Care Home: Southbourne Residential Care Home

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What the care home does well Southbourne is an attractive, warm and comfortable house, with a safe and pleasant garden. The home provides en-suite accommodation for people in mainly single occupancy rooms, although there are rooms available for a couple to share if they wish. Staff were kind, understanding, and were available when needed. They were engaging well with residents while carrying out daily tasks. Social activities were provided regularly, and people enjoyed their meals. An activity organiser provided individual social attention at least once a week, and other staff provided group activities during the afternoons. The laundry service was very good. Staff told us they enjoyed coming to work, and felt they worked well together as a team. They found that they were reliably kept up to date with information about any changes in residents’ needs. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 People receive a full assessment and opportunities to visit the home before making a decision about whether to move there. Some people at the home have previously visited the home for day and respite care before making a decision about moving in. What has improved since the last inspection? Care planning had been improved since the last inspection. All were up to date, with information staff would need to provide care appropriately. They felt better informed, as the home owner had met with them at their daily handover meetings. They felt this helped good team work, and gave staff more opportunities for their voice to be heard. Information had been gathered from residents with respect to their individual interests. Medication is administered with more care. Some staff training had been provided, a book was being used to record properly the return of unused medication to the pharmacy, and we found that the records kept were accurate. The manager was putting into place a monthly audit, to ensure that accuracy was maintained and a full audit trail could be completed. Recruitment practice is more sound and secure, with checks being made, to avoid potential harm to residents. A structured Induction training had been introduced, and all staff had completed it, to assure the home owner that they had the basic understanding of good practice. In-house training resources had been provided, to make a start on meeting staff training needs. What the care home could do better: Care plans should be further developed in consultation with residents and their families/ representatives. This is to ensure they reflect their needs, wishes and aspirations. The good work that had been done in gathering information about peoples’ personal interests needed to be translated into personalised social engagement and activities throughout the week. Meals served were tasty and nutritious, but consideration could be given to enabling people to have more choice in what they eat. The Manager should keep a record of minor concerns, so that she can show what has been done as a result, and so she may see whether any mistake is repeated.Southbourne Residential Care HomeDS0000069861.V378360.R01.S.doc Version 5.2 Staff training was needed in Fire Safety and in Moving and Handling. These shortfalls could potentially place at risk people who live and people who work at Southbourne. Further training was also needed to enable staff to improve their performance, and to improve the lives of the residents. Included in this was a fuller training in good care of people with dementia, including person centred care, and training in communicating with people who have memory loss. The home still needed a system for reviewing the service, to include the outcomes of the audits carried out in the home, feedback received from residents and other interested people, and any improvements that the management team are planning. This would demonstrate how residents’ lives could be improved, and allow for discussion. It could also be used as a basis for showing in the future the improvements that had been made, to enable people to appreciate the efforts, and evaluate them. Key inspection report CARE HOMES FOR OLDER PEOPLE Southbourne Residential Care Home Cary Avenue Babbacombe Torquay Devon TQ1 3QT Lead Inspector Stella Lindsay KI Unannounced Inspection 10:40 7th January 2010 DS0000069861.V378360.R01.S.do c Version 5.3 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. Southbourne Residential Care Home DS0000069861.V378360.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 Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southbourne Residential Care Home Address Cary Avenue Babbacombe Torquay Devon TQ1 3QT 01803 323502 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) southbournecarehome@btconnect.com Rosepost Healthcare Limited Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21), of places Physical disability over 65 years of age (21) Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum 21 places Dementia, aged 65 and over (Code DE(E) - maximum 21 places Physical disability, aged 65 and over (Code PD(E) - maximum 21 places The maximum number of service users who can be accommodated is 21. 7th July 2009 2. Date of last inspection Brief Description of the Service: Southbourne Residential Care Home is a detached residence that stands in its own grounds, it provides 24-hour residential care for persons in the category of Old Age, not falling into any other category, Dementia over the age of 65 years and Physical disability over the age of 65 years. The home’s accommodation is set over two floors, there are 17 single bedrooms, and two for shared occupancy. All rooms have en-suite facilities. A large comfortable lounge is available, meals are taken in a separate dining room at small tables seating up to four persons. A stair lift is provided for people who have mobility problems. At the front of the building there is a large hard standing car park, which has the capacity to take several vehicles. There are gardens with a large lawn area to the rear and sides of the home. Southbourne is situated in the Babbacombe area of Torquay and is within level walking distance of local amenities and the Babbacombe downs. The weekly cost of care at Southbourne is between £325.00 and £360.00. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over three days in January 2010. The inspector was accompanied by an Expert by Experience on the first day. An ‘expert by experience’ is a person who either has an experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Their views are included in the text. During this inspection we toured the premises, shared lunch with residents, and spent some time in the lounge. The Expert by Experience met with nine residents, either in their rooms or in the lounge. We met with four other residents and one visiting relative, the home owner Mr Vaughan Owen, the new Manager, and eight other members of staff on duty. We looked at care records, staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Southbourne. What the service does well: Southbourne is an attractive, warm and comfortable house, with a safe and pleasant garden. The home provides en-suite accommodation for people in mainly single occupancy rooms, although there are rooms available for a couple to share if they wish. Staff were kind, understanding, and were available when needed. They were engaging well with residents while carrying out daily tasks. Social activities were provided regularly, and people enjoyed their meals. An activity organiser provided individual social attention at least once a week, and other staff provided group activities during the afternoons. The laundry service was very good. Staff told us they enjoyed coming to work, and felt they worked well together as a team. They found that they were reliably kept up to date with information about any changes in residents’ needs. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 Page 6 People receive a full assessment and opportunities to visit the home before making a decision about whether to move there. Some people at the home have previously visited the home for day and respite care before making a decision about moving in. What has improved since the last inspection? What they could do better: Care plans should be further developed in consultation with residents and their families/ representatives. This is to ensure they reflect their needs, wishes and aspirations. The good work that had been done in gathering information about peoples’ personal interests needed to be translated into personalised social engagement and activities throughout the week. Meals served were tasty and nutritious, but consideration could be given to enabling people to have more choice in what they eat. The Manager should keep a record of minor concerns, so that she can show what has been done as a result, and so she may see whether any mistake is repeated. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.2 Page 7 Staff training was needed in Fire Safety and in Moving and Handling. These shortfalls could potentially place at risk people who live and people who work at Southbourne. Further training was also needed to enable staff to improve their performance, and to improve the lives of the residents. Included in this was a fuller training in good care of people with dementia, including person centred care, and training in communicating with people who have memory loss. The home still needed a system for reviewing the service, to include the outcomes of the audits carried out in the home, feedback received from residents and other interested people, and any improvements that the management team are planning. This would demonstrate how residents’ lives could be improved, and allow for discussion. It could also be used as a basis for showing in the future the improvements that had been made, to enable people to appreciate the efforts, and evaluate them. 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. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full information is provided about the service, visits are welcomed, and accommodation is only offered following assessment, to be confident that peoples’ needs can be met at the home. EVIDENCE: Southbourne has produced a Statement of Purpose, which was on display in the entrance hall. This includes detailed information about the service provided. A brief brochure, with photo of the home, can be distributed to interested people. The home owner told us that his normal practice is to visit prospective residents, to hear directly from them, and bring information and observations Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 10 to the staff group for consideration of their current capabilities. He said he encourages prospective residents and their families to visit. One resident had been admitted since the previous inspection. We saw that professional assessment had been carried out with respect to their care needs. We saw letters that the home owner had sent, to confirm that they were able to offer a service. We also saw that Contracts of Residence had been provided, to be clear about what is included in the fee, and any notice period. We saw that they had been signed by residents or their representatives. We advised that it should also include the room which was to be occupied. People now living at Southbourne responded very positively with comments including, ‘If I have to be in somewhere then this one is fine for me’, ‘I like it here’ and ‘I’m grateful I’ve got a nice place and can stay here’. The home does not cater for intermediate care. This means that they do not provide a specialist intensive rehabilitation service with the aim of returning the person to the own home. The home does provide respite care some limited day care. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care was being provided carefully and consistently, with records kept. Care planning could be improved by further consultation with residents and their families. Medication was being administered with care, to promote the good health of residents. EVIDENCE: A file had been compiled on behalf of each resident. We looked in detail at one, and at two others in less detail. We saw that they started with the resident’s ‘personal story’, to give staff information about their earlier life, occupation and interests, and their own family. Each resident had a care assistant designated as their key worker, and we found that staff were able to tell us about the residents for whom they were the key worker. The care plan followed, divided into sections for different tasks, including – personal care and dressing, hygiene and bathing, toileting, skin care, tooth Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 12 care, fingernails, and sight. We saw that these had been reviewed regularly and up dated, except that one resident was being cared for in bed, and the new instructions for staff had not been written in to the plan. Charts had been started and properly kept with respect to fluid intake and pressure relief. These showed that due attention had been given to