Care Home: Solent Grange

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What the care home does well During the inspection we observed interactions between staff and service users to be warm, friendly and positive. What has improved since the last inspection? The home has appointed a new manager who has experience of managing health and social care services. Since the previous inspection action has been taken to address the requirements made. The Isle of Wight Social Service safeguarding team has now closed the safeguarding investigation and has no current safeguarding concerns in respect of the home. The home has undertaken work on care plans and care related records which now more clearly state how health and personal care needs should be met. Evidence viewed indicates that most people are having their health care needs met. There remains room for continuing improvement in relation to care plans and documentation however the requirements relating to this are considered to be met. The home has also addressed the concerns and issues raised in the previous report in respect of medication although it must ensure that staff date when they open tubes or tubs of creams and that these are only used for up to one month from the date they are opened. Progress has been made to address the institutional and task orientated practices that were observed throughout the home during the previous inspection. There continues to be a need for the home`s management team to monitor the way care is provided to ensure that all care is provided in a person centered way. The home now provides outdoor space including a garden and patio area for service users to access. These areas must be kept safe and secure. The home was also able to show that a range of activities is provided throughout the week either in small groups or individually. Meals are now served at a suitable temperature with heated trolleys available in all parts of the home. The home now has a clear procedure for receiving and recording any complaints that will ensure the confidentiality of the complaints and should ensure that any complaints received are responded to in a timely and satisfactory manner. Staff are now receiving a full induction, including shadow shifts and training is underway and planned to ensure that staff have all the necessary skills to meet people`s needs. Staff now only commence working in the home after all pre-employment checks have been completed. The manager is developing supervision and quality assurance procedures to monitor the quality of staff and service provided at the home. What the care home could do better: The service must ensure that the improvements that have been made are sustained and embedded in practice. A new requirement is made that the registered person must ensure that risk assessments are completed for all people to ensure that any risks are correctly managed and people are safe. This is required because a new person admitted to the home had not had any risk assessments completed one week after moving into the home although other information viewed evidenced that the person did have identified risks. Key inspection report Care homes for older people Name: Address: Solent Grange Staplers Road Wootton Isle of Wight PO33 4RW     The quality rating for this care home is:   one star adequate 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: Janet Ktomi     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Solent Grange Staplers Road Wootton Isle of Wight PO33 4RW 01983882382 01983882954 solent@lrh-homes.com www.lrh-homes.com London Residential Healthcare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 91 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 91. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Solent Grange is a registered care home providing both nursing or residential care and accommodation for up to ninety-one older people who may or may not have dementia. Solent Grange is located in an extended older property in a rural location yet within a short bus ride or car journey from the town of Newport. Care Homes for Older People Page 4 of 38 Over 65 0 0 0 0 Brief description of the care home There are eighty-five single and three twin rooms. All fifty-one rooms in the new extension are spacious and have full en-suite shower, toilet and wash hand basin. Twenty-one rooms in the older part of the home are en-suite with a toilet and wash hand basin as a minimum, some do also have baths. Rooms in the older part of the home are of variable sizes. The home is owned by London Residential Healthcare Limited and at the time of this unannounced inspection did not have a registered manager. Care Homes for Older People Page 5 of 38 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: one star adequate 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 report contains information gained since the home was previously inspected in November 2009 and during an unannounced visit to the home undertaken on the 7th April 2010. All core standards and a number of additional standards were assessed. Also assessed was compliance with the thirteen requirements made following the inspection in November 2009 when the home was assessed as providing poor outcomes for people who lived there. The visit to the home was undertaken by two inspectors and lasted approximately eight hours commencing at 9.00 am and being completed at 5pm. The inspectors were able to spend time with the person managing the home and staff on duty. The inspectors were provided with free access to all areas of the home, documentation requested and people who live at the home. Care Homes for Older People Page 6 of 38 Following the previous inspection the home was required to submit an improvement plan to the commission. This was considered along with other information received at the commission about the home including notifications of incidents in the home. Since the previous inspection the Isle of Wight Social Services safeguarding team have undertaken a safeguarding investigation. Information from safeguarding reports is also considered as part of this inspection. