Care Home: Silverdale Nursing Home

What the care home does well A small nursing home, providing specialist care for people with dementia care needs. Being small, personal relationships are easily and positively established between people living there, staff and relatives. The Provider also has a daily presence in the home and closely monitors all aspects of care closely. He is known to - and easily accessed by people living in the home, their relatives, staff and visitors. The importance of contacts with relatives are considered a vital integral part of the care provided for people. Their view are sought individually by means of daily contacts and also with quality assurance questionnaires. Relatives meetings also provide a forum for feedback about the service. Relatives are invited to all events in the home and all have a monthly Newsletter to update them on the progress and changes being made at Silverdale. High dependency health care needs of individuals are known with good plans in place to support them and ensure their well being. There are positive relations with external health care professionals and swift referrals if there are concerns about specific health needs or deterioration in health. Recording in this areas has also improved. The deteriorating physical health of many people is monitored closely. What has improved since the last inspection? All people funding their own care are now provided with contracts, clearly stating the terms and conditions of residence. This provides people with the same information and contract terms as those receiving funding from sponsoring Local Authorities. Care plans have continued to be updated on the new care planning information format and also include social histories. This ensures that people needs are known and the actions that need to be taken by staff to meet those needs. Social histories provide a basis for ongoing help, support, discussion and engagement with people using the service. Risk assessments are now reviewed following falls. All risk assessments seen had been reviewed on a monthly basis as part of the care planning review process in place. Records relating to regular turning of people with, or at risk of pressure damage, were examined and records clearly showed the required actions being taken. This has improved since the last inspection. There has also been an improvement in the recording of pressure damage and the treatment regimes in place. Body maps now clearly define areas of damage and wounds are graded in accordance with required professionals standards to accurately record and monitor treatment and progress. A sample of hot water outlets were tested and were within the safe range of 43C. Weekly checks of hot water outlets now takes place with recorded temperatures identifying any risks.A requirement to provide catering facilities to support care staff at peak times has been implemented. A member of catering staff now works 8-11 am and 4-6 pm relieving care staff of the pressure of preparing meals so that they can continue to support the personal needs of people. This member of staff was also seen assisting with feeding those unable to do so themselves. More than half of the people resident need some assistance with eating. This promotes good nutritional care, a vital component of good tissue viability care. Areas of staff training shortfalls identified in the last report have been addressed. There has been training in Food Hygiene, Health & Safety, Moving and Handling and first aid. In addition other training has been provided and some courses arranged in the weeks following this inspection. There is a staff training matrix and the statutory training needs and appropriate updated training is evidenced. The home has established a comprehensive training and re-training programme with a new training provider. This proved positive in plugging gaps in some areas of training. The need to improve quality assurance of the service has been addressed with questionnaires to relatives that are intended to be ongoing and the re-establishing relatives meetings. The provider needs to extend the Quality Assurance process to include external stakeholders. Considerable further work has been completed on the internal part of the building since the last inspection. New ceiling and lighting has been provided in all areas, including corridor, bedroom and all communal areas. All bedrooms, bathrooms and toilet areas have been fitted with new vanity units with mixer taps. Corridor areas have been redecorated and new carpets provided. All bedrooms have now been upgraded, are well presented with good quality furniture and soft furnishings that are colourcoordinated. A new sensory room and jaccuzi-spa bathroom have been provided. This completes the total refurbishment of all parts of the building internally. What the care home could do better: The stock of creams provided in the medication store should be reviewed and those without labels or clear instructions should be removed. People with fluid intake charts should be offered drinks when they are turned or awake during the night. This will maximise fluid intake and improve their well being. Pressure relieving equipment identified in risk assessments to reduce the risks of damage, must be in place at all times. Arrangements for NHS chiropody care should be reviewed to ensure people receive the regular treatment they need to maintain good foot care. Privacy screens must be available at all times in shared bedrooms to ensure complete privacy and