Care Home: Somerville House

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What the care home does well Somerville House provides a very pleasant, warm and homely environment for people. The proprietor is very committed to ensuring the home is a place where residents can live safely and comfortably. The atmosphere in the home is very relaxed and laid back. Staff members ensure that residents make choices and decisions about their lives. Residents meetings were held and people told us their suggestions were listened to. Staff know the residents very well and were observed treating people with respect. They had also built up good relationships with relatives and visiting health and social care professionals. Residents said, ‘everybody is friendly here’ and ‘the staff are great’. The manager and staff team ensure that people access local community facilities and continue pursuing activities they enjoy such as swimming, going to the library, shopping and supporting the city’s football team. The manager and deputy manager always ensure that people are only admitted to the home after their needs have been assessed and they obtain assessments and care plans produced by commissioning bodies. The homes’ care plans are produced to meet the residents’ needs and people have access to a range of health and social care professionals. This ensures that staff members are aware of peoples’ needs, know how to meet them, and when to seek professional advice and treatment. People like the meals provided and there was choice and alternatives available, ‘the food is very nice – plenty to eat and drink’. Staff dealt with any complaints quickly to make sure they were resolved. What has improved since the last inspection? There have been significant improvements in the environment, which has improved the comfort and wellbeing of residents and also increased the morale of staff. Comments were, ‘I’m very happy with my new room’, ‘my new flat is lovely’ and ‘I love working here, it’s very rewarding’. The home’s statement of purpose and service user guide, which gives people information about the home, has been updated to reflect the services provided. This gives people all the important information they need about the home before they make a decision.Somerville HouseDS0000070519.V376913.R01.S.docVersion 5.2The care plans and risk assessments have been improved with more guidance for staff. They could be personalised even further. The way the home manages medication has improved but there were still some recording, like codes when medication was omitted, that was not used consistently. Staff recruitment files were much more organised. Some of the quality monitoring questionnaires had been sent out to people and staff to gain their views about the home. Questionnaires need to be sent out to professional visitors to the home. It was important to gain a full range of people’s views about how the home was managed so shortfalls could be addressed. Staff training has improved even further and the manager has developed a staff training plan for the coming year. It is important that staff have the right skills to be able to support people in their care. The amount of care staff that have gained a national vocational qualification in care (NVQ) at either level 2 or 3 has increased to 55%. This is a good achievement and has exceeded the required target of 50%. What the care home could do better: Care plans could be personalised even further to ensure staff write down the specific knowledge about residents that they currently hold in their heads. This will ensure any potential new staff member will have this information straight away. Recording of some medication could be improved to ensure codes for omitting medication are used consistently, medication is carried forward from the last MAR to the current one and topical products are signed when applied. Verbal references must be accurately recorded and followed up by written ones. This will enable a completed recruitment process and provide confidence that potential staff members are right for the role of caring for vulnerable adults. The manager should continue to work towards the Registered Managers Award and apply for registration with the Commission. Questionnaires should be sent to visiting professional to gain a full range of views about how the home is managed and a month by month quality monitoring plan would enable the manager and deputy to structure the QA process more effectively. Staff induction should also include skills for care induction standards for new staff that have not already gained an NVQ in care at level 2 or 3.Somerville HouseDS0000070519.V376913.R01.S.doc Version 5.2 Care staff should have at least six formal one to one supervision sessions a year. This will give the staff an opportunity to speak to the manager about issues and also assist the manager in recognising people’s strengths and development needs. Key inspection report CARE HOMES FOR OLDER PEOPLE Somerville House 262-264 The Boulevard Kingston upon Hull East Yorkshire HU3 3ED Lead Inspector Beverly Hill Key Unannounced Inspection 29th July 2009 09:00 DS0000070519.V376913.