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? The home has appointed a new manager who has experience of managing health and social care services. Since the previous inspection action has been taken to address the requirements made. The Isle of Wight Social Service safeguarding team has now closed the safeguarding investigation and has no current safeguarding concerns in respect of the home. The home has undertaken work on care plans and care related records which now more clearly state how health and personal care needs should be met. Evidence viewed indicates that most people are having their health care needs met. There remains room for continuing improvement in relation to care plans and documentation however the requirements relating to this are considered to be met. The home has also addressed the concerns and issues raised in the previous report in respect of medication although it must ensure that staff date when they open tubes or tubs of creams and that these are only used for up to one month from the date they are opened. Progress has been made to address the institutional and task orientated practices that were observed throughout the home during the previous inspection. There continues to be a need for the homes management team to monitor the way care is provided to ensure that all care is provided in a person centered way. The home now provides outdoor space including a garden and patio area for service users to access. These areas must be kept safe and secure. The home was also able to show that a range of activities is provided throughout the week either in small groups or individually. Meals are now served at a suitable temperature with heated trolleys available in all parts of the home. The home now has a clear procedure for receiving and recording any complaints that will ensure the confidentiality of the complaints and should ensure that any complaints received are responded to in a timely and satisfactory manner. Staff are now receiving a full induction, including shadow shifts and training is underway and planned to ensure that staff have all the necessary skills to meet peoples needs. Staff now only commence working in the home after all pre-employment checks have been completed. The manager is developing supervision and quality assurance procedures to monitor the quality of staff and service provided at the home. Care Homes for Older People Page 8 of 38 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. Care Homes for Older People Page 9 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a range of information for prospective service users including a brochure and service users guide which provide relevant information. The home has appropriate pre-admission assessment procedures however the home had failed to complete full risk assessments for the one person they had admitted since the previous inspection which may have placed the person at risk. Standard 6 is not applicable as the home does not provide intermediate care. Evidence: The manager detailed the homes admission procedures and the records relating to the one person admitted to the home since the previous inspection were viewed. We spoke with staff about new admissions and considered how needs had been met since admission. Due to age related memory loss it was not possible to discuss admissions with people living at the home. We looked at information the home has produced for Care Homes for Older People Page 11 of 38 Evidence: existing and prospective service users. The home provided copies of the service users guide to the inspectors. This provides a range of relevant and important information for prospective and existing service users and their relatives. Copies of the service users guide were seen in each bedroom viewed. The manager also provided the inspectors with a copy of the letter that is sent to people once an assessment has been carried out informing the person and their representatives that the home is able to offer them a service. This contained additional information about fees and services they should expect. The home agreed to a voluntary suspension of new admissions in November 2009 whilst a safeguarding investigation was being undertaken by the Isle of Wight Social Services. The home wrote to the commission in March 2010 requesting permission to lift the voluntary suspension in order to admit one person to the home. The home has therefore only admitted one person since the previous inspection in November 2009. The records relating to this person were viewed and the manager explained the homes admission procedure. The deputy manager and a senior carer completed the pre-admission assessment for this person. This was viewed and was completed on a form that covered all the necessary areas and questions that the home would need to ask to establish if it would be able to meet the persons needs. A relative of the person visited the home and selected a room from those vacant. The care file for the person admitted one week before the inspection was viewed. This contained an initial care plan that detailed the persons general care needs. The file also contained a range of forms that had not been completed that would constitute the persons main care plan. There were also uncompleted risk assessment forms. The pre admission assessment detailed that the person had a history of falls however no falls risk assessment or management plan had been completed. A body map had been completed showing that the person had sore areas on their sacrum and heels. This was undated and no risk assessment in respect of pressure areas or management plan was in place. Neither a moving and handling risk assessment or a nutritional risk assessment had been completed nor had any other risk assessments that may be relevant to the person. The manager was present when the persons care plan was viewed and arranged for this to be completed on the day of the inspection therefore an immediate requirement was not issued. The person had been living at the home for a week and the homes failure to complete risk assessments or a full care plan has placed the person at risk that their needs may not be met. Care Homes for Older People Page 12 of 38 Evidence: Staff stated that they felt they receive sufficient information about people they are to care for. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation therefore standard 6 is not applicable. Care Homes for Older People Page 13 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has complied with the four requirements covering care plans, health and personal care, privacy and dignity and medication that were made following the previous inspection however there remains scope for further improvements in all these areas. Evidence: Six care plans were viewed from four of the five sections of the home including two for people who were receiving nursing care. The inspectors discussed with staff how care needs are met. The inspectors spent time around the home and observed support provided to people in communal areas. The homes medication administration systems were assessed in the nursing section and records relating to medication in the residential section and part of a medication round in the residential section was also viewed. Following the previous inspection in November 2009 a requirement was made that the