Care Home: Silver Court

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What the care home does well People who are considering moving into this home have their needs assessed before they decide if it the right place for them. This means the home is aware of new residents needs before they move in and can take any necessary action to ensure they can meet individuals’ needs. One new resident confirmed their satisfaction with the home. They told us, “It’s very nice, not the same as home, but staff are lovely and my room is lovely”. Residents have access to community based health professionals as required such as district nurses, doctors and chiropodists. This helps residents maintain good health. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 All the female residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. One resident that we spoke to confirmed their satisfaction with the support they receive with regards to personal care. They informed us, “Staff member X is lovely. Asked how I am, I said I don’t like this blue top, want green so he sorted”. Residents can participate in a range of activities if they wish. During our visit people within the dementia units were observed participating in a number of activities including preparing vegetables, washing crockery, looking at photographs and listening to music. Visitors are made to feel very welcome in the home. The home provides well balanced and healthy meals. Comments that residents made regarding meals varied. These include ‘meals are nice’ ‘it’s not warm enough’ and ‘meals lovely’. Residents can access an outside area where vegetables are grown and chickens reared. One resident was seen feeding the chickens and appeared to enjoy this activity. Residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. Each room has been equipped with an en-suite shower/WC. All residents that we spoke with expressed satisfaction with their rooms. As one person explained, “my bathroom is nice and big, makes it easy to get in and out”. All residents that we spoke with praised the staff working at the home. Comments include ‘staff very good, excellent’ and ‘very friendly, hospitable’ Staff are not allowed to work at the home unless all the required recruitment checks have been undertaken. This helps ensure residents are supported by staff who are will not harm them. Checks on services and equipment are undertaken within recommended timescales. This promotes residents safety. What has improved since the last inspection? Improved monitoring of medication systems and further training for staff has been provided. This helps ensure safe medication practices are applied. The overall outcome of a safeguarding investigation was that the allegations were not substantiated but that control measures to improve service should be put in place. As a result the home has implemented an action plan that is currently being implemented. This should offer greater protection to residents. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Improvements that have been made to the environment include all communal areas being decorated using a `dementia colour pallet` which aids in resident orientation and navigation. Also a new fire alarm system has been fitted and new carpets provided in the lounge, dining room, reception, entrance and offices. During our visit to the home the registered manager informed us that the numbers of staff having either completed or in the process of undertaking a NVQ has increased to 89% and the majority of staff have received training in areas including fire, first aid, health and safety, safeguarding, infection control and dementia. This means greater numbers of staff have been provided with the knowledge to support and care for residents. What the care home could do better: Care plans and documentation for assessing residents at risk of falls must be reviewed and amended regularly to reflect the changing needs of individuals. This must happen so that residents’ needs are met consistently and safely by staff. Some residents did not know what meals were available on the day of our visit or how to raise concerns if unhappy with a service provided by the home. For example one resident said, “don’t know” when asked what was on the menu and another “not sure”. Consideration could be given to the displaying of menus and the complaint procedure to aid communication. Key inspection report CARE HOMES FOR OLDER PEOPLE Silver Court Halsford Park Halsford Lane East Grinstead West Sussex RH19 1PD Lead Inspector Lesley Webb Key Unannounced Inspection 10th June 2009 10:00 DS0000014716.V375780.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Court Address Halsford Park Halsford Lane East Grinstead West Sussex RH19 1PD 01342 321717 01342 321202 soonita.shaw@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Soonita Shaw Care Home 42 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 42. 2. Date of last inspection 23rd June 2008 Brief Description of the Service: Silver Court is a care home, which is registered to accommodate up to fortytwo residents in the category (OP) old age, not falling within any other category. This includes up to twenty-two residents who are over 65 years of age who also have dementia. It provides personal care only. Silver Court is a purpose built single storey building providing single flat let accommodation with ensuite WC and shower facilities to all residents. The accommodation is laid out in four units, three of whom have ten flats whilst the fourth has twelve flats. Each unit also provides a communal lounge and a dining room with a kitchenette. The property is located in a quiet residential area on the outskirts of East Grinstead close to shops and a local post office. Attractive garden and patio areas are also available to residents. The fee levels range from £525.59 to £800.00 per week. Additional charges are made for the following services: chiropody, hairdressing, dentist, optician, telephone, and newspapers. The registered provider is Anchor Trust, who has appointed Mrs Jane Ashcroft to be the Responsible Individual and to supervise the overall management of the care home. The registered manager is Mrs Soonita Shaw who is responsible for the day to day running of Silver Court. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We visited this home on Wednesday 10th June 2009, arriving at 10.00am and staying until 3.30pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The registered manager and deputy assisted us throughout our visit. During our visit to the home we had conversations with eight residents and three care staff. We examined the care records of five residents and recruitment records of three staff. We also looked at other documentation maintained in the home such as health and safety records, monitoring forms for staff training and supervision and complaints. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Prior to our visit the home supplied us with a copy of its Annual Quality Assurance Assessment (AQAA). Over the last twelve months we have also received information from West Sussex Adult Services and the home regarding safeguarding alerts, investigations and outcomes. Information from all of the above sources was assessed and used to help us form judgments on the quality of service provided to residents. The quality rating for this service is 2 Star – Good. What the service does well: People who are considering moving into this home have their needs assessed before they decide if it the right place for them. This means the home is aware of new residents needs before they move in and can take any necessary action to ensure they can meet individuals’ needs. One new resident confirmed their satisfaction with the home. They told us, “It’s very nice, not the same as home, but staff are lovely and my room is lovely”. Residents have access to community based health professionals as required such as district nurses, doctors and chiropodists. This helps residents maintain good health. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 6 All the female residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. One resident that we spoke to confirmed their satisfaction with the support they receive with regards to personal care. They informed us, “Staff member X is lovely. Asked how I am, I said I don’t like this blue top, want green so he sorted”. Residents can participate in a range of activities if they wish. During our visit people within the dementia units were observed participating in a number of activities including preparing vegetables, washing crockery, looking at photographs and listening to music. Visitors are made to feel very welcome in the home. The home provides well balanced and healthy meals. Comments that residents made regarding meals varied. These include ‘meals are nice’ ‘it’s not warm enough’ and ‘meals lovely’. Residents can access an outside area where vegetables are grown and chickens reared. One resident was seen feeding the chickens and appeared to enjoy this activity. Residents are encouraged to furnish their rooms with personal belongings such as furniture and pictures, to make it feel like home. Each room has been equipped with an en-suite shower/WC. All residents that we spoke with expressed satisfaction with their rooms. As one person explained, “my bathroom is nice and big, makes it easy to get in and out”. All residents that we spoke with praised the staff working at the home. Comments include ‘staff very good, excellent’ and ‘very friendly, hospitable’ Staff are not allowed to work at the home unless all the required recruitment checks have been undertaken. This helps ensure residents are supported by staff who are will not harm them. Checks on services and equipment are undertaken within recommended timescales. This promotes residents safety. What has improved since the last inspection? Improved monitoring of medication systems and further training for staff has been provided. This helps ensure safe medication practices are applied. The overall outcome of a safeguarding investigation was that the allegations were not substantiated but that control measures to improve service should be put in place. As a result the home has implemented an action plan that is currently being implemented. This should offer greater protection to residents. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 7 Improvements that have been made to the environment include all communal areas being decorated using a dementia colour pallet which aids in resident orientation and navigation. Also a new fire alarm system has been fitted and new carpets provided in the lounge, dining room, reception, entrance and offices. During our visit to the home the registered manager informed us that the numbers of staff having either completed or in the process of undertaking a NVQ has increased to 89 and the majority of staff have received training in areas including fire, first aid, health and safety, safeguarding, infection control and dementia. This means greater numbers of staff have been provided with the knowledge to support and care for residents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents’ needs are assessed before they move into the home. This means the home is aware of new residents needs before they move in and can take any necessary action to ensure they can meet individuals’ needs. EVIDENCE: Prior to our inspection the home sent us it’s Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states ‘Appropriately trained and skilled staff undertakes the comprehensive needs assessment before admission. The SSP500 -Statement of need from West Sussex carried out by the care manager is used alongside this assessment’. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 10 During our visit to the home we spoke with the registered manager and deputy, both confirming that the practices described in the homes AQAA are always applied. We sampled pre admission documentation for the three newest people to move into the home. The areas covered in the assessment include mobility, daily care, lifestyle, physical health and emotional needs. Care plans are then completed for needs identified through the assessment process. We also spoke with three of the newest residents to move into the home. In the main, all confirmed their satisfaction with the service provided. For example one person explained, “It’s very nice, not the name as home, but staff are lovely and my room is lovely”. Intermediate care is not provided at this home. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place. However these are not always being amended to reflect the changing needs of individuals. This means residents needs might not be met consistently and safely by staff. Residents’ health care needs are being met. Residents are treated with dignity and respect. EVIDENCE: Prior to our visit the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to care planning and health care it states ‘The Service User Plans act as a good working tool for all the care team and enables holistic assessment for that individual. All health care interventions and appointments are recorded. Refferal systems are in place to ensure access to health and social care proffessionals e.g nursing needs assessments or referral to CPN. Any specific areas of health care according to the service users needs are Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 12 developed within the care plan. Improved monthly monitoring of Service user planning and reviewing. Residents needs are clearly outlined in their service user plans. Changing needs are documented, reviewed and monitored. We carry out risk assessments to prevent falls. Local fall awareness team support the home’. We sampled three residents care plans. The care plans sampled were being used in conjunction with other monitoring tools that are used as part of the care planning process for individuals. Care plans were in place for areas including mobility, personal care and behaviour. One resident’s records detail a recent fall and a fractured shoulder. This has resulted in changes to the support they require with personal care. These changes have not been reflected in the persons care plans. A falls risk assessment form was on the same persons file but this was blank as was a Waterlow assessment. Another resident has had a series of falls over two months, with the analysis stating they require hourly checks during the night. Records demonstrate appropriate medical intervention has been sought. The night care plan has not been updated to reflect changes in the support and care needed. This was last reviewed 22.02.09 and still states 2 hourly checks to be undertaken. This person has a falls risk assessment dated 20.10.08. We could find no evidence of this being reviewed after this date. A Form titled ‘alert sheet’ is used as part of the care planning process. At the top of this form staff are instructed ‘please provide details of any changes in care plans and where this is recorded in the service user plan for example see care plan 1,5 and 7. any event or condition you are observing for more than one shift of duty should be transferred to a care plan’. None of the records that we looked at demonstrated that this document is being used in this way. We found that staff are recording specific incidents but that if these continue changes to care plans are not being made. On some occasions it appears that staff are using these forms to record daily events. As at the previous inspection records show that residents have access to community based health professionals as required. For example visits by professionals such as district nurses where appropriate, G.P, chiropodist are noted and any advice or treatment recorded. All the female residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. Some were seen to be wearing make up and jewellery and many had their hair styled. Three of the four male residents that we met did not appear to have shaved and their clothing was stained. We talked to the registered manager about this who said she would look into. One resident that we spoke to confirmed their satisfaction with the support they receive with regards to personal care. They informed us, “Staff Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 13 member X is lovely. Asked how I am, I said I don’t like this blue top, want green so he sorted”. Staff were observed speaking and assisting residents with dignity and respect. We had seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. Risk management forms part of the care planning system that is in place. This includes assessment of mobility, pressure care and nutrition. As mentioned above, assessment of falls is not always being undertaken on a regular basis for residents who have been identified as being at risk. With regard to medication the home AQAA states ‘There is an extensive policy and procedure in place for medication. An assessment process including a risk assessment is in place to enable those who wish to self medicate. locked storage facilities are provided to residents who wish to self administer. Controlled drugs are kept in line with national legislation. We have audit programme for all aspects of medication storage and administration. Extensive training programme for administration of medication. We use our competency assessments training format. Boots pharmacy deliver, monitor and provide training in all areas of medications’. During the past twelve months the home informed us of two medication errors that have occurred. One relating to storage and another to administration. At our visit to the home the registered manager informed us of actions that have been taken as a result. These include improved monitoring of systems and further training for staff. At lunch time we indirectly observed a team leader administering medication. We saw that residents were given their medication before the team member signed to say it had been administered and that residents were offered a drink to aid swallowing. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can participate in a range of activities if they wish. Visitors are made to feel very welcome in the home. Residents are able to make choices and decisions about their lives. The home provides well balanced and healthy meals. Staff would benefit from further guidance with regards to meal times to ensure all residents enjoy this time of day. EVIDENCE: With regard to lifestyle choices the homes AQAA states ‘Social interaction/activities are service user specific and outlined in the Service User Plans as well as the homes programme. The pace of the day is set by the residents. We provide a holistic therapist who visits the home to provide aromatherapy treatment to some of our residents. We also have outside entertainers who visits the home to sing along with their musical instruments. A hairdresser attends twice weekly. We have a pat dog who visits on a fortnightly basis. Outings to a chosen destination by the residents in the local Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 15 or surrounding communities. This is in direct consultation with the residents wishes and preferences - Residents visit places of interests such as Wakehurst place, Snowhill garden centre, Tulleys and Godstone farm. We have a weekly, monthly and annual activity planner for residents who wish to take part as a group. Person centred activites are held with individual residents using the CLIPPER questionnaires. A variety of facilities are available within the home for flexible use, such as the mobile library, shop and magazines. Community participation is activly encouraged with local schools participating in carol concerts and harvest festivals. Some residents attend the local day centres on a regular basis and enjoy community outings with them. We are within a short walking distance to the town centre and regular shopping trips are arranged for those who need assistance. Local churches provide services within the home that residents can choose to attend or if they prefer they can travel to the services held at the local churches’. During our visit we spoke with residents, examined records and undertook observations, all of which confirmed the above information to be accurate. For example the home consists of four units, two of which are specifically for people with dementia and two that mainly consist of older persons without dementia. During our visit people within the dementia units were observed participating in a number of activities including preparing vegetables, washing crockery, looking at photographs and listening to music. Residents can also access an outside area where vegetables are grown and chickens reared. One resident was seen feeding the chickens and appeared to enjoy this activity. Residents on the residential unit were not seen participating in any activities. The deputy informed us that the majority of residents on these units prefer to spend time in their rooms. On the afternoon of our visit a ‘pat dog’ was seen in the home. The homes AQAA informs us that this activity is arranged on a fortnightly basis. Activities are displayed on community notice boards. The home also publishes a monthly newsletter, which outlines forthcoming events within the home. We noted that the notice boards do not include timetables for events. The deputy manager informed us that the activities co-ordinator was currently off work and that the timetable was going to be emailed to the home in order that it can be displayed. Discussions with residents confirm that they can choose what they want to do as far as social events and also what times they go to bed and get up in the morning. In addition residents and relatives meetings are held that give people the opportunity to comment on how they view the home and contribute to decision-making. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 16 The home operates an open visiting policy that supports residents to maintain family contact. A relative we spoke with confirmed that the visiting arrangements for the home are open and visitors can come and go as they please and are made welcome by the staff. During our visit we sat with residents for lunch. The atmosphere was relaxed and informal, with some residents expressing satisfaction with the meal of potato soup, fish, salad, sandwiches and a choice of home made cakes provided. Residents were offered a choice of juices and hot drinks during and after the meal. We did observe that some residents had to wait twenty minutes for their lunch to be served and others had to request cutlery and condiments as these had not been provided. Three members of staff were available to assist with lunch. One care assistant was observed washing up in the kitchen area and another coming and going out of rooms taking trays to residents who were eating in other areas of the home. We discussed our observations with the registered manager who agreed staff need further instructions with regards to planning and supporting people during meal times. Comments that residents made regarding meals varied. These include ‘meals are nice’ ‘it’s not warm enough’ and ‘meals lovely’. Two residents that we talked to did not know what meal options were available for that day. We observed that the menu was on display. This is produced in a small font size. We discussed this with the registered manager who agreed it would aid communication to produce it in a larger print size. One resident expressed a wish to have milky drinks after supper. The deputy informed this person these are available on request. The resident informed us that not all staff offer these. We discussed this with the registered manager who agreed to discuss this with staff. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main residents are able to express their concerns and have access to an effective complaints procedure. Safeguarding procedures are in place that offer protection to residents. EVIDENCE: With regard to complaints and protection the homes AQAA states ‘Complaints and feedback is actively welcomed,as a mechanism to improve best care practice and make things right. Complaint process is in place( Anchor & CSCI now CQC ) are documented in statement of purpose,notice boards,service user guide & leaflets. Report all complaints, however small or large. Deal with complaints within allowed timescales 28 days, in a proactive and sentitive manner and put action plans in place to rectify any issues. Confidential whistle blowing line on display. Documentation process for all complaints and fixed response times with action taken. Clear guidelines of responsibility and escalation. Safeguarding Adults process is in place outlined in our policy. This is available to all staff and visitors. Safeguarding training for all staff. Both the safeguarding policy and care alert line are displayed in the communal areas’. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 18 In the main, during our visit to the home we found the above information to be accurate. For example the deputy directed us to leaflets at the entrance of the home that inform people how to complain and the homes complaints records that we viewed demonstrate that these have been investigated and responded to appropriately. The complaints records that we viewed did not include the two complaints that we found recorded in the residents’ files we had examined earlier. We talked to the registered manager regarding this. She expressed the view that staff require further guidance with regards to reporting and recording. We did note that the complaints procedure was not displayed on notice boards throughout the home as indicated in the AQAA. The registered manager informed us this would be addressed. We also talked to the registered manager about producing the procedure in large print as an aid to communication for people with dementia as two residents that we spoke with said they did not know what or who to speak to if they wished to make a complaint. She agreed to explore this further. Records confirm that that most staff working at the home have undertaken Protection of Vulnerable Adults training. A copy of West Sussex safeguarding adult policy was seen on display in the registered manager’s office. The AQAA informs us that four safeguarding referrals and investigations have been undertaken in the last twelve months. This information does not correspond with information obtained by the commission. During our visit to the home we discussed this with the registered manager and deputy who confirmed this information was not accurate. There have been a total of twelve safeguarding referrals. Four of these were looked at together, at the highest level (4) of West Sussex safeguarding adult’s investigations. The overall outcome of the investigation was that the allegations were not substantiated but that control measures to improve service should be put in place. As a result the home has implemented an action plan. Evidence from our inspection confirms that all of the agreed actions apart from one (care planning) have been completed. Work has started to improve care planning documentation but further work is still required (see the care planning section of this report for further details). Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. EVIDENCE: We looked around some of the home and we were able to see communal areas such as dining rooms and lounges. The communal areas are clean and furnished in a homely fashion with plenty of suitable chairs for residents. Seating is arranged in small group settings to promote a non-institutional environment. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 20 The building has been divided into four units to aid orientation for people. There are small kitchen areas within each that residents are not restricted from using. These help promote independence for people. A call bell system is provided in every room so staff can attend an emergency situation swiftly, should it arise. We also viewed four residents’ bedrooms. Residents are encouraged to furnish their rooms with personal belongings such as pictures and ornaments. In addition residents can bring larger items including their own beds, wardrobes and items of furniture such as wall units. This helps create a feeling of home. Each room has been equipped with an en-suite shower/WC that are larger than what are recommended in the National Minimum Standards for Older People. All residents that we spoke with expressed satisfaction with their rooms. As one person explained, “my bathroom is nice and big, makes it easy to get in and out”. Residents that we spoke to also confirmed their views are sought with regard to decoration of the home. One person informed us that new curtains have been purchased for all bedrooms but they do not have to have these. If they prefer they can keep the ones in place or use their own. The AQAA informs us of improvements that have been made to the environment. These being ‘New décor in all communal areas. It was selected from the dementia colour pallet which aids in resident orientation and navigation. New fire alarm systems throughout the home. New carpets in the lounge, dining room, reception, entrance and offices. NHS and Anchor Trust hand washing posters in communal bathrooms and toilets. Infection control audits in place. Promoted effective hand washing. No smoking policy implemented– internal and external. We did observe that residents’ individual bedroom doors are not easily identifiable. The deputy informed us that this is being addressed and that ‘memory boxes’ are being implemented to aid orientation for people with dementia. The garden is accessible to people who use wheelchairs. This includes a vegetable plot, green house and chicken pen; all of which have been designed to support and encourage residents to use. The home was seen to be very clean throughout, with no offensive odours. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are in sufficient numbers and are suitably qualified to meet residents’ needs. Recruitment practices promote residents safety. EVIDENCE: The registered manager informed us that seven care staff and a team leader are deployed on the morning and afternoon shifts. During the night there are three staff, one of whom is a team leader. In addition auxiliary staff including housekeepers, laundry, catering and maintenance staff are employed. We spoke with three care staff and indirectly observed care practices. In the main staff demonstrated understanding of their roles and responsibilities. For example residents with dementia were given encouragement and support to undertake activities and staff were heard to talk in a manor and pace that aided communication. One member of staff informed us that they found it difficult to communicate with a resident as they could not understand what they said. We informed the registered manager of this who agreed to talk to the individual concerned. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 22 As mentioned earlier in the lifestyle section of this report some staff need further guidance with regards to mealtimes. All residents that we spoke with praised the staff working at the home. Comments include ‘staff very good, excellent’ and ‘very friendly, hospitable’. With regard to recruitment the homes AQAA states ‘People have confidence that their needs will be met by a staff team who are checked and suitably trained. We operate an equal opportunities policy and recruit staff from all cultures and backgrounds. HR and recruitment policies in place supported with newly established recruitment team and manual’. Evidence found during our visit substantiates this information. For example we examined the recruitment records of the three newest staff to commence employment at the home. All contained the required documentation including two references and evidence of Criminal Records Bureau (CRB) disclosures. The homes AQAA informs us that ‘58 of staff hold a National Vocational Qualification (NVQ) and that all staff complete induction training. During our visit to the home the registered manager informed us that the numbers of staff having either completed or in the process of undertaking a NVQ has increased to 89 . The majority of staff have received training in areas including fire, first aid, health and safety, safeguarding, infection control and dementia. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home promotes residents best interests. Monitoring systems promote the health and welfare of individuals. Staff are supported to fulfil their roles and responsibilities. EVIDENCE: With regard to management of the home the homes AQAA states ‘Management team are supportive of activity and service progression. Approachable and proactive with dealing with staff requests and responses. Registered Home Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 24 Manager has a postgraduate Diploma in Health and Social Services Management, Registered Manager’s Award, NVQ Assessors Award, NVQ Verifier’s Award. The Deputy Manager has Registered Manager’s Award and NVQ Assessors Award. Ongoing training and development programmes for the Registered Home Manager, Deputy Manager and all staff employed within the home’. Both the registered manager and deputy were present during our visit to the home and demonstrated knowledge appropriate for their roles and responsibilities. There are a number of quality monitoring tools in place at the home. These include internal health and safety audits, residents and relatives’ questionnaires and meetings for residents, relatives and staff. The home sent us its AQAA when requested. The contents of this are detailed, informative and demonstrate quality monitoring and reviews undertaken by the home. We viewed the finding of the residents and relatives questionnaires for August 2008. We discussed with how the home evidences actions taken as a result of the findings with the registered manager and deputy. We were informed that these could be evidenced in by reading staff meeting minutes and individual residents’ files. The staff meeting minutes did evidence action taken but the deputy could not locate evidence in the residents’ files she examined. There was some confusion between the registered manager and deputy when we asked if the views of outside agencies such as General Practitioners, Social Workers or District Nurses are obtained in the form of surveys. Evidence could not be produced to confirm these are obtained. The registered manager agreed it would be beneficial to quality monitoring and to enhance communication with outside agencies if these were implemented. The registered manager informed us that the home does not manage the finances of anyone living there. Staff receive individual support to discuss their roles in the form of one to one supervision. The registered manager informed us that in addition to this all staff are due to undertake an annual appraisal. Information within the homes AQAA states that checks on services and equipment have been undertaken within recommended timescales. We sampled a number of health and safety records, finding all to be in good order and up to date. Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure care plans are reviewed and amended when residents care needs change. Timescale for action 08/07/09 2. OP7 13(4) This must happen in order that residents receive the support they need consistently and safely. The registered person must 08/07/09 ensure that falls assessments are completed and reviewed on a regular basis for residents who have been identified at risk. This must happen in order that risks to residents are minimised where possible. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 27 Silver Court DS0000014716.V375780.R01.S.doc Version 5.2 Page 28 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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