dignity for people being given personal care. It is important to check with the PCT and GP to ensure that DNAR decisions are recorded on the correct forms, otherwise hospital and paramedic staff may not be able to comply with peoples prior-decisions. Key inspection report Care homes for older people Name: Address: Silverdale Nursing Home Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ     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: Peter Dawson     Date: 0 4 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Silverdale Nursing Home Newcastle Street Silverdale Newcastle Staffordshire ST5 6PQ 01782717204 01782717204 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Silverdale Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 27. The Registered Person may provide personal care (including nursing) and accommodation for service users of both sexes whose primary care needs are on admission to the home are within the following categories: - Dementia Elderly not falling into any other category (DE(E) 27) - Mental Disorder Elderly not falling into any other category (MD(E) 27) Date of last inspection Brief description of the care home Silverdale Nursing Home provides nursing care for up to twenty-seven older people, both male and female, requiring long stay, short stay and respite care. It provides a specialist service to people with dementia and other mental health needs. The home is Care Homes for Older People Page 4 of 30 Over 65 27 27 0 0 Brief description of the care home situated in the residential area of Silverdale and is approximately two miles from Newcastle town centre and easily accessed by public transport. There are local amenities in Silverdale village within walking distance of the home. The home provides single storey accommodation and has single and shared rooms. The majority are single rooms and some of them have en-suite facilities. All parts of the communal areas and all bedroom areas have been upgraded to a high standard and provide improved accommodation and facilities. A visual/audio therapy room has recently been added and also a jaccuzei-spa room. These facilities provide a relaxing, therepeutic environment for people in the various stages of dementia care need. There is a small private garden/patio area where people can sit or wander safely and is easily accessed from the lounge area. There are small car parking areas to the front and rear of the home. An extension is planned but meanwhile the external presentation of the building is poor and belies the high standard internal environment. The home provides a good standard of nursing and care for people with dementia and is based upon individual needs. Current fees are in the range of 342 - 600 pounds per week depending upon the level of care needed. No additional top-up to the fee is requested. Care Homes for Older People Page 5 of 30 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 service was last inspected on 2th May 2008 and was rated a 1 Star Adequate service. This key unannounced inspection was carried out on one day by one inspector from 08:30 - 18:00. The provider completed and AQAA (Annual Quality Assurance Assessment) and returned it to us by the required date prior to the inspection. This is a legally required self-assessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. Some information from the AQAA is included in this report. We were not able to obtain written feedback from people using the service and their Care Homes for Older People Page 6 of 30 relative prior to this visit, however 3 visitors were seen and spoken with. They all expressed satisfaction with the care provided at Silverdale Nursing Home and gave examples to support their views. They made positive comments about the vast improvements made to the environment, including the past year when an audio/visual sensory room has been added and also a new spa bath. Very positive comments were made about the excellent staff providing support to a fairly highly dependent group of people. All the communal areas and a sample of bedrooms were seen during this inspection. Standards of hygiene were high, bedrooms have all been upgraded and were well personalised. The inspection was carried out with the Provider, Mr Malik. Three Acting Managers have been appointed over the past 2 years and proved unsuccessful appointments. The Provider was able to give us all the information and detail we needed about the running of the home, people living there and their needs. Records seen included: care plans, risk assessments, staff rotas and records, medication records, financial records and other documents and information needed to complete the inspection . All people resident at Silverdale Nursing Home were seen and many spoken with both separately and some with staff present. Three visitors were spoken with privately. Staff on duty were also spoken with including the nurse on duty, carers, activity coordinator and catering staff. There were 24 people living at the home at the time of this inspection. Observations indicated positive engagements between people using the service and the staff group. Many examples were seen of sensitive, reassuring and relaxed approaches by staff to the people using the service. