Care Home: St Augustine`s Home

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Key inspection report Care homes for older people Name: Address: St Augustine`s Home Simplemarsh Road Addlestone Surrey KT15 1QR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 1 9 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Augustine`s Home Simplemarsh Road Addlestone Surrey KT15 1QR 01932842254 01932843857 manager@hsc-uk.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sisters Hospitaller of the Sacred Heart of Jesus Name of registered manager (if applicable) Mr Paul Davies Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 52 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Established in 1944, St Augustines is a 52 bedded care home owned by the Sisters Hospitallers of the Sacred Heart of Jesus. It provides personal care and accommodation for older people some of whom may have dementia.The home is situated in a residential area near the town of Addlestone, close to shops and is served Care Homes for Older People Page 4 of 34 Over 65 0 52 52 0 Brief description of the care home by public transport. It is set in large secure grounds with footpaths, walkways and a sensory garden. Extensive parking is available at the front of the property. Bedroom accommodation is arranged on two floors near assisted communal bathroom, shower and toilet facilities and accessible by two passenger lifts. A ten place living unit is on the first floor specifically for people with dementia and conditions causing memory loss. This has a combined lounge and dining area, kitchenette, bathing and toilet facilities. All bedrooms throughout the home are for single occupation and have washbasins and TV aerials. Nine bedrooms have en-suite facilities. Each section of the home has a kitchenette for making drinks and serving breakfasts. Communal living accommodation and a spacious dining room is on the ground and a small lounge also on the first floor.Other facilities include a hairdressing salon, commercial kitchen, laundry and offices. The home has its own chapel in which there is a daily service and a weekly Mass. Weekly fees at the time of this inspection ranged between 400 to 600 pounds, based on dependency and type of accommodation. Contractual fees apply for commissioning agencies. Additional charges include hairdressing and contributions towards the cost of optional community activities. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Date of last Key Inspection: 18th October 2007. Two unannounced inspection visits to the home were undertaken over eleven hours by one inspector as part of the key inspection process. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). Engaging with people using services is an integral part of inspections. We involved an expert by experience, which is one of a range of stakeholder involvement methodologies we use for this purpose, in this inspection. Experts by experience are recruited and trained by support organisations and visit homes with inspectors. Because of their shared experience of using services and/or ways of communicating, they help inspectors form a picture of what it is like to live in or use services. The expert by experience spent four hours at this home and her observations are included in this report. Care Homes for Older People Page 6 of 34 All available information has been taken into account when forming judgements about how well the home is meeting the National Minimum Standards (NMS) for older people. This includes accumulated evidence, knowledge and experience of the home since its last key inspection. In response to a survey of the homes stakeholders we received feedback from three people using the service and eight from relatives also six from staff and three from health professionals. Each year providers registered with the Care Quality Commission (CQC) must complete a self assessment called an annual quality assurance assessment (AQAA). They are required to send this to the CQC, providing quantitative and numerical information about their service. The AQAA requires assessment of the service against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time, was clear, of good quality and validated by evidence. Its content also informed the inspections outcomes. The first visit was facilitated by the recently appointed deputy manager, the head of care and Local Mother Superior of the Sisters Hospitallers of the Sacred Heart of Jesus. The second visit was facilitated by the home manager who took up post in March this year. We gathered information through discussions with people using services, staff, the catering manager and chefs. We viewed all communal areas and sampled bedrooms. Documents examined included marketing and information publications and menus, also a range of records relating to the health, safety and welfare of people using service and staff recruitment, training and deployment. We sampled a meal, carried out practice observations, spoke with the activities organiser and viewed the activities programme. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 34 The expert by experience felt the daily contribution of the Sisters living on site who have clearly defined roles, are a significant factor to the homes continuing capacity to efficiently meet the needs of its current population. Discussions with management and staff confirmed a substantial increase in the homes dependency levels in recent years. The home manager was noted to be in the process of arranging professional reassessment for a number of people to ensure their complex needs are being appropriately met. The layout of the building poses significant challenges to staff in their ability to maintain adequate levels of supervision of the vulnerable people, to ensure their safety. This year a number of changes have been instituted to the homes operation, staffing and working patterns to manage these difficulties. Survey feedback from staff was very positive about recent changes at the home and those being implemented. Some respondents acknowledged colleagues fears, anxieties and resistance to change however felt it was necessary and in the best interest of people using services. Comments included, Management is doing a lot to improve issues around training, care plans, staff sickness. Overall this is the best home Ive worked in. We provide excellent care, staff are trained to carry out their role, since the new manager came into role I have noticed a vast improvement in and around the home. The new manager is more approachable and understanding of service users and carers alike. He has made big improvements in the day to day running of the home. He is more hands on and listens to any concerns we may have. The service users have great regard and respect for him. A major work programme was nearing completion at the time of the visits, reducing health and safety hazards in the environment. Risk assessments and risk management had also improved with input from specialist services and consultants. Suitable window restrictors had been fitted also valves for control of hot water temperatures to all bathing and washing facilities. Contract arrangements now ensured weekly monitoring and recording of hot water temperatures.Radiators and hot pipes had also been covered. To control risk of slip injuries, housekeepers had changed their practice Other safety improvements included new provision of an inner door fitted with coded key pad at the front entrance, and coded key pads fitted to other doors throughout the building. An internal review of infection control and moving and handling practice had identified shortfalls which the manager acted on and resolved. The focused programme of training has targeted priority team training needs to ensure a skilled and competent workforce. Since the inspection visits additional communal lounges on the ground and first floor have enhanced the homes facilities. What they could do better: Though staff stated they inform people in the main building of daily activities and encouraged their participation, many need much support to engage in these activities. At the time of the first visit many of the people using services not involved in the group activity in progress in the lounge were sat unoccupied, some sleeping in chairs. The home manager is aware that this is an area for further development and reported consideration being given to employing a part-time activities assistant. There are also plans to introduce use of suitable complimentary therapies, for example massage and reflexology. The location of managers office accommodation away from the hub of the home detracts from their capacity to easily maintain an overview of the homes operation during this important phase of the change programme. Care Homes for Older People Page 9 of 34 Survey feedback from staff and relatives identified some shortfalls in communication between departments. The home manager is aware of service strengths and shortfalls and has produced and is gradually implementing a development plan for continuous improvement and driving up standards. Potential risks to vulnerable people using services are currently being managed pending remedial action planned to secure access to the fire escape and car park on the ground floor through emergency exits. The home manager confirmed work was imminent in these matters following consultation with the fire officer. Other improvements in progress will strengthen and enhance records and systems, improve communication and ensure the full scope of notifications made to the CQC. The role of key workers and senior care officers is being further developed. In order to enhance assessment, care planning and review processes, a new standardised care planning system is at an early stage of implementation. The home is efficient at maintaining existing documents up to date during this transition period. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service and their representatives receive the information they need to enable an informed choice of home. There are comprehensive preadmission assessment procedures to ensure needs can be met. Written contracts or terms and conditions of the home are issued to all people using services . Standard 6 was not assessed on the basis the home does not offer intermediate care. Evidence: The homes management understands the importance of having sufficient information when choosing a care home. People considering using this service or their representatives receive a copy of the homes statement of purpose and brochure. On admission they then receive a service users guide. We viewed copies of all of these documents during the inspection. The statement of purpose sets out the service objectives and philosophy of care and contains all statutory information. The service users guide informs people of what they can expect in the day-to-day operation of the home. It provided information about services and facilities, staffs qualifications and Care Homes for Older People Page 12 of 34 Evidence: experience and the complaint procedure. These documents had been recently updated and were prominently displayed in the reception area, which is a new development. Suggestions for minor amendments to these documents were discussed with the home manager. The home admits people of all religious faiths and those