registered person must ensure that, after consultation with the service user or their representative, that a written plan as to how the service users needs in respect of Care Homes for Older People Page 14 of 38 Evidence: health and personal care are to be met is prepared. This must be kept under review to ensure it clearly states how the persons health and personal care needs will be met. A requirement was also made that the registered person must ensure that peoples health and personal care needs are being met. The home is in the process of changing the format it uses for care plans. Some care plans viewed were in the original format and others in the new format. The previous outcome group in this report identified that a new admission to the home only had a basic care plan completed and other forms and documentation including risk assessments had not been completed one week after their admission. All other people had a care plan in place. Care plans were stored in lockable filing cabinets however none of these were locked during the inspection and this would allow unauthorized people to access confidential information about service users. This is also against the homes policy on paper information which it states should be kept secure. A new requirement is made following this inspection that the registered person must ensure that risk assessments are completed on all service users so that any risks may be correctly managed to ensure that people are safe. Although there was evidence that care plans had been reviewed on a monthly basis it was identified that changes recorded on review sheets had not been incorporated into the persons care plan. An example being a person whose care plan stated they did not wear jewelery however the review stated that they now has a box of jewelery which was seen in front of the person and they were wearing necklaces. This was discussed with staff caring for the person and the manager who acknowledged that the care plan had not been updated following a change in the persons personal care needs. The same care plan also stated that the person has a general bath once or twice a week. Records of how personal care needs had been met evidenced that this person had a daily wash supported by care staff. This was discussed with the staff caring for the person who stated that the person did not like a bath and they would shower her when she was in agreement. A care plan viewed in another section of the home stated that it had been reviewed however it did not correlate to the changes that had occurred in the persons care needs and would be inadequate to inform unfamiliar staff about how the person should now be cared for. This care plan was discussed with the manager who stated that they would arrange for a complete review. Parts of the care plan contained negative wording such as bedridden. Daily records stated that the person could be hoisted out Care Homes for Older People Page 15 of 38 Evidence: of bed for a shower using a shower chair but also stated that the rest of the time the person remained in bed. There was no information, and the manager did not know, why the person was not sat out in a suitable chair for meals or periods of the day to socialize. The photograph in the care plan required updating as was no longer a good likeness of the person. The care plan stated that the person liked listening to the radio however when the persons room was visited the radio was not turned on and the room was completely quiet with overhead lighting on. Information in the care plan was therefore not being used effectively to influence the care the person received. Other care plans viewed stated that they had been reviewed but only contained a date and signature that the plan had been reviewed and no additional information about changes to the persons needs or if needs remained unchanged. One care plan viewed contained recording sheets for nursing staff to check the persons blood sugar levels twice a week. The records showed that this had generally been done up to ten days prior to the inspection and then this had not been done and there was no record of any monitoring of the persons blood sugar levels. The manager was shown this recording sheet and could not explain why this important monitoring of a persons health had not been completed. The manager has since written to the commission stating that action had been taken in respect of the staff responsible for not completing the monitoring. Other records viewed in the same section of the home had also been poorly completed in relation to bowel movements and if the records were correct no action had been taken when people had not had their bowels open for up to ten days. The manager stated that staff record this information in daily records but this could not be identified in the persons daily records. Some records had been well completed such as those viewed in respect of peoples food and fluid intake where there was a need to monitor this. Care plans contained risk assessments in respect of peoples pressure areas. Some people were high risk and had airwave pressure mattresses in place. A number of these were viewed. Only one care plan contained a record of the setting of the airwave mattress (which is dependent on the persons weight). At the time of the inspection this did not appear to be correct and the manager and staff on duty could not explain the care plan setting. Following the inspection the manager provided information to the commission showing how the setting had been recorded and information about the airwave mattress, however staff caring for the person should have been aware of this and been in a position to answer the inspectors questions. Fitted comer sheets should not be used with airwave mattresses and all beds viewed with the manager had Care Homes for Older People Page 16 of 38 Evidence: cornered sheets in use. The manager has since written to the commission stating that staff have been reminded about this and cornered sheets will not be available in parts of the home where people have airwave mattresses. The issue of cornered sheets and settings on pressure mattresses is also recorded on the report following the previous inspection. The safeguarding team from the Isle of Wight Social services have visited the home since the previous inspection. Their visits in February and March 2010 were reported in a safeguarding meeting in early April 2010 where it was stated that they no longer had concerns that people were not having their health and care needs met. This was also the view of health care professionals at the meeting. The safeguarding in respect of the home was therefore closed. This inspection identifies that there are still improvements that need