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? All people funding their own care are now provided with contracts, clearly stating the terms and conditions of residence. This provides people with the same information and contract terms as those receiving funding from sponsoring Local Authorities. Care plans have continued to be updated on the new care planning information format and also include social histories. This ensures that people needs are known and the actions that need to be taken by staff to meet those needs. Social histories provide a basis for ongoing help, support, discussion and engagement with people using the service. Risk assessments are now reviewed following falls. All risk assessments seen had been reviewed on a monthly basis as part of the care planning review process in place. Records relating to regular turning of people with, or at risk of pressure damage, were examined and records clearly showed the required actions being taken. This has improved since the last inspection. There has also been an improvement in the recording of pressure damage and the treatment regimes in place. Body maps now clearly define areas of damage and wounds are graded in accordance with required professionals standards to accurately record and monitor treatment and progress. A sample of hot water outlets were tested and were within the safe range of 43C. Weekly checks of hot water outlets now takes place with recorded temperatures identifying any risks. Care Homes for Older People Page 8 of 30 A requirement to provide catering facilities to support care staff at peak times has been implemented. A member of catering staff now works 8-11 am and 4-6 pm relieving care staff of the pressure of preparing meals so that they can continue to support the personal needs of people. This member of staff was also seen assisting with feeding those unable to do so themselves. More than half of the people resident need some assistance with eating. This promotes good nutritional care, a vital component of good tissue viability care. Areas of staff training shortfalls identified in the last report have been addressed. There has been training in Food Hygiene, Health & Safety, Moving and Handling and first aid. In addition other training has been provided and some courses arranged in the weeks following this inspection. There is a staff training matrix and the statutory training needs and appropriate updated training is evidenced. The home has established a comprehensive training and re-training programme with a new training provider. This proved positive in plugging gaps in some areas of training. The need to improve quality assurance of the service has been addressed with questionnaires to relatives that are intended to be ongoing and the re-establishing relatives meetings. The provider needs to extend the Quality Assurance process to include external stakeholders. Considerable further work has been completed on the internal part of the building since the last inspection. New ceiling and lighting has been provided in all areas, including corridor, bedroom and all communal areas. All bedrooms, bathrooms and toilet areas have been fitted with new vanity units with mixer taps. Corridor areas have been redecorated and new carpets provided. All bedrooms have now been upgraded, are well presented with good quality furniture and soft furnishings that are colourcoordinated. A new sensory room and jaccuzi-spa bathroom have been provided. This completes the total refurbishment of all parts of the building internally. What they could do better: The stock of creams provided in the medication store should be reviewed and those without labels or clear instructions should be removed. People with fluid intake charts should be offered drinks when they are turned or awake during the night. This will maximise fluid intake and improve their well being. Pressure relieving equipment identified in risk assessments to reduce the risks of damage, must be in place at all times. Arrangements for NHS chiropody care should be reviewed to ensure people receive the regular treatment they need to maintain good foot care. Privacy screens must be available at all times in shared bedrooms to ensure complete privacy and dignity for people being given personal care. It is important to check with the PCT and GP to ensure that DNAR decisions are recorded on the correct forms, otherwise hospital and paramedic staff may not be able to comply with peoples prior-decisions. Care Homes for Older People Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 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. Pre-admission procedures and assessments ensures people have adequate information to make a judgment about the suitability of the home before they live there. Evidence: Since the last key inspection information in the Statement of Purpose has been updated and now includes information about the dementia care service provided by the home and the current fees are also included. This ensures people and their families considering living at Silverdale Nursing Home have all the information they need to make a judgment about the suitability of the home. A requirement of the last report to provide written contracts for those financing their own care, has been addressed. We were shown contracts for the 3 people where these were needed and they were satisfactory. It is not always possible or indeed advisable for people to visit the home to assess Care Homes for Older People Page 12 of 30 Evidence: suitability. People are always invited but generally relatives are involved in preadmission visits and negotiations. In the records seen of people recently admitted, there was a pre-admission assessment carried out by the homes staff in the persons current environment and also a