of none. A commitment to meeting the multicultural and diversity needs of all people for whom the home is intended was demonstrated. Future plans include producing information about the home in large print and for staff training on equality and diversity policies and procedures. There is a clear admissions criteria and procedure. Potential users of this service are encouraged to visit for a pre-admission assessment. If unable to do so, they are assessed at home or in hospital by the home manager, the deputy manager or other suitably trained staff. The emergency admission procedure does not include a preadmission assessment however as much information as possible is gathered before to admission to ensure needs can be met. Admission decisions are based on the homes management being confident of the suitability of services and facilities to meet individual needs and that staff have the necessary skills, qualifications and competencies. The files of three people using services were examined, focusing on pre-admission assessment processes. Two of the files contained pre-assessment information using an holistic and comprehensive assessment tool. The third file did not contain evidence of the pre-admission assessment process however the home manager was confident an assessment was carried out before admission. All three files evidenced additional assessments undertaken soon after admission from which individualised care plans had been generated. The files contained statements of the homes terms and conditions or contracts. The need to ensure these are signed by all parties was discussed on observing a contact unsigned by a representative of the home. Standard 6 was not inspected on the basis that the home does not offer intermediate care services. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services receive personal and health care support in accordance with their assessed needs. Their rights of dignity, equality, fairness and autonomy are respected. Medication practices are safe. Evidence: Observations confirmed good attention was given by staff to the personal appearance and state of dress. Staff were putting into practice principles on which the homes philosophy of care is based, respecting rights of dignity and privacy. The annual quality assurance assessment (AQAA) told us that ten people using services were diagnosed with dementia. Observations during the visit indicated this number may be significantly higher which was acknowledged by the home manager. He confirmed he was actively arranging mental health assessments for several individuals. Discussions with management and staff established a clear criterion for admission to the homes Memory Care Unit. This first floor unit is for ten people with dementia or other conditions, in need extra support and monitoring to ensure their Care Homes for Older People Page 14 of 34 Evidence: safety and wellbeing. The home manager has prioritised dementia refresher training for the whole team, this year, aimed to further develop the teams skills and competencies in this specialist area of care.The expert by experience spent over three hours observing practice in the Memory Care Unit. In the combined lounge/dining area of this unit seven people were being supported by three care staff who were present most of the time. Staff made an effort to engage people using services in conversation. Discussions with the home manager confirmed awareness of what needs to be done to create a more positive environment for people with dementia, d meeting individual communication needs.We discussed the need for additional visual cues which could give people a sense of security and more confidence in navigating their way round this large building. Use of pictorial cues for locating toilets and familiar objects from the past on bedrooms doors could be considered. When next redecorating the premises it is suggested areas be colour coded as a further orientation aid. The new assessment and care planning system at an early stage of implementation was observed to identify diversity of ability, age, race, religion and identity of people using services, within a person-centred planning process. A commitment to meeting individual diversity needs is evident from the the homes facilities and services and arrangements for meeting spiritual and religious beliefs. The service ethos and practice promotes independence, encouraging people using services to practice and retain activities of daily living skills.Signage, ramp and lift access in the building and to the garden further promotes independence. Adaptation of facilities over recent years have afforded additional en-suite bedrooms, wheelchair accessible bedrooms and bathing facilities. The development of the Memory Care Unit and enclosed furnished sensory courtyard has enhanced the homes dementia care provision. The AQAA stated the home has a loop system for people with a hearing impairment. Survey feedback from people using services and some relatives was mostly positive about the standard of care. It was stated there is a warm and welcoming atmosphere, staff are friendly, caring and kind, know people using services very well and respect their dignity. Though generally relatives found communication with the home enabled informed decisions and choices about care, one said improvement is necessary to lines of communication between staff and the head of care. Specifically regarding requests for podiatry or hairdressing appointments. Another relative whilst acknowledging staff appear genuinely caring, was of the view that attention was necessary to staffs management of incontinence. This relative felt staff needed to be more