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Somerville House Address 262-264 The Boulevard Kingston upon Hull East Yorkshire HU3 3ED Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01482 210368 somervillehouse@somervillehouse.karoo.co.uk Mr John Mark Beyer Manager post vacant Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E), Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 18 9th September 2008 2. Date of last inspection Brief Description of the Service: Somerville House is situated at the Hessle Road end of the Boulevard approximately 1½ miles from Hull city centre. This location is at the centre of the Hessle Road shopping area and near to major bus routes into Hull. In addition to the shops there are local pubs, churches, a health centre, a library and a community centre close by. Somerville House is registered to provide care and accommodation up to 18 people aged over 65years, some of who may have needs associated with dementia. Accommodation is on three floors with a passenger lift accessing all three floors and a chair lift. The home has eight single and five shared bedrooms. One of the single bedrooms now has en-suite facilities. Communal space consists of a large lounge, arranged with a dining area at one end, a further small lounge and an additional small seating area for two easy chairs and a dining table. Bathing facilities consist of a shower room and unassisted bathroom on the first floor and a bathroom with a manual hoist on the top floor. There are three additional toilets to the ones located in the bath and shower rooms. There is an enclosed patio/garden area to the rear of the home. Visitors would have to park cars on the road at the front of the house. The current scale of charges is £359.50 per week. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and taxis for personal use. The home purchases weekend newspapers. Information about the home is included in the statement of purpose and service user guide, which are located in the home and distributed to potential residents. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 5 Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on 1st August 2008 and a random inspection completed on 9th September 2008. It includes information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like for them at Somerville House. We also had discussions with the manager, care staff members and three visiting health and social care professionals. Information was also obtained from surveys received from seven people that live at the home, two relatives, four staff members and one visiting professional. Comments from the discussions and surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Somerville House, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 7 only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the service does well: Somerville House provides a very pleasant, warm and homely environment for people. The proprietor is very committed to ensuring the home is a place where residents can live safely and comfortably. The atmosphere in the home is very relaxed and laid back. Staff members ensure that residents make choices and decisions about their lives. Residents meetings were held and people told us their suggestions were listened to. Staff know the residents very well and were observed treating people with respect. They had also built up good relationships with relatives and visiting health and social care professionals. Residents said, ‘everybody is friendly here’ and ‘the staff are great’. The manager and staff team ensure that people access local community facilities and continue pursuing activities they enjoy such as swimming, going to the library, shopping and supporting the city’s football team. The manager and deputy manager always ensure that people are only admitted to the home after their needs have been assessed and they obtain assessments and care plans produced by commissioning bodies. The homes’ care plans are produced to meet the residents’ needs and people have access to a range of health and social care professionals. This ensures that staff members are aware of peoples’ needs, know how to meet them, and when to seek professional advice and treatment. People like the meals provided and there was choice and alternatives available, ‘the food is very nice – plenty to eat and drink’. Staff dealt with any complaints quickly to make sure they were resolved. What has improved since the last inspection? There have been significant improvements in the environment, which has improved the comfort and wellbeing of residents and also increased the morale of staff. Comments were, ‘I’m very happy with my new room’, ‘my new flat is lovely’ and ‘I love working here, it’s very rewarding’. The home’s statement of purpose and service user guide, which gives people information about the home, has been updated to reflect the services provided. This gives people all the important information they need about the home before they make a decision. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 8 The care plans and risk assessments have been improved with more guidance for staff. They could be personalised even further. The way the home manages medication has improved but there were still some recording, like codes when medication was omitted, that was not used consistently. Staff recruitment files were much more organised. Some of the quality monitoring questionnaires had been sent out to people and staff to gain their views about the home. Questionnaires need to be sent out to professional visitors to the home. It was important to gain a full range of people’s views about how the home was managed so shortfalls could be addressed. Staff training has improved even further and the manager has developed a staff training plan for the coming year. It is important that staff have the right skills to be able to support people in their care. The amount of care staff that have gained a national vocational qualification in care (NVQ) at either level 2 or 3 has increased to 55 . This is a good achievement and has exceeded the required target of 50 . What they could do better: Care plans could be personalised even further to ensure staff write down the specific knowledge about residents that they currently hold in their heads. This will ensure any potential new staff member will have this information straight away. Recording of some medication could be improved to ensure codes for omitting medication are used consistently, medication is carried forward from the last MAR to the current one and topical products are signed when applied. Verbal references must be accurately recorded and followed up by written ones. This will enable a completed recruitment process and provide confidence that potential staff members are right for the role of caring for vulnerable adults. The manager should continue to work towards the Registered Managers Award and apply for registration with the Commission. Questionnaires should be sent to visiting professional to gain a full range of views about how the home is managed and a month by month quality monitoring plan would enable the manager and deputy to structure the QA process more effectively. Staff induction should also include skills for care induction standards for new staff that have not already gained an NVQ in care at level 2 or 3. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 9 Care staff should have at least six formal one to one supervision sessions a year. This will give the staff an opportunity to speak to the manager about issues and also assist the manager in recognising people’s strengths and development needs. 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. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that potential residents have full information prior to admission in order for them to make a decision about whether the home is right for them. People have their needs assessed prior to admission. This enables staff to be sure they can meet the persons’ needs. EVIDENCE: Since the last inspection the manager has updated the homes’ statement of purpose and service user guide. Both documents are on display in the home and copies are available for people to take away after their initial visit to the home. There is also a checklist for people to consult and complete when they Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 12 view the home. This is good practice as it prompts people to ask particular questions and check things out. We examined three care files during the visit, two of which were for people recently admitted to the home. There was evidence of assessments and care plans completed by care management which were received prior to admission, or in the case of an emergency admission, on the day the person arrived. Even for the emergency admission there was evidence that the manager had visited the person at their previous home. The assessments were used to assist the manager and staff in the decision-making process regarding whether the home could meet the persons’ needs. For planned admissions, the process remained unchanged. People were encouraged to visit the home to look around, and the home provided them with information about services. The first four to six weeks of any admission were seen as a trial period after which a review was held to discuss the stay and whether permanent residency was required. The home offered a respite service to give people the opportunity to try the home and get to know staff and the homes way of working during regular visits before making any final decision about permanent residency. The manager is reviewing the homes current pre-admission assessment documentation to make it more user-friendly for staff. It was suggested that a review page could be added to the documentation to prompt staff to keep assessment information about residents updated. The home does not provide intermediate care services. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that peoples’ health and social care needs are planned for and met in ways that promote privacy, dignity and independence. Medication was well managed but care is needed when recording some aspects of it. EVIDENCE: We examined three care files during the visit and all had plans of care that gave staff guidance regarding the tasks they needed to complete. Two of the care plans were for residents recently admitted to the home and staff members were a little behind in their monthly evaluations of them. It is important for the evaluations to take place so that any changes in need can be quickly reflected in the care plan especially during the initial few months of residency. The care plans covered each area of daily living and included some preferences and some details about what the person could do for themselves. However, the Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 14 care plans could be personalised even further and this was discussed with the manager and deputy manager. Staff members spoken with were very knowledgeable about peoples’ needs. They described ways in which they would promote independence, privacy and dignity and this was confirmed in discussions with people. Residents were smartly dressed and looked well cared for. We received seven surveys from residents and all stated they received the care and support, and medical care they required, ‘always’. One regular visitor who completed a survey stated, ‘they gave my friend thirteen months of happiness and care when she had given up. I am grateful for that and now I visit her friends’. When asked what the home does well a relative stated, ‘care and attention’. Two visiting social care professional told us how the staff work with their clients and follow care plans, ‘the staff manage the issue very well – they work with her (resident)’ and ‘they have taken people from other homes that couldn’t manage and there have been no issues here – the approach of the manager and staff is good’. They also told us that recording had improved. Recording in daily records covered bathing, personal care, meals, fluids and the persons’ mood and what they had participated in that day. We saw risk assessments for moving and handling, the use of bedrails, potential risk to pressures areas and swallowing difficulties for one person, the need for staff to accompany a resident when in the community for another person and the potential risk for one person to wander from the home. One resident had received input from the dietician and a nutritional monitoring tool had been left for future use when required. People had access to a range of health professionals for advice, guidance and treatment. One resident spends a portion of their time in bed but had not developed any pressure sores. Specialist equipment was in place and monitoring