multi-disciplinary assessment made available prior to admission by the social worker involved in the admission. Letters confirming that the home were able to meet needs following assessment had been sent prior to admission, to the person or relative. Care Homes for Older People Page 13 of 30 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. Improvements in the recording of information in care plans and daily in daily notes ensure that peoples health and personal care needs are known and met. A safe system of medication is in place. Evidence: At the time of the last inspection 4 Requirements and 2 Recommendations were made in relation to Health and Personal Care. These related to updating care plans, reviewing risk assessments following falls, better recording when people are turned in bed 2 hourly and improved recording of pressure damage care to professional standards. These matters have all been satisfactorily addressed. The remaining care plans have been updated in the new format and social histories obtained. Risk assessments seen had all been reviewed on a monthly basis. Two people needing 2 hourly turns in bed were seen and recording evidenced that the instructions were being followed. Improved recording of pressure damage care was seen with body maps identifying areas of treatment and pressure wounds now graded (Sterling grading) - recording Care Homes for Older People Page 14 of 30 Evidence: and monitoring progress. Two people had nutritional deficits and fluid intake charts established. The objective being to maximise the daily intake of fluid. In both instances there had been recorded inputs throughout the day but overnight (from 8pm - 8am) there had been no fluid input. These people had been turned 2 hourly during the night. A requirement was made in a previous inspection report in relation to this and improvements seen on the last visit. Unfortunately this has not continued and the provider will ensure night staff are instructed to ensure this happens. Care plans seen have been reviewed and updated on to the new care planning format. The Acting Registered Manager at the last inspection had commenced this task but made little progress. This has since been addressed. Many aspects of care planning information were good with nutritional, waterlow moving and handling and falls risk assessments in place and to a good standard. Recording of health care and personal needs showed improvements and were good. Daily records of staff interventions seen had improved in quantity and quality since the last inspection. It was pleasing to see also, that care staff (as well as nursing staff) now record personal care interventions in the daily notes/care planning information. It was noticed that 2 people in chairs in the lounge area were sliding down the chairs to an almost horizontal position. Both had recently been supplied with anti-slip mats that were clearly not improving the situation. A visiting relative of one was concerned to find her mother in a horizontal position upon arrival. It was a busy period and staff had failed to notice this had happened. The provider confirmed that a new reclining chair was on order. This would be pursued to ensure the safety and comfort of the person. The relative concerned was happy with the plan. She did say that apart from this incident, she was highly satisfied with the care her mother receives at Silverdale. The other person in this position did in fact have pressure damage and the provider was asked to check whether the anti-slip mat had pressure relieving properties. This person was not on a pressure relieving cushion. When drawn to their attention staff proceeded to put the cushion in place, although they were unsure how to locate this. It was later confirmed that the staff involved had received moving and handling training in recent weeks. The provider will deal with this issue. Although this persons records showed good waterlow and handling assessments, with a pressure relieving mattress put into place - the assessment did not include the fact that a pressure Care Homes for Older People Page 15 of 30 Evidence: relieving cushion should also be provided, although this was known to staff. It was pleasing to see on this visit that the home had requested and received a visit from the Tissue Viability Team to assess and confirm that the wound care treatment of a person was suitable and effective. A good nutritional plan was in place for this person. Nutritional supplements prescribed by the GP and regular weighing showed that there had actually been a weight gain over recent months. A person with complex diabetic needs was monitored closely with good recording and 4 daily insulin injections given by nursing staff. Her condition is potentially unstable but monitored well with advice from an external diabetic nurse specialist. Inputs from health care professionals were all recorded chronologically and in sufficient detail. Discussion revealed that the NHS chiropody service being provided to the home was poor and generally people were seen up to 6 monthly. All visits are recorded and one showed that the service had not been provided by 10 months. This is clearly unsatisfactory and the home were advised to contact the primary health care team to seek more regular visits. The home appointed a retained GP last year and reported an excellent service with regular visits and reviews of health care and medication. Nursing staff have had training from the Palliative Care Nurse in End of Life Care, implementing aspects