. We saw that these are robust in their approach and carried out regularly. These visits include talking to people about the service. Directors of the Company also now carry out unannounced visits to monitor the service and produce a report from this. Internal strategies are in place to monitor the service such as monthly health and safety audits, medication audits and floor audits. The AQAA was completed by the manager. The AQAA was adequately completed and showed us that management know what they need to do better, and how they can continue to improve the service for the benefit of residents. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Care Homes for Older People Page 27 of 31 Evidence: Monies checked were correct, with receipts in place for all transactions. Monies are regularly audited by the Company. The AQAA completed identified that systems and services within the home are monitored and maintained. A partial tour of the premises showed that the home seemed well organised and safe. A local fire risk assessment was seen to be in place. Fire records were maintained. Systems are tested weekly, and fire drills are carried out to ensure that staff know what to do in an emergency. We could not tell when the fire service had last visited the premises to assess the homes compliance with fire regulations. We saw that they planned to visit the home in November 2008, but no other records were available. The home has not been visited by environmental health officers since they opened. However the homes kitchen won the Companys Kitchen of The Year Award for 2009 to recognise what good standards they maintain. Training records showed that staff are kept up to date in core areas such as moving and handling, health and safety. Where shortfalls were identified on the training matrix we saw that dates were booked to address this. A number of staff have yet to undertake training in food hygiene, but no dates were identified. Following the inspection the manager confirmed that training in this area was booked for April. Care Homes for Older People Page 28 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 29 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 Care Homes for Older People Page 30 of 31 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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