to be made in respect of both care planning and meeting peoples health and personal care needs. The manager has provided additional information since the inspection visit and this indicates that action has been taken to address the issues identified during this inspection. The requirements are considered to have been generally met however there is a need to ensure that the improvements made are sustained and embedded fully in the procedures in the home. A requirement was also made following the previous key inspection that the responsible person must ensure that all institutional and task orientated practices are discontinued and that the home ensures that peoples privacy and dignity is maintained at all times. This inspection visit did not identify any concerns in respect of privacy. Whilst viewing one bedroom selected randomly it was noted that there were large quantities of continence products stored in a persons bedroom. This was all visible to anyone visiting the bedroom and affects the persons dignity. This was discussed with the manager who was present who has since written to the commission and stated that additional storage has now been provided and continence products will no longer be stored in view in peoples bedrooms. Overall the issue of task orientated care practices has reduced. In one section of the home there remained some evidence of this. The manager was present whilst lunch was being served. A member of staff attatched disposable clothes protectors (via sticky tabs to peoples shoulders) to all the people sitting in the room. There was no effort made to move people to dining tables that were available in the room and people ate their lunch when it arrived about ten minutes later where they were sat in the lounge chairs with low tables in front of them. One staff member dished up all meals which were given to people and then staff darted between people assisting Care Homes for Older People Page 17 of 38 Evidence: them. The manager has since written to the commission to state that action has been taken to make the communal rooms in that section of the home more homely and social and that people are now using the dining tables provided. Generally improvements have been made to increase peoples privacy and dignity and to reduce task orientated and institutional practices. These have not completely stopped however sufficient action has been taken and the manager has identified additional steps that will be taken to further improve this area and therefore the requirement will be assessed as met. A requirement was also made in respect of medication following the previous inspection in that the responsible person must ensure that medication is administered as prescribed by the persons GP and that full and accurate records are maintained and that guidelines are in place for as required medication. We observed medication practices and records in several parts of the home covering people who have both nursing and residential care needs. In the nursing section nurses administer medication and in the residential section senior staff who have completed medications training administer medication. There was information in care plans viewed as to what may indicate that people require as required medication such as pain killers. The procedures and records for medication administration observed and viewed should ensure that people receive their medication as prescribed. Medication was appropriately stored and secure including controlled medications and medications that should be kept at cooler temperatures. Records for medication were well maintained. This was also the findings from a community pharmacist who has completed work at the home as part of the safeguarding investigation. Whilst viewing some bedrooms it was noted that the home is not recording dates of when tubs of creams have been opened and use has commenced. Many tubs of creams must only be used for a maximum of one month from the date of opening. One tube of cream had a date of opening on it but this was in excess of the one month that the tube stated it should be used once open. This was found in several parts of the home. The manager was present when some of these creams were viewed. We also looked at the clinical rooms in various parts of the home. In one clinical room we found medication pots and syringes (which should be disposed of after use) left drying on tea towels. Tea towels should not be used in clinical areas as they can present an infection risk. There were no disposable towels for staff to dry items or their hands present in this clinical room. The manager was present and took immediate action to dispose of these items and discuss the situation with staff therefore an immediate requirement was not issued. Care Homes for Older People Page 18 of 38 Evidence: Although some issues in respect of medication creams has been identified the manager has taken action and the requirement in respect of medication has therefore been met. Care Homes for Older People Page 19 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has complied with the requirements made following the previous inspection in relation to activities and meals and must ensure that the improvements are sustained and embedded in practice. There are still some areas of daily life that, in some parts of the home, are organized on task orientated and not individual lines. Evidence: Information from care plans, discussions with staff, the manager and visitors is considered. We observed how people living at the home spent their day and observed people having lunch in several sections of the home. Care plans contained information about peoples life histories and previous interests and social activities they had enjoyed. Information was also present in care plans about peoples likes and dislikes. This information appeared to be incorporated into peoples care plans however as previously identified one persons care plan stated that they liked the radio on and when this person was visited in their room where they spent most of their time the radio was not on. A requirement was made following the previous inspection that the responsible person must ensure that activities for all people in the home are provided on a daily basis. Care Homes for Older People Page 20 of 38 Evidence: This requirement also stated that the home must ensure that people have access to safe outdoor spaces and fresh air as they wish. This was required to ensure that people receive mental and physical stimulation and do not become bored or depressed. Throughout this inspection visit it was noted that staff now have sufficient time to spent sitting and chatting with service users or doing individual activities for short periods of