of the Liverpool Pathway model of care - to include the person, relatives, GP and other professionals in end of life care to support the homes team of nurses and carers. Recommendations of the last report called for creams to be more clearly recorded and controlled. Examination of the medication system on this visit showed that all prescribed creams are entered on MAR (Medication Administration Records) sheets and their application recorded. Creams are now dated when opened to improve good management in this area. It was noted that 2 tubs of cream in the medication cabinet were unlabelled/undated. They were removed disposed of during the inspection. It was suggested that a check of all current creams in use should be checked. All other aspects of the medication system were satsifactory. There was good recording of the receipt, storage, administration and disposal of medication, ensuring a safe system in place for people in the home. Care Homes for Older People Page 16 of 30 Evidence: A DNAR (Do No Attempt to Resuscitate) election was seen with a persons care plan. This was not on the required red card - prescribed by the PCT (Primary Care Trust). Paramedics and hospital staff will only act if on the prescribed form. It was suggested the provider check with the PCT and discuss with the GP the validity of the document ensuring the persons wishes would be acted upon at the required time. Care Homes for Older People Page 17 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities and facilities put into place ensure that people have the required stimulation and activity to maintain and improve their quality of life. Evidence: The provider has been very keen to extend the activities both inside and outside the home for all people. He does in fact take people out himself, shopping or visiting local facilities. He was hoping that Acting Managers appointed would progress this for him, but has been unsuccessful in being able to appoint a reliable and innovative manager. A lot of progress has been made in this area recently. A new Activities Coordinator with care experience and skills in motivating activity has recently been appointed. She works 25 hours per week over 5 days from 2pm- 7pm. These are key and important times for occupation and activity following the peak personal care activity time for people in the morning. One person was able to show us a completed photograph album of her life. Completed with assistance from family, activities coordinator and herself. She is proud of the results and her relative has praised the effect, saying that her mothers memory has been stimulated and improved as a result of this exercise. This is an example of the progress being made. Social histories, missing previously from care plans, are now completed with/by relatives and provide a basis for stimulation, discussion and promotion of self-awareness. Care Homes for Older People Page 18 of 30 Evidence: There are a range of internal activities, some craft based, others reminiscence or communication based to provide individual stimulation for people. Those unable to communicate or who may have limited skills due to their advanced physical deterioration are provided with 1:1 input including hand-massage or simply time spent talking with them. All activities are recorded in individual records for each person and is impressive. Since the last inspection the home have provided a therapy room with therapeutic lights, sound and slides to stimulate or relax people. This has been successful, not least with a person who shouts constantly throughout the day and who relaxes in the therapy room where he responds positively to the stimulation and his shouting stops. A new jaccuzi bath has been installed in one of the bathrooms, several people enjoy the relaxation and stimulation that also provides. Relatives spoken with said that they were pleased and impressed with the changes made at Silverdale Nursing Home one saying the home have spent money on improving the facilities here, my relative likes the changes and I am pleased with what they have done, it is a credit to them. The AQAA summarises the changes: Where possible we take service users out on shopping trips so they can make their own individual choices. The light therapy room and hydrotherapy suite have been installed for their comfort. The quiet area in reception is an area where service users can relax and enjoy the fish tank and moving photograph display. The beautiful garden area with colourful flowers for service users and their family to enjoy and have afternoon tea at their leisure in the summer months. Involvement of relatives/visitors is an integral part of the philosophy of care of the home. Relatives meetings have been established and there are monthly Newsletters to inform and invite relatives to visit and participate where possible in the care of their relative. There was ample evidence of the considerable progress being made to improve the quality of life for people in this home. Care Homes for Older People Page 19 of 30 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 can be sure that their complaints are listened to and acted upon and high staff awareness of Safeguarding ensures swift investigation of any concerns. Evidence: A suitable complaints procedure is in place. A copy in the home available for people living there and all visitors. There is also a copy in the Statement of Purpose as required. The introduction of relatives meetings provides as an opportunity for feedback and questionnaires