charts were completed to ensure they were turned two hourly when in bed and that they were offered hourly fluids. Since the last inspection the home has purchased sitting scales and staff are able to weigh people unable to use the standing scales. When checked the records showed that peoples’ weights were stable. The deputy manager confirmed that two residents followed a healthy eating plan, with a moderate degree of success, as they wished to lose weight. Reviews of care plans are completed with residents, their relatives and local authority representatives present. A comment from the latter was, ‘reviews are planned and there are never any problems with care’, Generally medication was managed well. Each resident had an information sheet with a photograph, list of any allergies, any specific needs and GP information. It was stored appropriately, stock controlled and people received Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 15 their medication as prescribed. There were some recording issues to be actioned. For example, medication not delivered in cassettes should be carried forward onto the new medication administration record and codes should be used consistently when medication is omitted. Staff should record when prescribed topical products are applied and a risk assessment for one resident needed updating. One person was prescribed a regular dose of laxative but frequently declined. This needs to be checked with the GP to see if an, ‘as required’ alternative can be prescribed instead. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a happy and relaxed atmosphere and were supported to live fulfilled and occupied lives. Routines were flexible and individual choice and decision-making was promoted. People were provided with well-balanced meals, sufficient to meet their nutritional needs. EVIDENCE: The activity log had likes and dislikes for each person identified and information about the activities they participated in. Residents in the home continued to access a range of community facilities and participated in inhouse activities. There were lots of signs of wellbeing and it was clear that the manager and staff team had developed very good relationships with the residents, and their family and friends. Local clergy hold monthly services in the home. One person continues to use a season ticket for the ‘Tigers’, his life long football team, and attends the local Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 17 KC (football) stadium for all the home games. Some people were still able to visit local shops and library unescorted and some continued to manage their own finances. Several residents accessed a day centre and on the day of the inspection two people were enjoying a trip out arranged by the centre staff. The manager has also started a swimming club and escorts two residents on a regular basis. Other residents are escorted to shops and local venues. The manager told us that he and the staff liked to be spontaneous with the residents and one day they closed the home and all went to Paull, a local beauty spot, for a drive out and a pub lunch. Although a feat of organisation, the residents thoroughly enjoyed it. A visiting professional also confirmed this spontaneity, ‘it’s not a regimented place – they do things ad hoc like all have fish and chips for tea or shut the home and go to Paull in a minibus’. One resident also told the manager he had never been in a carwash so this experience was arranged for them. The manager joked they did ensure the resident was in a car! This type of light-hearted humour and focus on residents’ needs, wishes and goals was apparent throughout the day in conversations with all staff, residents and visitors. The atmosphere was cheerful and homely and the whole staff team took pride in trying to improve residents’ quality of life. Comments from a range of people were, ‘residents are so happy, it’s a joyful establishment, a home from home and has a very good atmosphere’, ‘its friendly, homely and has a family atmosphere – its very welcoming’, ‘I’ve come here for a break and it’s my first time in a home – I really like it’, ‘everyone’s friendly here’, ‘it’s a fine home’, ‘I’m happy here – Lisa and Dean (deputy and manager) are lovely people’, ‘the lasses are really nice – I have a good laugh with them’, ‘all the staff are great’ and ‘the wellbeing and happiness of all the residents can be seen by all. They keep everyone up to date on news and nothing is too much trouble for the staff’. There was clear evidence that people could make choices about aspects of their lives and were consulted on important issues, such as how to decorate and personalise their bedrooms and communal spaces, what time they wanted to rise and retire, their meals, bathing times, the activities they participated in and how much contact they had with family and friends. People told us in surveys and discussions that they liked the meals, ‘the food is smashing’, ‘they look after me well – we get three meals a day’, ‘I enjoy the food’, ‘the food is beautiful – we have a lovely cook and there is no shortage’ and ‘the food is very nice – we get plenty to eat and drink’. Special diets could be catered for and staff consulted with dieticians for specialised advice. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that residents felt able to complain and protected them from abuse by staff training and adherence to polices and procedures. EVIDENCE: The home had a complaints policy and procedure that was on display in the entrance and there were complaint forms for people to fill in and give to staff members or the manager if people wished to make a formal complaint. The procedure on display contained brief details of what people could do and who to speak with, if they were unhappy with the service provided in the home. The full complaints policy in the homes statement of purpose stated timescales for resolution of the complaint. The service user guide also gave the address and telephone numbers of the local authority complaints department and the Care Quality Commission. The Commissions information has been changed recently and this needs to be reflected in the complaints information. The manager stated that they tried to deal with any complaints quickly before they reached a formal stage. Staff members stated they were aware of what to do if people raised concerns with them. People spoken with stated they felt able to complain if they were unhappy and they continued to see the manager and proprietor on a regular basis. This was Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 19 confirmed in documentation completed by the proprietor during his visits to the home. All seven surveys from residents stated they knew how to make a complaint if they needed to. Surveys from relatives stated they were aware of how to complain and that any issues raised were dealt with appropriately. The Commission has not received any complaints about the home since the last inspection. According to the homes’ annual quality assurance document, and records examined during the visit, no complaints have been received by the home. All staff have completed a safeguarding of adults briefing facilitated by the local authority and have signed to say they have read and understood the policy and procedure for safeguarding vulnerable adults from abuse. In discussions staff were clear about what to do should they witness any abuse or poor practice. The manager has also obtained a training video and has sessions planned with staff. Some staff have also completed more in-depth training with the local authority and the manager and deputy manager have completed training regarding their role in referral and investigation. Staff had also received briefings on mental capasity legislation and the manager and deputy manager completed training in deprivation of liberty safeguards with the local authority. In September 2008 a staff member made an allegation about poor care practices and the manager being slow to request a hospital admission for a resident. The allegation was fully investigated but was not substantiated. The local authority visited the home at the time and the Commission completed a random inspection. The same staff member made a further allegation that alcohol had been removed from a residents’ room without their consent. The removal of alcohol for safekeeping had been observed during the random inspection and was part of the residents’ care support plan. It had been fully agreed with the resident, who confirmed it in discussion with us during the visit. All staff had also been aware of the plan. It was reported to the manager that a staff member fell asleep at night and ignored a resident whilst they had a cigarette break. The staff member was dismissed. The manager was advised to make a referral to the protection of vulnerable adults register for possible inclusion of the staff members’ name. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements in the environment have improved the quality of life for people. It is a safe, clean, pleasant and homely place for people to live in. EVIDENCE: There has been significant improvement in the environment since the new owner took over the home. A redecoration and refurbishment plan has been adhered to and it was clear that residents’ needs have been at the focus of the plans. The home was clean, fresh and had no unpleasant odours. The dining room has been transformed into a large shared bedroom mainly to provide additional space for one resident who spends a portion of their day in bed. It has been re-carpeted and redecorated and a ceiling track hoist has been installed to aid moving and handling. The person likes to watch television Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 21 and he has been assisted to buy a large television for his bedroom wall. The bedroom overlooks the garden and patio doors ensure he has a much improved view when he is in his room. This has had a big impact on the persons’ quality of life and has given more space to the person that shares the bedroom. The main lounge has dining tables and chairs at one end near the kitchen and comfortable chairs and a television at the other end. New carpets have been fitted and the room redecorated. A shared bedroom at the front of the home has been completely refurbished into a smart quiet lounge. This, combined with the small seating area near the treatment room, enables the residents to have alternative quiet areas away from the bustle of the main lounge. Several bedrooms have been completely refurbished with new carpets, curtains, furniture and redecoration, and they look very pleasant and homely. The bathroom on the first floor annex, used by more ambulant people as there are two steps leading onto the landing, has had new flooring fitted and is due for redecoration when the proprietor returns from holiday. The top floor bathroom has had new flooring and paintwork freshened up. All bedroom doors have had privacy locks installed and over-bed tables purchased for each bedroom. A new chair lift to the first floor has been installed in one of the two houses that make up the home; the other house already had a chair lift and there is a passenger lift to all three floors. The exterior of the house has been repainted making it look smarter, and guttering has been replaced at the front. It is due for replacement at the rear of the property in the next phase of refurbishment. The upstairs corridors are also due to be redecorated. People spoken with were very happy with their new home, with staff and the manager clearly thrilled with the improvements and the affect this has had on residents. Comments from people were, ‘when I first started here it was dim – there’s lots of things ongoing’, ‘the improvements have been uplifting’, ‘there have been lots of improvements – we are moving on’, ‘it’s a lovely home – I like to sit in the quiet lounge’, ‘it’s a clean home’, ‘I’m very happy with my new room’ (now en-suite), ‘I like my new bedroom and lounge’ and ‘it’s a nice house and a nice area’. All seven surveys from residents stated the home was fresh and clean, ‘always’. A visiting professional stated, ‘the décor has improved and the second lounge is lovely – its clean and smells nice’ and a relative said, ‘everything is so clean and there are no smells – it must be a difficult job at times’. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported by caring and appropriately trained staff. The process of gathering references could be improved to enable full confidence in the recruitment processes. EVIDENCE: There were seventeen people living in the home at the time of the site visit. Some of the residents had quite low level needs and were independent with many aspects of their care. Discussions with care staff members indicated that there were two care staff members and the manager on duty during the day, and two care staff at night. The manager had calculated the hours provided by the home as 350 care hours a week, which includes fourteen hours that the manager completes as care hours. This is within the guidelines produced by the residential care staffing forum which, for the number and needs of the current residents has been calculated at 324 hours per week. Should the needs of residents change in any significant way or if the home admits another resident, this will affect the staffing hours and the situation needs to be closely monitored. The home employs sufficient catering and domestic staff. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 23 People were complimentary about the care received from staff, ‘the staff look after me and Mr Dean takes me to Boyes’ (a local store), ‘the boss is great and all the staff are lovely’, ‘they look after me and see to anything I want’, ‘everyone is friendly here’, ‘the staff are alright as far as I’m concerned’, ‘the staff are great’, and ‘the staff do a good job’. Six of the seven surveys received from residents stated staff listened to people and acted on what they had to say, ‘always’, one person said this was, ‘sometimes’. Two visiting professionals spoken with on the day, and a survey received from another, said the home had a very friendly atmosphere. One said, ‘I review eight residents care and they are all happy here – there are never any problems’ and another stated, ‘the manager is hands-on and the staff professional – they have a reputation for managing people who may have difficulties in other homes’. A relative said, ‘nothing is too much trouble for the staff’. A training plan was in place that covered mandatory training such as medication, basic food hygiene, first aid, infection control, moving and handling, fire and safeguarding adults from abuse. Individual logs evidenced that courses had been attended or were booked for staff to attend. Some staff had completed service specific training such as dementia care, nutrition, mental capacity legislation and deprivation of liberty. One staff member had completed a, ‘train the trainer’ course in infection control and so was able to cascade this training to other staff. The home had also obtained a selection of DVD’s on conditions such as Parkinson’s disease, leg ulcers and sensory issues, and areas such as infection control and safeguarding adults from abuse. Staff watched the recordings then completed questionnaires to test their comprehension. We received four surveys from staff members and had discussions with two on the day. They told us that they received training that was relevant and kept them up to date. The home had 11 care staff and six had completed a national vocational qualification in care at level 2 or 3, which equates to 55 . This was an improvement since the last inspection and an achievement for the home as it exceeds the target of 50 of care staff trained to this level. The induction of new care staff gives an overview of the home and its policies and procedures. However new staff, that have not already obtained an NVQ in care, should complete skills for care induction standards to evidence that their competence in basic care tasks and knowledge has been checked. Staff recruitment was generally sound, as application forms, criminal record bureau checks and references were obtained. The manager had received verbal references for one candidate but written, follow up references had not been received yet. These need to be chased up. Recording of the verbal reference should reflect the actual conversation. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 24 The two staff records checked showed that they had been started on shift after an initial povafirst check but prior to the return of the criminal record bureau check (CRB). There is a particular problem locally with CRB’s taking a very long time to be returned and leading to staffing difficulties for some homes. It has been agreed that when staff start work prior to the return of the full CRB they must be stringently supervised. The deputy manager told us that new staff members were always paired with more experienced staff until the CRB was returned. Staff recruitment files were much more organised and information easier to locate. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers’ fitness to manage the home cannot be tested until they proceed through registration with the Commission. However, in view of the findings from the site visit and comments from residents, staff, relatives and professional visitors to the home we are confident the home is well managed. EVIDENCE: The manager has had over fifteen years experience in the care sector as a team leader in a nursing home, and also in a community day care centre. They had gained a National Vocational Qualification in care at levels 2 and 3 and are progressing through their Registered Managers Award. There was evidence that he has completed training relevant to his role. For example, moving and Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 26 handling, fire safety, first aid, dementia and sight loss, mental capacity legislation briefings and deprivation of liberty safeguards. He has also completed a safeguarding of adults from abuse course, facilitated by the local authority, especially for home managers. The manager stated he was well supported by the proprietor who continues to be involved in the home and visits regularly to complete maintenance tasks, decoration, support the staff team and chat to residents. The manager is in the process of gathering the information required in order for them to proceed with an application to register with the Commission. In surveys the staff told us they had regular contact with the manager as he was, ‘hands on’. They said they were kept informed and up to date about things with regular meetings and had a handover diary to pass on information to each other. Staff described the manager as very supportive, ‘he’s a good manager and you can ring him and Lisa (deputy) at weekends’, and ‘Dean is lovely – communication has really improved’. Morale was high and the atmosphere relaxed in the home, which was down to good management. Other comments in surveys from staff were, ‘I love my job and enjoy coming to work, as it’s always a pleasure’ and, ‘I think the day to day running of the home is good’. People that lived in the home knew the managers’ name, which told us he made his presence felt about the home and a visitor said, ‘I cannot fault anything at Somerville House and I have seen other homes. I always enjoy my visits’. It was clear that the manager made an effort to be involved with residents and improve the quality of their lives. The manager had put a staff supervision plan in place and everyone had a supervision contract so there had been discussion with staff about what was expected. The manager and deputy manager was to share the responsibility of staff supervision and dates have been arranged. The plan now needs to be implemented. Staff told us they were supervised during their day to day work but there needs to be evidence of one to one formal discussions covering topics such as, the philosophy of the home, care practices and training and development. The quality assurance system had been reorganised and new surveys produced for people that live in the home, their relatives and professional visitors. To date surveys have been sent out to residents and staff. Audits of the environment were undertaken and the manager audits training and medication. Any repairs or maintenance issues were dealt with as they occurred. A month by month quality assurance plan would help the manager and deputy manager to structure the quality monitoring process and prevent things being missed. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 27 The home had completed the annual quality assurance assessment (AQAA) required by the Commission but the information included was still rather brief in parts and could be improved upon to evidence the manager was fully aware of what the service does well and how they evidence this and what shortfalls needed to be addressed. People were encouraged to look after their own financial affairs. However, the home continued to keep small amounts of personal allowance for most people and assisted some people to budget their amounts. Individual records were maintained and receipts obtained for any purchases made by staff at peoples’ request. Fire alarm tests were carried out and the manager confirmed that equipment was checked. We were unable to locate the current log that evidenced fire doors, emergency lights and fire equipment had been checked. Residents had very few accidents but those that had occurred were recorded appropriately. The AQAA document evidenced that equipment used in the home was serviced as required. The new laundry needs to display a very hot water sign for staff and be inaccessible when not in use. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 X 3 Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement Verbal references must be accurately recorded and followed up by written ones. This will enable a completed recruitment process and provide confidence that potential staff members are right for the role of caring for vulnerable adults. Timescale for action 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans could be personalised even further to ensure staff write down the specific knowledge about residents that they currently hold in their heads. This will ensure any potential new staff member will have this information straight away. Codes used on the MAR charts to detail why medication has been omitted should be used in a consistent way. This will prevent confusion for staff and avoid mistakes. The amounts of remaining medication received on a previous MAR chart should be carried forward to the next DS0000070519.V376913.R01.S.doc Version 5.2 Page 30 2 3 OP9 OP9 Somerville House 4 5 6 7 OP9 OP30 OP31 OP33 8 OP36 one. This will enable a clear audit of use and stock control. Prescribed topical products should be recorded when applied. This will evidence people are receiving the care. Staff induction should also include skills for care induction standards for new staff that have not already gained an NVQ in care at level 2 or 3. The manager should continue to work towards the Registered Managers Award and apply for registration with the Commission. Questionnaires should be sent to visiting professional to gain a full range of views about how the home is managed and a month by month quality monitoring plan would enable the manager and deputy to structure the QA process more effectively. Care staff should receive a minimum of six supervision sessions a year in line with national minimum standards, which should cover all aspects of practice, philosophy of care in the home and career development needs. Somerville House DS0000070519.V376913.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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