time. Care staff confirmed this to inspectors and identified it as part of the job they enjoy. Some care staff were concerned that when the home recommenced admitting new people that staff levels would remain the same and they would no longer have the time to spend with service users. The manager stated that staffing levels would be constantly reviewed to ensure that they were adequate to ensure that all needs, including social needs, could be met. The home employs specific activities staff who organize activities six days per week. The records of activities are kept separate to the care plans and were viewed. These evidenced that a range of individual and group activities are provided in various parts of the home. External entertainers also visit the home and staff from one section stated that they take service users to other parts of the home to enjoy the visiting entertainers. From observation and records viewed the requirement in respect of activities has been met. The manager showed the inspectors the homes outdoor areas, the garden and patio. The garden is accessed via the lounge on the ground floor in the new part of the home. This has pathways and has been planted with a range of shrubs and flowers. Seating is also provided. The area will also be protected from extremes of sun due to trees to one side which should provide shade. The manager stated that the garden was secure however the padlock that should secure the gate to the front of the home was missing. This was located during the inspection and the garden again secured. The home also has a patio area accessed from the older part of the home. The manager was aware of the risks posed by the slope into the patio and stated that this was planned to be corrected in the near future before the weather became such that people would be accessing this area. The patio also had seating. The home therefore now has two outdoor areas accessible from different parts of the home and the part of the requirement in relation to accessible safe outdoor areas has therefore been met. Care Homes for Older People Page 21 of 38 Evidence: There were previous concerns that the communal parts of the home were not homely and were described in safeguarding meeting minutes as having the appearance of airport waiting areas. The communal lounges have had their furniture rearranged and now have a more homely appearance. The manager wrote to the commission following the inspection to inform that one lounge which still had the chairs arranged around the walls had been rearranged to take advantage of the views from the windows that were previously blocked by chairs. The previous report identified that the only concern of visitors was in connection with car parking which they felt was inadequate. Since the previous inspection the car park has been extended and should now be of a more suitable size for the size of the home. The home maintains a visitors book and this would indicate that people are able to visit at any reasonable times. The home has a range of communal rooms and if required private space for visiting could be arranged. A requirement was also made in respect of meals in that the responsible person must ensure that people receive their meals at a suitable temperature. The home has now purchased heated trolleys for the parts of the home that did not have them. These were seen in use during the inspection. This requirement has therefore been met. We observed people having meals and refreshments in several parts of the home. Overall there are sufficient staff to ensure that people receive the help they need with their meals however as identified in the previous section of this report the way that meals were managed in one part of the home was task orientated and not individual in that nobody was taken to the dining tables and disposable clothes protectors were attached to peoples shoulders via sticky tabs before the meal had even arrived in that part of the home. In other parts of the home there is a separate dining room and most people were taken to the dining room for their meals. This provides a more sociable occasion and encourages movement and a better sitting position to eat than remaining in the lounge chairs with a small table placed in front of the person. The manager was present with one inspector when lunch was served in this part of the home and following the inspection wrote to the commission to state that the arrangements for meals in this area had been reorganized and that people were now using the dining tables and that the deputy manager would be spending more time in this part of the home to ensure that the task orientated practices were not continued. People appeared to be enjoying their meals and choice was available. The manager provided a copy of the homes menu to the inspectors and this showed that a varied diet is provided. Some service users were asked their opinion of the food provided at Care Homes for Older People Page 22 of 38 Evidence: the home and their responses were positive. Staff working long day shifts receive a meal and they stated that the food is good. Discussions with catering staff indicated that they felt they had good quality ingredients however they were concerned about the size of the kitchen and how they would manage when the home increases the number of people living there and staff working in the home. Care Homes for Older People Page 23 of 38 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. The home now has a suitable recording procedure to ensure that complaints will be fully investigated. Staff have received safeguarding training although some remain unclear about what they should do should they suspect that abuse has occurred. Evidence: We discussed complaints and safeguarding with the manager and viewed related records. We also talked to staff about safeguarding. Following the previous inspection the home was required to ensure that the home has a clear policy and procedure for the receiving, recording and responding to complaints that ensures the confidentiality of service users and complainants and ensures that complaints are responded to in a timely and satisfactory manner. The homes complaints policy was seen in the service users guide. Due to age related memory loss it was not possible to talk to service users about complaints. The improvement plan submitted by the home following the previous inspection stated that complaints forms and envelopes are now available on the administration desk near the front entrance to the home. These were seen to be present during the inspection with information as to how people could complain. The manager stated that since they had been managing the home no complaints had been received. The manager has