now sent to all relatives provides the opportunity for all to express views about the service. No complaints have been received by the home or by us since the last key inspection. There have been no referrals to the Safeguarding Vulnerable Adults team during the past year. Staff training in Safeguarding (Protection of Vulnerable Adults) has been provided with ongoing courses for new staff. Care Homes for Older People Page 20 of 30 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 safe, comfortable, improved environment with good facilities. Evidence: The environment has been vastly improved over the past 2- 3 years. The results are readily seen throughout the home. Since the last inspection all ceilings throughout this single story building have been replaced with new suspended ceilings, to a high specification to meet the fire regulations. New lighting has been installed in all the ceilings giving a softer and more focussed light which is also energy saving. All corridor areas have been repainted and some re carpeted following the changes. A new jaccuzi spa bath has been installed in one of the bathrooms, all have now been upgraded. All bedrooms have new furniture, curtains, bedding and bed-covers with matching themed colour schemes. Bedrooms are well presented, 5 have en-suite facilities. Recent replacement of several windows with double glazed units completes the replacement of all windows. All bedrooms, toilet and bathrooms have been fitted with new vanity units with mixer taps. A new sensory room has been established including lighting and audio facilities - this was completed at a cost of five thousand pounds. 75 thousand pounds has been spent Care Homes for Older People Page 21 of 30 Evidence: on the environment since the last inspection. The cost of the total refurbishment programme over the past 2-3 years has been in excess of 300 thousand pounds. A sample of the bedrooms seen showed well presented rooms with quality furniture and fittings that were well personalised reflecting the individuality of people. There is an assisted bath, walk-in shower room and jaccuzi bath giving people a choice of bathing facilities. The external part of the building has been part renovated but the remaining part gives a poor impression, awaiting the commencement of a building programme to extend the home - the planning permission has recently been approved by Newcastle Borough Council. The poor presentation of the exterior completely belies the considerable improvements that have been made internally. This can prove a disadvantage to people viewing the home for the first time. A visitor told us on this visit that when she first came to Silverdale Nursing Home she saw the exterior and did not want to look further. Her son said he would go inside, called her into the home and both were impressed with the standard of the interior and the care provided. Her husband has been resident for 2 years and she is more than pleased with the standard of care. This home cannot be judged from the exterior and has a high occupancy rate to prove it. At the time of the last inspection a requirement was made to monitor hot water outlets in some areas were found to exceed safe limits. Regular weekly checks of the hot water outlets have been established and are recorded. Sample outlets tested during this inspection showed hot water was provided at a safe temperature. It was noted that in one of the shared rooms there was no privacy screen. One should always be in place to ensure its use to protect the privacy of dignity of people receiving personal care. Care Homes for Older People Page 22 of 30 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 by a well trained, committed staff team with robust recruitment procedures that protect those using the service. Evidence: Two requirements were made in relation to these outcomes at the last key inspection. They required additional catering facilities at peak times and training for staff in areas of food hygiene, Moving & Handling and Health & Safety. The requirements have been adequately addressed. A member of catering staff works 8-11am and 4-6 pm, mainly in preparing food in the kitchen, but also was seen assisting people with feeding. The AQAA states that half the people need some assistance or oversight with feeding. This therefore, greatly assists to ensure people have adequate support with eating. Staff training has been improved. A new training provider has been commissioned to provide statutory and professional training to meet the needs of all staff. Since the last inspection 25 staff have completed Moving & Handling Training. A course in March 2009 provided Food Hygiene training and a further Health & Safety training course is arranged. Addiitional training provided includes Safeguarding (Adult Protection), Fire Training, Care Homes for Older People Page 23 of 30 Evidence: Mental Capacity Act, Dementia Care. - Apart from all staff - the provider has also attended the training courses. Additionally 4 nursing staff have completed the End of Life (Liverpool Pathway) course provided by the Palliative Care Nurse Specialist. At this time 8 of the 14 care staff have completed NVQ training, the remainder are presently studying for the award. Catering staff are being enrolled for NVQ in catering. The objective is 100 NVQ trained staff. The number of staff on duty remains the same: There are carers on duty throughout the 24 hour period as follows: 4:3:2: Plus a Nurse at all times. Additionally a catering assistant is