aware of individual needs and incontinence pants more readily available. It was found the home does have regular input from a continence adviser. Another relative said that whilst her mother was very happy with the home, she was sometimes frustrated by delays in responding to requests for assistance to the toilet. At the time of the visit a person in Care Homes for Older People Page 15 of 34 Evidence: her room was calling out for the toilet but care staff in the lounge did not hear her. A housekeeper passing her room eventually alerted staff to her needs. Though she had access to a call bell it was established this was faulty. When draw to the attention of the deputy manager it was repaired the same day. Care staff reported a shortage of bleeps they carry linked to the emergency call system. It was established additional bleeps were on order, replacing a number that could not be located. A new system is proposed for signing bleeps in and out at shift hand-overs. We viewed files of three people using services to inform judgements about how well the home is meeting personal care and health care needs. Each person had a plan of care generated from needs and risk assessments, reflecting current needs. Discussions with staff confirmed these are reviewed monthly however this was not supported by record keeping. The need to record these reviews was discussed. Moving and handling, nutrition and pressure sore risks had been assessed and weights were regularly monitored. The home manager is aware of shortfalls in the current care planning documentation and the need to further extend the scope of individual risk assessments. The deputy manager has been tasked to roll out the new care planning system and staff are receiving training in care planning. Relatives are being consulted regarding their wishes to be involved in care planning and review processes. The key worker system had recently been extended to a wider group of care staff. Improved systems and records are being implemented for staff hand-overs and for recording incidents and accidents. The records we viewed gave an overview of health needs of people using services and act as an indicator of any change. All people using services are registered with a general practitioner (GP). We received feedback from three GPs. Comments included, They truly care for their residents, all is satisfactory, this is an excellent nursing home. Generally there is good awareness of when GP input is required. The nuns are caring and keen to look after the patients to the best of their ability. GP suggestions for improvement included, early input from families to gauge their level of understanding and wishes for how their loved ones health needs should be managed, i.e. active or conservative management. People using services access specialist medical and therapeutic services and receive visits from chiropodists, podiatrists and opticians. Nursing needs are met by the district nursing service.Though a GP expressed the view that the Sisters should continue to provide basic wound care and change dressings the home manager has reviewed practice to ensure this is within the scope of the homes registration. There is agreement between the home and the district nursing service on which clinical interventions can be delegated to the homes staff. Staff are trained and have an understanding of the health needs and conditions of the people they care for. Suitable equipment and aids are available to support their health and wellbeing.These include specialist assisted baths and Care Homes for Older People Page 16 of 34 Evidence: showers, mobility aids, height adjustable beds, hoists and for pressure sore prevention. There has been a review and improvement in moving and handling and infection control practice in recent months. The home has a good record of compliance with receipt, administration, safekeeping and disposal of medication. There is an efficient medication policy supported by procedures and practice guidance, which staff understand and follow.The head of care has designated responsibility for medication management and senior care officers are trained to administer medication. The need to maintain a record of their signatures was discussed. We sampled medication storage and record keeping in the ground floor clinical room, which is a new facility. On this occasion areas for attention include the need to have written protocols for medication prescribed for administration when needed. It was agreed that Temazepam prescribed for an individual will in future be stored and recorded as a controlled drug. The home needs to produce a risk assessment for people who on admission wish to continue self - administration of medication. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Visitors are made welcome by staff, supporting people using services to maintain relationships with people important to them.Arrangements for social stimulation need to be further developed to ensure suitable social opportunities and stimulation for all people using services. Catering standards are excellent. Evidence: The home strives to promote a warm, relaxed and comfortable environment. Staff promote the rights and choices of people using services, supporting them to maintain independent living skills within individual levels of capacity. Relatives said staff make them welcome and are friendly. Since the last inspection an activity coordinator has been employed. The AQAA states he is very creative and able to motivate, support and promote interest in social activities. He usually works weekdays between 10 a.m. and 4 p.m. The activities coordinator is stated to have a relevant qualification