developed a computer data sheet that would be used to record and track complaints should any be received. As the home has not received any complaints it is Care Homes for Older People Page 24 of 38 Evidence: not possible to fully assess the effectiveness of the new complaints system however the systems in place would seem appropriate and the requirement has therefore been met. The home was also required to ensure that all staff receive additional safeguarding training to ensure that they are able to recognize abuse and know what action they should take in the event of having safeguarding concerns. Training information and discussions with staff indicated that they had all received safeguarding training. However discussions with staff showed that whilst some staff were clear about safeguarding and action they should take if they suspected that service users may be at risk of abuse others remain unsure about the action they should take. This was discussed with the manager who stated that she would again raise the issue of action staff should take at the next staff meeting and provide additional written information to remind staff about safeguarding and their responsibilities. Although not all staff were fully aware of the action they should take the requirement is considered to have been met but the manager should ensure that this topic is regularly discussed with all staff as part of supervisions and staff meetings to ensure full and complete understanding of this important aspect of care. Since the previous inspection the home has been the subject of a safeguarding investigation by the Isle of Wight Social Services safeguarding team. A meeting held shortly before the inspection identified that the home has addressed the issues of concern, which were in relation to ensuring peoples health and care needs were being fully met, and the safeguarding investigation has now been closed. Care Homes for Older People Page 25 of 38 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 home that is generally well maintained and suitable to their individual and collective needs. The previous requirements in respect of infection control and storage of substances hazardous to health have been met. The home has also addressed issues raised in the previous report in respect of car parking and access to gardens for service users. Evidence: Most parts of the home were viewed during the course of the inspection visit including all communal rooms and randomly selected bedrooms were viewed as were some bathrooms, WCs, laundry and clinical areas. Certificates relating to safety and the testing of services and equipment and fire detection systems were viewed at the previous inspection in November 2009. The home is situated in a rural location between the towns of Newport and Ryde. A main bus route runs past the home. In 2008 a large extension to the home was completed. The home now provides a total of ninety-one beds, eighty-five in single rooms and three twin rooms. Seventy-two rooms have en suite facilities. All bedrooms in the new section are spacious with en suite facilities of shower, WC and washbasin. The new section of the home has assisted bathrooms and communal rooms appropriate for the number of people in each area. The new extension covers three floors, ground, first and second with a shaft lift providing access to all areas. The Care Homes for Older People Page 26 of 38 Evidence: extension is linked to the original home on the ground and first floors via a secure entry system. The original home has a appropriate bathrooms and WCs, dining room and two lounges and provides predominately single rooms although three are registered for twin occupation. There are two shaft lifts in the older part of the home. The report following the previous inspection in November 2009 stated that some parts of the older building felt cold and we were informed that there were problems with the boiler serving that part of the home. The manager informed us that the problems with the boiler had been resolved and on this inspection all parts of the home felt warm. The previous report also identified that carpets throughout the home were looking dirty and stained. The manager stated that new carpet cleaners had been obtained and overall carpets were looking cleaner although in some places they did appear stained. Despite being in need of redecoration the older section of the home felt friendly and homely and the people had a choice about where they spend their time in the two lounges and other informal seating areas provided. The new section of the home was also viewed and although generally this was decorated to a higher standard parts were already showing signs of wear through daily use. The home has a well equipped laundry room with specific laundry staff. The previous report noted that clean linen and bed coverings were seen stored on the floor of laundry cupboards in the new extension as there were insufficient shelves provided although the cupboards were of a good size. One clean laundry cupboard was viewed in the new section of the home and again clean items were seen on the floor. The manager was present when this cupboard was viewed. The previous report identified that substances hazardous to health were not being stored securely. At the time of this inspection all such items were seen to be stored securely. Since the previous inspection the home has addressed the issue of car parking for staff and visitors. The car park has been extended and is now of a more suitable size. The home has also addressed the issue of outdoor space for service users. The home has a garden area accessible from the ground floor new build lounge. This has pathways and seating and has been planted with a range of flowers and shrubs. The manager stated that the garden has been secured however on the day of the inspection visit the gate to the front was not secure. The manager identified that the Care Homes for Older People Page 27 of 38 Evidence: padlock had been removed. The home must consider if a padlock is the best way to secure this gate as this would also prevent people leaving in an emergency and a lock linked to the fire alarms should be considered. There is also a patio area accessible via the older part of the home. The ramp leading from the house to the patio requires attention as has a drop to one side and no hand rail. The manager stated that this is planned to be cambered off to make safe for all service users. Care Homes for Older People Page 28 of 38 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. Staff are now provided in sufficient numbers who have commenced working at the home only after all pre-employment checks have been fully completed and they have received an