provided, as stated from 8 - 11 am and 4- 6 pm and the Activities Coordinator works 25 hours per week over 5 days. There are adequate catering and domestic hours. At the time of this inspection there was no Registered Manager working in the home. The provider has a full-time daily input into the home. The number of staff on duty is adequate for the current dependency levels of people in residence. A sample of staff files showed that all required checks and references had been obtained prior to employment and all documents required under Schedule 2 of the Regulations were present in the staff files seen. Care Homes for Older People Page 24 of 30 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. Efforts to recruit a suitable manager have not resulted in a satisfactory appointment but the provider has continued to improve the service for people in the home. Evidence: Several Acting Managers have been appointed over the past 2 years. None reached the stage of being approved by us as the Registered Manager. The Provider has conducted a ceaseless search for an appropriate person to manager the home but without success - the last manager left some months ago and the search has continued. In the interim period the provider has continued to manage the home on a daily basis and continued to support staff well throughout the several changes of Manager. The provider is not a nurse and has appointed a nurse to oversee the clinical operation and supervision of the nursing staff. This has been successful and is working well. Ten requirements made at the time of the last report have all been satisfactorily Care Homes for Older People Page 25 of 30 Evidence: addressed by the Provider. The many improvements made since the last inspection have been mainly as a result of the providers management of the home. He has also undertaken the training courses that all carers are involved in and now registered to commence the Leadership in Management Course and considering the possibility of continuing to be the person in full time day to day charge of the home and not having a Registered Manager. The record of improvements made in the home have been attributable to the provider and not the succession of Acting Managers that have been appointed. The provider has the required skills to operate the home and would continue to have a nominated nurse responsible for clinical matters if he chose to continue the present management arrangements. All policies and procedures in the home were seen to be reviewed and updated by the provider in January 2009 A requirement was made at the last inspection to seek the views of residents/relatives and other stakeholders and make the results available to all. Questionnaires have now been circulated to all relatives, the first sent in March 2009 and to be repeated at least annually. The results were seen and included comments such as First Class Care and Much improved activities. Questionnaires need to be extended to other stakeholders and advice was given to the provider in relation to this. The new relatives meetings provide a verbal opportunity for them to feedback about the service. There have been changes in the way peoples personal finances are dealt with. Cash or personal allowances are no longer held for people using the service. Expenditure for items such as hairdressing or toiletries are purchased by the home, receipts obtained and all residents/relatives invoiced monthly retrospectively. No cash handling provides a better, improved safe service. The home has been involved in a decision to apply for a Deprivation of Liberty Safeguard under the Mental Capacity Act 2005. This part of the Act came into force on the 1st April this year and an application was made by the Provider 2 weeks later, to the Managing Authority (Local Authority). Two emergency applications were made (lasting 1 week each) and approved. The required standard application was simultaneously made. The provider worked very closely with the Local Authority Special Interests Team, Social Workers, and Advocate. The applications were confirmed to restrict the persons liberty, although the final decision was given only verbally and not in writing. This is still awaited and is a serious shortfall in this legal Care Homes for Older People Page 26 of 30 Evidence: process by the Local Authority. The home had pre-arranged training in the Deprivation of Liberty Safeguards on 7th April 2009 for all staff - 3 days after this inspection. It was unfortunate that they were presented with a situation to deal with less than 2 weeks after the introduction of the new legislation, but they handled the matter well and complied with all the legal requirements. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Ensure where people are assessed at risk of pressure damage, that equipment necessary to reduce that risk is documented and always in place. This will ensure good tissue viability care for people in the home. Review the arrangements for NHS chiropody care to ensure people have the required service to meet their needs. People with fluid intake deficiencies should be offered fluids when awake at night as well as during the day. This will improve their health and well being. Unlabelled and unused creams should be removed from the medication store for disposal. Privacy screens should always be availablein shared bedrooms to ensure privacy for personal care. 2 3 8 8 4 5 9 24 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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