maintaining well being and keeping their skin intact. The Continence Nurse had been supplied with information in order that continence equipment might be prescribed, and the District Nurse had visited, and had arranged for delivery of an air mattress. We did not see evidence that residents or their relatives had been consulted. The Manager confirmed that this was still work to be done. We did, however, see a family member involved in caring for their relative, including helping them at mealtimes. All the residents seen were cleanly dressed, the men were clean-shaven and attention had been paid to the ladies hair. People appeared to be very content and secure in their environment. We saw that risk assessments had been carried out with respect to peoples’ mobility, and help they may need with standing, walking, climbing stairs, or being moved by staff using mobility equipment. We saw that equipment used in the home had been assessed by a physiotherapist in October 2009. Three residents who had mobility difficulties had been given exercises to help maintain any movement, and staff had completed charts to show these were being carried out. Staff had in a systematic way observed and recorded residents’ response to a questionnaire, to demonstrate the extent of their memory loss. The home owner told us this had been important in demonstrating to the staff the extent of the residents’ disabilities, to help them understand and respond appropriately to their needs. We saw how the medication was stored and administered. Record keeping had been improved, and now all medicines returned to the pharmacy were recorded, to enable the responsible people to know what stocks they still had on the premises. We checked some supplies and found all the ones we checked were accounted for. We recommended to the Manager that she does a monthly audit to check and record the balance of each medicine, so that she may see that they have been correctly administered. All interactions that we saw between staff and residents demonstrated that staff were treating residents with respect. The staff were seen to engage with residents beyond the essentials of the task in hand, and we saw residents respond favourably to members of staff. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although new ways of working were being introduced, to provide a better quality of social engagement and improve the lives of residents who had dementia, they had not yet been fully put into practice. A good variety of tasty and wholesome food is provided, though people were not offered choices. EVIDENCE: Everyone was of the opinion that they chose the time of their retiring and rising. One person said that he was usually woken with a breakfast tray at 8am ‘which was fine by me’. Residents said they were pleased with of the efficiency of the laundry which is done overnight, and delivered consistently to the right person. The home employs an activity organiser, who is a qualified occupational therapist, to visit once a week to promote good social engagement. She had come in to the home for additional time during this inspection. We saw that she provided one to Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 14 one contact with some of the residents, and was engaging with people in a meaningful manner. She recorded not only the activities that she engaged people in, but also their response to her and to the activity. This was good practice, and a good example for others. The occupational therapist and some other staff had asked residents about their interests and recorded these, in order to base future activities on peoples’ interests. Using this information, further ideas were being developed for enabling good social engagement throughout the week, but were still at an early stage. We were told that three residents had enjoyed baking during the weekend, though a resident who had expressed an interest had not been included this time. Residents who completed surveys all said that they were only ‘sometimes’ offered activities they could join in. A person had recently been appointed to work four days a week as ‘staff trainer and activities organiser’ but impact of this had yet to be seen by the residents. The home owner told us that as of the following week, this staff member would be increasing their working hours, and would be introducing a new initiative in personalised activities. There is a people carrier available for this home and a neighbouring home under the same ownership. Only the home owner is able to drive it. He had recently taken people on a trip to see the Christmas lights. Staff were not available to take people out individually, for example, to buy clothes for themselves. A new cook was appointed subsequent to the last inspection and was working to a four week fixed menu. This showed that a good variety of meals were provided, but a choice of main meal was not offered. The cook was aware of dislikes and dietary needs, and was able to provide alternative meals. The teatime meal alternated daily between soup and sandwiches and items on toast or pies prepared before the cook leaves at 2pm for others to finalise and serve. Fresh meat, fruit and vegetables were purchased locally. Generally residents were complimentary about the food saying, ‘Food’s pretty good but I must say I will eat anything’, ‘On the whole the food is good’, ‘Food is very good, I can’t find anything wrong with it’. No one was aware of having being asked what his or her favourite meal was. One person said they would like to have a ‘proper pasty with green vegetables’ and also thought that soup should be available every tea-time ‘for us old people in this cold weather’. The home owner told us that he had intended residents to be offered a choice of soup or a hot snack every evening, but this had been interpreted by staff as one or the other to be offered on alternate evenings. Some people took lunch in their bedroom, others in the dining room and one in the lounge. The lunch was a tasty, hot homemade chicken and leek pie served with mashed potatoes, carrots, green beans, cabbage and gravy. Dessert was fruit and custard. Diners appeared to enjoy the meal and everyone said they had enough to eat. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 15 The plated meals were brought from the kitchen by a carer shortly after people took their seats in the dining room, so people were not waiting around. Assistance was given in the appropriate manner, including to those who were unable to feed themselves. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 16 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. Residents were protected by sound policies and staff awareness, and management were prepared to take action when necessary. EVIDENCE: Southbourne had a complaints procedure which was available in the service user guide in the entrance hall. Forms on which to record a formal complaint were available in the office, but none had been received, either by the home or by the CQC since the last inspection. In surveys returned to us, one resident said they did not know how to make a formal complaint, and two said they did not know who speak to if they were unhappy – but one of these said it was because they were ‘happy here’. We recommended to the Manager that she keeps a record of when minor concerns come to her notice, so that she can show what has been done about it, and so that she may see if it happens again. The home had shown that when incidents had happened that affected the well being of residents in the home the home owner had taken appropriate action. The new Manager was aware of what had to be done if any allegation of abuse was brought to her attention, and had the contact details of the safeguarding team available in the office. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 17 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, 22, 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. Southbourne is an attractive house, providing a clean and comfortable home for the residents. Some features needed introduction to make the house fully suitable for the occupants’ particular needs. EVIDENCE: The building was seen to be in a good state of repair and provided a clean, comfortable, warm environment and homely atmosphere. There is a choice of two adjoining lounges with full-length windows affording views into the garden and a secondary seating area (again with views into the garden). There is a separate dining room, where residents could sit at small tables that seat four. There is a large and pleasant enclosed garden with seating and easy access. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 18 There were call bells in each room, but staff needed to go to a central point to cancel them, not the residents’ bedroom. The home owner told us that a new system is on order, and due to be fitted later in the month of this inspection. This will improve the already good staff response time when residents need assistance. There were no alarms to alert staff when people were on the move. A risk assessment had been done on behalf of one resident who occupied an upstairs room, and was apt to walk downstairs without asking for help. Risk assessment showed that staff attention was needed; provision of an alarm to alert staff should be considered. Bedrooms have been personalised to varying degrees. The home owner told us that when the new call bell system is in place, he will provide numbers and other distinguishing features for peoples’ doors, to help them find their own room. He also told us he will fit suitable door locks for privacy and dignity, which may be locked from inside without a key (with a simple knob) and accessible by staff from outside in an emergency. We saw disposable gloves for staff in bedrooms where personal care was given, and liquid soap was available, but paper towels had not been provided. The laundry was in good order, with easily cleanable tanked walls. The kitchen floor was damaged, and could cause a risk to health as it was not cleanable. The home owner agreed to provide a safe floor covering, in advance of his planned kitchen improvements. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff, well motivated and working well together. However, they needed further training to ensure they would provide a safe and suitable service to the residents. EVIDENCE: The outcomes of the interactions between staff and residents indicated the staff had good knowledge of the needs and wishes of the residents. People spoke well of the staff saying, ‘The staff are very good’, ‘The girls are good, gentle and kind’, ‘They look after me very well’, and ‘I get on with the staff alright, they are helpful and gentle’. We found that peoples’ needs were being met promptly, which demonstrated that enough staff were available. A resident who chose to remain in their bedroom said, ‘I never use the call bell as the girls are always popping into my room to see me’. Others said the call bell response time was almost immediate. We were given a staff rota which showed that absences were being covered. Staff told us this was an improvement, which they appreciated. There are now a minimum of three staff on duty throughout the day, which is essential for peoples’ safety, as some residents needed two staff for their personal care, while others Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 20 needed constant supervision to assure their well being in the lounge. From 8pm till 8am there were two awake night care staff. The home owner had been implementing the recruitment policy, and we found that all checks had been made to protect residents from potential harm, and all documents required by the regulations in respect of recently recruited staff were available for inspection. An Induction programme suitable to meet the Skills for Care standards had been introduced, and all staff had been required to complete it, in order to assure the home owner of their basic understanding of good practice. Some still awaited evaluation. A new administrative assistant had been appointed, and given responsibility to arrange staff training. A box file had been provided for each staff member, where they could keep their certificates, and information that would help their development in their role. It was not easy to see which staff needed mandatory training to be up-dated. She had started the process of setting up charts to show training needs as well as achievements, so that together with the manager she would be better able to make arrangements to keep training up-dated. In-house training in dementia care had been provided, but apart from the most inexperienced staff, people had not found it very helpful. There had not been a trainer experienced in good care of people with dementia to lead the training. Further training should be provided, in order to develop good practice in the home. The home owner said that he has been put to expense when staff have failed to attend training they had applied for. Management should find what is preventing their attendance, and work together on ways of improving this. Other DVDs have been used for in-house training, including health and safety, and managing diversity, and safe administration of medication. While such learning makes a contribution to staff knowledge backed up with written tests, we found staff were not confident that it improved their competence in their jobs. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team are keen to develop good practice in care of people with dementia, to improve the quality of life for the residents at Southbourne. Systems are in place to check for safety. Some staff training was outstanding, in areas that could potentially affect the health and safety of people who live and people who work at the home. EVIDENCE: Mr Vaughan Owen is the registered provider of this home. Since the resignation of his former registered manager he has been in day to day control of the home. A new Manager took up her position five weeks before this Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 22 inspection. She has achieved the Registered Managers Award and NVQ level 4 in care, and has undertaken other related training. She has previous experience of managing care, but is new to the care of people with dementia and was researching current ideas of good practice with enthusiasm. A staff member had recently been appointed to deal with administrative work in the home and arrange training. She had achieved NVQ3 in Health and Social Care, but as yet did not have expertise in dementia care. She was booked to attend training on dementia care in the week following this inspection, alongside the new Manager. Staff told us they felt they have more opportunity now for their views to be heard. Staff meetings had been held daily, and recorded. They highlighted to staff any particular needs of residents, including protocols, regimes, charts that had to be introduced when people had particular care needs. These helped management ensure that their guidance was followed. Staff told us they felt it helped the team working, and also, they felt their voice was being heard better now. The home owner had gathered feedback from residents, and planned to send questionnaires to relatives and professionals who visit regularly. Some residents had come up with suggestions about activities and food, which he was pleased to consider. He had not yet produced a development report, to include the outcomes of the audits carried out in the home, feedback received from residents and other interested people, and any improvements that the management team were planning. We looked at the way the home had offered help to residents to manage their money. The homeowner is prepared to pay for requisites such as the hairdresser, or toiletries, and bill the resident’s representative in arrears, by agreement. He kept cash on behalf of a small number of residents. We checked a sample of two, and found them to be properly recorded and accurately maintained. Staff were concerned that some residents were not given access to their own money to buy things they needed, such as slippers and toiletries. The home owner explained that one resident has a problem with accepting new items that are bought on their behalf. It might help if this person could be taken to choose their own slippers. The home owner denied that any resident was prevented from accessing their own money, so efforts should be made to ensure that all have what they want, within their means. The home owner had carried out appraisals and supervision sessions with his staff. The new Manager was anticipating taking over this duty. She said she would use these sessions to raise with staff any problems they have with accessing training that is provided, any anxieties about administration of medication, as well as giving feedback on their performance. The recent records showed that staff had been expressing their needs for training. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 23 We were shown the methods that are used to check for safety in the home. The manager was due to carry out a structured risk assessment of the premises, including window restrictors. We checked the fire log book; the fire precaution system had been professionally serviced at six monthly intervals. Staff training was needed in Fire Safety and in Moving and Handling, to ensure the continued safety of people who live and who work at Southbourne. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 24 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 25 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 OP22 Regulation 13.4(c) Requirement Timescale for action 31/03/10 2. OP38 23(4) A suitable alarm must be provided to alert staff, when assessment shows that a resident might need assistance to avoid risk of harm when, for example, they leave their room. The registered person shall make 31/07/10 arrangements for persons working at the care home to receive suitable training in fire prevention, to ensure they will act appropriately in an emergency to protect people in the home. The registered person shall make 31/07/10 suitable arrangements for the training of staff in first aid, in order that a qualified First aider is on duty at all times. 3. OP38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 26 No. 1. Refer to Standard OP7 Good Practice Recommendations The Manager and staff should consult with residents and their family or representative to consider their care plan, to ensure that care is being provided in a way that suits the resident. Management should ensure that staff are supported to put into action the developments in social engagement, to make person centred activities more available throughout the week. The Manager should keep a record of minor concerns, so that she can show what has been done as a result, and so she may see whether any mistake is repeated. Doors to residents’ private accommodation should be provided with locks suited to their capabilities, to promote their privacy and dignity. Paper towels should be available for staff use where personal care is given, and in communal toilets, to protect people from cross-contamination. The home owner should present annually a development report for Southbourne. It should include the outcomes of the audits carried out in the home, feedback received from residents and other interested people, and any improvements that the management team are planning. This is to show how the lives of the residents may be improved. 2. OP12 3. 4. 5. 6. OP16 OP24 OP26 OP27 Southbourne Residential Care Home DS0000069861.V378360.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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