induction. Whilst not all staff have completed all mandatory and service specific training the home now has a clear training plan and a high number of staff have a care qualification. Evidence: We viewed duty rotas, observed how staff are deployed in the home and what they were doing at various times of the inspection visit. Also considered are discussions with staff and records viewed relating to staff training and recruitment. In August 2009 concerns were raised and confirmed via a safeguarding investigation that the home had insufficient staff to meet the needs of the people who live at the home. At the time of the inspection in November 2009 it was identified that the home had recruited a number of new staff but that some of these were working long hours. It was also identified that staff were working in a different parts of the home. The manager provided copies of the homes duty rotas and explained how staff are now allocated to one of the homes five areas and unless there is a specific need they only work in this area. We spoke with staff who confirmed the new allocations systems which had only been in place a couple of weeks. Staff were positive about being Care Homes for Older People Page 29 of 38 Evidence: allocated to a specific part of the home and felt that it would improve relationships and knowledge of service users in that area. The home has also recently introduced a key worker system and staff were also positive about this. Staff on duty corresponded to the duty rotas supplied. Staffing numbers would appear appropriate for the numbers of people living in each part of the home and staff were observed to have time to sit and talk to service users. Staff stated that they felt they generally had time to meet peoples needs. Following the previous inspection the home was required to ensure that staff do not commence working at the home until all pre-employment checks have been satisfactorily completed and they have completed an induction. We looked at three staff files for new staff and the manager explained the changes that have been made to the homes recruitment procedures to ensure that all staff complete a comprehensive induction before working in the home. The recruitment files viewed all contained evidence that all pre-employment procedures and checks had been completed before new care staff commenced working at the home. One file viewed was for a qualified nurse and although there was a copy of the nurses registration card (which shows that they are registered with the nurses and midwifery council) there was no evidence that the nurses registration had been checked prior to their commencing work at the home. The registration card is only valid at the time it is issued and registration can be withdrawn after this time. Continuing registration can be checked by employers. The manager tried to check this during the inspection visit but realized that they did not have the necessary passwords to do this. The manager explained that there is now one week per month when new staff commence working at the home. All staff undertake two days formal induction which covers all mandatory and service specific training. Staff then undertake between one and two weeks shadow (additional to staffing numbers) work depending on the level of their previous experience. New staff spoken with confirmed that they had undertaken a weeks training and then two weeks shadow shifts. Staff stated that they felt they had received a thorough induction and had most of the skills they needed when they commenced working at the home. Other staff confirmed that new staff work as additional to numbers during their first week or so. The requirement in respect of recruitment and induction has therefore been met however the manager must ensure that she is able to check the continuing Care Homes for Older People Page 30 of 38 Evidence: registration of nurses employed at the home. The manager showed the inspector the homes training matrix and provided a copy of this. The matrix was discussed with the manager during the inspection. The matrix shows what training individual staff have undertaken. The matrix does not show when updates or refresher training are due and the manager stated that either she or the senior staff member who is responsible for training have to go through the list to work out which staff need training. The matrix showed that whilst the home does have a clear training plan and staff are receiving training not all staff have completed all mandatory or service specific training. This was discussed with the manager who agreed that this was what the matrix showed and that work was continuing to ensure that all staff have completed all required training. We discussed training with care staff who confirmed that they had done a range of training and felt that they had the necessary skills to meet peoples needs. Care staff maintain their own training records. Some were viewed and some had been better maintained than others but did contain evidence that staff have undertaken training. We asked staff about qualifications they had in care. Many stated that they either had an NVQ or were hoping to start their NVQ in the near future. The manager stated that forty of the homes fifty-three care staff have a qualification in care of level 2 NVQ or above. Care Homes for Older People Page 31 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant action has been taken by the homes management team including the Responsible Individual and manager to address the thirteen requirements made following the previous inspection in November 2009. These have all been met or are in the process of being met. The homes management team must now ensure that these improvements are sustained and embedded in practice to ensure the ongoing safety of people living at the home and that their needs are met. Evidence: Information from other sections of this report along with information from discussions with the manager during the inspection are considered. Records relevant to the organization and running of the home are also considered. The homes registered manager resigned in August 2009 and a new manager was appointed in mid September 2009. The new manager did not commence the registration process and another new person was appointed to manage the service in January 2010. The person now managing the service stated that they have completed Care Homes for Older People Page 32 of 38 Evidence: their CRB with the commission and once this has been returned will be applying to be the homes registered manager. The person now managing the service stated that she is a registered nurse with a management qualification at masters degree level. The person stated that they have previously managed