and is currently working towards a National Vocational Qualification specific to his role. A social activities programme was displayed in the lounge and in other sections of the building. Staff were stated to remind people who may wish to join in of the days social activities. The home is supported by a group of volunteers who provide regular input to the social activities Care Homes for Older People Page 18 of 34 Evidence: and entertainment programme. There is also input from external providers of musical and exercise activities. A group creative craft session was in progress in the lounge at the time of the first visit. Care staff were supporting individuals to participate and there was lots of laughter and fun. The expert by experience observed that many of the people not engaged in this activity had complex needs associated with the ageing process. They could not easily engage in the programme without considerable support. Many of the people sat in the lounge during this visit were observed to be sleepy and appeared negatively isolated. At the time of the second visit a volunteer was assisting the activities coordinator with a group quiz and musical activity. Again a number of people were sat unoccupied in chairs. Care staff were observed giving one to one time with some of these individuals. Best practice observation were made on this occasion in how staff were communicating with individuals on a feeling level, using appropriate physical contact. In fine weather people using services were stated to enjoy using the garden which has a furnished patio area and is maintained to a high standard. Community inclusion is promoted by the home and visitors stated to sometimes take their relatives out to use community facilities. Three outings had taken place this year, using a hired vehicle and driver, with input from relatives and volunteers. Plans for a trip to a pantomime and other Christmas festivities were under discussion. A Pastoral team provides extra care and support as needed. Regular Catholic and Anglican religious services take place in the chapel attached to the building. Services are attended by people using services who wish to do so, members of the local community and Sisters who live on site. Members of both Churches also visit and talk with people using services. The activities coordinators remit does not extend to provision of social activities in the Memory Care unit. The home manager said there may be potential to recruit a parttime activities assistant. Also being considered is provision of complimentary therapy services, for example massage and reflexology. The higher staffing ratio in the Memory Care unit affords staff time for social interaction with individuals, on a one to one basis, promoting social engagement. A staff member was observed supporting a person in this unit to do a puzzle. Discussions between the expert by experience and staff on the unit demonstrated good awareness and understanding of individual needs and behaviours. It was felt however that a ball game with one individual may have gone on too long. The staff member did not appear aware of non-verbal communication indicating this person was becoming frustrated and anxious. Staff are trained to carry out nutritional assessments and weights are monitored at least monthly.Kitchenette facilities are available on both floor from which care staff prepare breakfast of cereals, toast and tea or coffee served on trays in bedrooms. Care Homes for Older People Page 19 of 34 Evidence: Porridge and optional cooked breakfasts are prepared by chefs in the main kitchen, if preferred. The home contracts with a catering service and discussions took place with the catering manager and both chefs on duty during the first visit. People using services are encouraged to be involved in menu planning and the menu is changed in response to their feedback and suggestions. Developments since the last inspection include meals served by chefs in the dining room from a heated trolley. Chefs were observed to know the people using services and are aware of their food preferences and dietary needs. This new system provides catering staff with immediate feedback about the quality of meals, enabling chefs to promptly respond to and address any issues. The five-week rotating menu was observed to be varied, affording choice of meals. The menu is produced in large print and is displayed outside the dining room and on dining tables. Meal times at lunch time and in the evenings have changed in recent months for operational reasons. Though the evening meal is served earlier, night staff were stated to offer biscuits or sandwiches when they go round with night drinks. The main kitchen was clean and organised on the day visited. It had been inspected by the Environmental Health Department in 2007 at which time there were no requirements. Chefs are qualified and provide a three course lunch and a two course evening meal. The food is mostly freshly prepared including the home made battered fish sampled at the time of the visit. The standard of catering was observed to be high and feedback from people using services confirmed they usually enjoy their meals. Meals for the Memory Care unit were plated in the main kitchen and transported in a heated trolley. Discussions with the catering manager confirmed chefs use extra butter, cream and milk powder to fortify food for those who need it.The spacious dining room provides a congenial environment, promoting mealtimes as a social occasion with well presented dining tables of four places. A dining table is also provided in the Memory Care unit where one individual was encouraged and assisted by staff to have her meal. In this unit and the main dining room Sisters living on site were observed supplementing staffing levels, enabling good levels of individualised support with meals and social interaction. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaint procedure which includes timescales for the process. People using services are protected from abuse. Evidence: The complaint procedure is displayed in the home and included in the statement of purpose, service users guide and the statement of terms and conditions. It is clear and accessible and includes timescales, ensuring complaints are dealt with promptly. Complaint records regarding a complaint to the home in May 2008 from a relative were not available for inspection, to establish the outcome. Further comment is made in this matter in the Management and Administration section of the report. All staff receive safeguarding adults training as part of their induction and refresher training. This ensures they are able to recognise indicators of abuse and know the procedures to follow. The home has a copy of Surreys safeguarding procedures for responding to suspicions or evidence of abuse or neglect. Its policies and practices mostly protect people using services though some improvement necessary to staff recruitment procedures. The need to produce a local safeguarding procedure that integrates with the Surrey procedure was discussed. The home does not manage the financial affairs of people using services however does handle their money, on request. This is held securely and records of all transactions receipted and maintained. These individuals were stated to have access to their money at any time. Care Homes for Older People Page 21 of 34 Evidence: It was evident that the manager keeps abreast of changes in legislation including the new legal framework and assessment responsibilities under the Mental Capacity Act. There is commitment to ensuring best interest assessments carried out for individuals, as necessary. Plans for related staff training to be cascaded to the team were noted. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment promotes independence, is comfortable and hygienic, overall safe, suitable equipped and well-maintained. Whilst the physical design and layout of the building presents challenges the homes management makes best use of resources, ensuring the home is fit for purpose. Evidence: The homes extensive landscaped grounds with pathways, water features, ornaments and sculptures, was well - maintained at the time of the visit. This setting affords a tranquil, interesting outlook from the lounge and some bedrooms. Provision includes a sensory garden and tables and chairs on a terrace outside the lounge. The large car park is accessed through a gated entrance set on a timer for additional security.External CCTV is also fitted and monitors are currently being relocated to be more visible to staff. The large two storey building is fully accessible to wheelchair users with ramps. The front entrance door is fitted with an automatic door opening device. A recent development is an interior door inside the main entrance, fitted with key pad code access known to staff and relatives. This has improved the safety of vulnerable people using services. The building has been tastefully extended but its complex layout presents challenges for staff trying to maintaining adequate observation levels of all areas. The homes management is continually striving to overcome these problems. For operational purposes the building is sectioned and staff are allocated to each section. This year a substantial work programme has taken Care Homes for Older People Page 23 of 34 Evidence: place, upgrading the premises and improving the health and safety of the environment. Bedrooms accommodation is arranged on both floor. Bedrooms are all single occupancy and nine have en-suite facilities. They vary in size and shape and are gradually being redecorated and refurbished. Since the visit communal lounge facilities have been enhanced by an additional small first floor lounge and a ground floor library in addition to the existing spacious ground floor lounge. The library and small lounge have been re-carpeted and have new furnishings. The large lounge which is used also for social activities in a designated area is comfortably furnished and has a new large screen television. A rolling programme of replacing carpets and floor coverings throughout the home is ongoing. There are several assisted bathrooms and shower facilities. Future plans include conversion of three bathrooms into wheelchair accessible shower rooms and for wheelchair accessible toilets with sufficient space for hoisting. The home was clean throughout to an exceptionally high standard. With the exception of one bedroom, odour control was excellent. The home uses a contract housekeeping service and seven house-keepers were on duty at the time of the visit. The homes sluice rooms had been made safe this year through provision of key pad entry system. The home does not have sluice machines and instead uses porcelain sluice sinks. Infection control practice has been enhanced this year through new arrangements for a clinical collection system; also provision of containers with lids on all floors for transporting soiled pads to the macerator machine on the first floor. The home manager has ensured each unit has a clinical waste bin with yellow bags and has introduced use of wipes and disinfectant hand gels. The area used by staff for macerating incontinence pads was observed to be clean. Care staff are stated to be training to hygienically perform this task and are supplied with disposable aprons and gloves.Discussion with the home manager confirmed the need to ensure safe infection control practice when transporting soiled incontinence pads to the macerator room. If pads are not immediately macerated they should be transported in yellow bags. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained, skilled and mostly in sufficient numbers to support the people who use this service. People using services are not fully protected by the homes recruitment practice. Evidence: Staff turnover has adversely affected staffing levels, particularly at weekends owing to the contractual constraints of some staff. Relatives feedback confirmed least satisfaction with care practice at weekends, specifically the management of incontinence. There is an ongoing staff recruitment strategy and whilst staff recruitment has not been easy, new care staff have taken up post. Additionally, two carers were waiting to take up post whilst going through vetting procedures. There had also been turnover in senior care officers and internal promotions recently made to these posts. We were informed by the former registered manager that a decision not to pay staff their annual pay increase had affected staff morale. Sisters living on the premises support staff and assist with personal care and at mealtimes. The head of care is on-call and covers staff absences, if necessary. The deputy manager also works alternate weekend to cover staff shortfalls. The new home manager undertook a comprehensive review of staffing on taking up post. By necessity he implemented a number of changes to ensure the home is staffed Care Homes for Older People Page 25 of 34 Evidence: efficiently and in accordance with legislative requirements. Constrained by the terms and conditions of employment of some staff, he was unable to creatively deploy staff in the best interest of the service. He continues to negotiate changes to staffs terms and conditions and to their work patterns. He has also increased staffing levels on day and night duty. Care staff are now assigned to specific sections of the home and though this has been unsettling for some staff and people using services, it was necessary. Other changes have ensured night staff work and stay on their allocated sections and a senior care officer is now on each shift. Recruitment procedures have also been reviewed and the home manager is currently taking over this responsibility.We sampled two staff files and found significant shortfalls in recruitment practice which the home manager plans to address. There has been failure to ensure a full employment history is obtained for prospective employees and to probe any gaps in employment and ensure relevant references sought. Inconsistencies in information supplied by an employee who applied for two posts went unnoticed or the matter that a referee supplied did not cross refer to the applicants work history. One of the files only evidenced one reference received. Though a carer said in her application that she had undertaken relevant training courses in a previous post this information was not evidenced. A matter of months elapsed before this employee and another received induction workbooks. The home manager confirmed that staff responsible for recruiting and managing staff are currently undergoing recruitment and industrial relations training. A company has been approached to develop the homes human resources procedures. Records confirmed staff, Sisters and most volunteers had Criminal Records Bureau (CRB) clearance and checks carried out to ensure they are not on the national data base of people unsuitable to work with vulnerable adults. It was stated that volunteers supplied by a voluntary organisation are being requested to obtain CRB disclosures. Whilst the home manager confirmed arrangements for the homes maintenance employee to directly supervise maintenance workers not employed by the home on the premises, these arrangements were not in force at the time of the first visit. The home manager agreed to follow this up. Contract catering and housekeeping services are used.The home manager has satisfied himself that recruitment and vetting procedures of these companies comply with statutory requirements; also these staff are trained to safely and competently fulfil their duties. There has been a change to the hours covered by housekeepers this year. Previously they worked only on weekdays in the mornings whereas now there is domestic cover also in the afternoons and at weekends. Laundry assistants are employed by the home. Care Homes for Older People Page 26 of 34 Evidence: The home has good training facilities and uses external trainers. The manager is currently carrying out a training analysis for his team. Staff training this year has been focused on priority areas identified when he first took up post. Refresher moving and handling training has been delivered to the whole team and refresher dementia training is in progress. Refresher safeguarding adults training is planned also training on the organisation values and the Mental Capacity Act. During conversations with staff they confirmed they had received statutory training in food hygiene, infection control and health and safety. A record of staff who have had first aid training was in the ground floor clinical room. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services benefit from a efficiently managed home and a competent and approachable manager. Improvements in the past seven months have enhanced their health, safety and welfare however attention is necessary to staff recruitment and induction practice. Quality assurance systems ensure the home runs in the best interest of people using services. Evidence: The registered home manager retired in March 2009 and the a new home manager took up post at the end of March. He has the required qualifications and experience to manage the home and has submitted an application for registration. The homes management structure has been strengthened by the new post of deputy manager. The deputy manager appointed to this post was very new at the time of the visit. The management team includes a local Sister Superior and head of care. A review of management roles and responsibilities was reported to have taken place to ensure these are within individual senior staffs levels of competency. Shortfalls in industrial relations management at the home since the last inspection, before the home Care Homes for Older People Page 28 of 34 Evidence: manager took up post, and in recent staff recruitment practice are being actively addressed through a training programme for senior staff. The manager confirmed he has taken over responsibility for staff recruitment to ensure future compliance with legislation and promotion of equal opportunities. The reception is covered by an administrator during office hours weekdays. Though only in post four months this administrator was observed to be of significant support to the management team and very helpful and knowledgeable throughout the inspection. Her responsibilities also include payroll and general administration. Following a fundamental review of the management and operation of the home the manager has implemented the major change programme in progress at the time of this inspection. A major work programme is nearing completion, reducing health and safety and other environmental hazards. This was essential for compliance with health and safety legislation requirements made by the Environmental Health Department on the managers second day in post. The home now has a health and safety committee reviewing health and safety systems, ensuring local management fulfil their compliance responsibilities. Improvement in the area of risk assessments has been achieved and other safety measures and systems implemented. A fire safety company carried out a fire safety audit and the outcome has been a programme of replacing fire doors and purchase of fire evacuation sliding sheets. The home manager confirmed imminent plans to fit alarms to fire exit door leading to the car park and to secure the fire exit door leading to the fire escape further to consultation with a fire safety officer.Accident and incident record keeping and systems were being further developed. Other changes being progressed by management are referred to throughout the report. Whilst some staff have clearly had difficulty in accepting the changes those who responded to our survey were of the view they were necessary and in the best interest of people using services. Comments included, Management is doing a lot to improve issues around training, care plans, staff sickness. We provide excellent care, staff are trained to carry out their role, since the new manager came into role I have noticed a vast improvement in and around the home. The new manager is more approachable and understanding of service users and carers alike. He has made big improvements in the day to day running of the home. He is more hands on and listens to any concerns we may have. The service users have great regard and respect for him. New updated policies and procedures have been implemented and new systems are being introduced to improve communication, record keeping and compliance with statutory notification requirements. Missing record, other than care records, prior to Care Homes for Older People Page 29 of 34 Evidence: the home managers appointment have been a further challenge to the homes management. At the time of this inspection it was understood none of the people using services were subject to a deprivation of liberty authorisation or application under the Mental Capacity Act (MCA). The manager is aware of the need to have a MCA policy and protocol specific to deprivation of liberty safeguards. A copy of the MCA Code of Practice had been obtained. The new care planning format records capacity to take decisions as part of the standard assessment and care planning process and any advance directives also lasting power of attorney arrangements. There home has an efficient system for safeguarding the money of people using services. The homes management does not act as a corporate appointee for any individual. Money is held securely on behalf of individuals by an administrator who maintains a record of all financial transactions. The home manager is reviewing quality audit and quality assurance systems. Surveys questionnaires are sent out by head office to stakeholders. The outcome is then analysed however currently there is not a system to communicate the findings to people using services. The need to include this in the service users guide was discussed and any action plan in response to survey outcomes. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 04/12/2009 ensure robust recruitment practice and information and documents in place in accordance with Schedule 2 of the Care Homes Regulations 2001(amended) This will ensure people using services are protected. 2 30 18 The Registered Person must 14/12/2009 ensure timely induction of new staff covering the common induction standards to be met within a maximum of twelve week period from taking up post. To develop competency and support continuing professional development of workers. Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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