health and social care services. The manager is supported by an experienced deputy manager and senior nurse. The manager was present for the inspection visit and was able to provide additional information when required. The manager has written to the commission following the inspection visit stating action that has already been taken to address areas of concern identified during the inspection visit. Following the previous inspection a total of thirteen requirements were made. This inspection has identified that progress has been made and all have been met however there is a need to make further progress to ensure that people receive the care they require and they are safe and there is a need for all the improvements that have been made to be sustained and embedded in practice. Specific information about the requirements can be found in the relevant sections of this report. A new requirement is made following this inspection that the registered person must ensure that risk assessments are completed for all service users to ensure that any risks are correctly managed and people are safe. One of the requirements made following the previous inspection was in relation to quality assurance and the monitoring of the service provided at the home to ensure that people are not placed at risk. The manager described the homes quality assurance and auditing systems. In January 2010 the home sent surveys for relatives to complete. Returned surveys were viewed along with an analysis of the responses. Overall people were happy with the service provided at the home. The manager has also undertaken a meeting with relatives and held service user meetings. The minutes of these were also viewed. The manager described how the improvements to the homes car park had resulted from comments made by relatives. The responsible individual has assigned an area manager for the home who undertakes visits to the home on their behalf. These visits are called Regulation 26 visits and are designed to assess the quality of the service provided at least monthly with a report being provided for the manager. Copies of the reports were viewed during this inspection visit. The home provided the commission with an improvement plan following the previous inspection. The improvement plan was completed by the person now managing the Care Homes for Older People Page 33 of 38 Evidence: home however this should have been completed by a registered person. This has been considered as part of the inspection and the information within the improvement plan and other information provided to the commission was confirmed during the inspection. Some issues in respect of care plan reviews were identified in the relevant outcome group of this report. Reviews are a way in which the quality of service provided to individual people can be monitored to determine if the home is continuing to meet their needs in the most effective manner. Where needs have changed care plans must be updated to reflect changing needs. The requirement in relation to quality assurance has been met however there is a need to ensure that the quality assurance processes continue to improve the service and that all improvements made are sustained and that people are safe. We looked at the arrangements in respect of peoples personal finances during the previous inspection and again at this inspection. The home does not hold money for people and any additional services, such as hairdressing or chiropody are invoiced to the person responsible for paying the service users bill. This was the same process used previously and invoices were viewed at that inspection. The report from the previous inspection also stated that the manager had some small sums of money held in the homes safe for individual people. The manager stated on this occasion that money was no longer held and this had been returned to the service user or their representative. It was identified at the previous inspection that staff were not receiving formal supervision and a requirement was made that the responsible person must ensure that staff receive formal supervision that is recorded at least every two months. The manager stated in the improvement plan that formal supervision plans are being put into place for all staff and that the manager and deputy will monitor that supervision is occurring as per the supervision plan. Discussions with staff confirmed that they are now receiving supervision although this process has only just commenced and not all staff have received formal supervision. Supervision has been organized on a cascade system with senior staff supervising junior staff. Supervision records were viewed. Although the process of supervision is only just commencing the procedures in place should ensure that all staff receive formal supervision and therefore the requirement has been met. Care Homes for Older People Page 34 of 38 Evidence: During the inspection we viewed a range of records relating to care, staff and the organization of the home. These have been described in more detail in the relevant section of this report. It was identified that care plans containing personal and confidential information were not being stored securely as filing cabinets were not kept locked and access would have been available to anyone. Most records were well completed although there is a need to ensure that care plans and risk assessments are amended after reviews and that reviews that are completed are robust and record any changes and do not just include the date and signature of the staff member undertaking the review. Specific issues in respect of some records were discussed with the manager during the inspection. The previous report identified various concerns in respect of health and safety. Specific concerns were noted in the previous report concerning the safe storage of substances hazardous to health and in relation to some aspects of infection control. During this inspection no concerns were noted in relation to substances hazardous to health and generally the home is managing the risk of infection. Staff confirmed that they have sufficient supplies of disposable gloves and aprons and that they have received infection control training. Care Homes for Older People Page 35 of 38 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 36 of 38 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 1 8 13 The registered person must ensure that risk assessments are completed for all people following admission to the home. To ensure that risks are appropriately managed and people are safe. 15/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 37 of 38 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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