Care Home: St Benedict`s Nursing & Residential Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well People`s rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. People could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that people living at the home and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home, on the whole, was clean, tidy and free from unpleasant odours. People are able to bring in furniture and personal belongings to personalise their private room. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as "very good, very kind". People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. What has improved since the last inspection? Care planning has improved The care plans now provide clear guidance to staff on the care needs of the individuals living at the home. The environment has improved with the home undergoing decoration and refurbishment.This has been completed to a good standard. The storage, documentation and administration of medication has improved and now complies with good practice guidelines in the majority of areas. Staff training including induction is now more robust and staff appear to have completed all mandatory training. What the care home could do better: Charts had been introduced for some people living at the home. These charts are used to document such things as a change of position and diet and fluids taken. Some of the charts had not been completed. It is therefore difficult to assess how these influence the care and support that is being provided by staff. During the inspection it was noted that some medication was not stored at the correct temperature. This needs to be rectified. Staff need to develop the systems for ensuring people with dementia are able to make choices and have influence over their lives. Pictures and photographs could be used to aid communication. In addition staff need to support people to maintain Independence and life skills by supporting them to complete daily tasks such as making drinks and snacks and completing household tasks. staffing levels need to be kept under review particularly in the evening in the area supporting people with dementia.The home manager needs to implement quality assurance systems to monitor the care, support and services provided by the home. The manager needs to submit an application to register with us. Key inspection report Care homes for older people Name: Address: St Benedict`s Nursing & Residential Home St Benedict Street Glastonbury Somerset BA6 9NB     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: Justine Button     Date: 0 2 1 2 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 31 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 31 Information about the care home Name of care home: Address: St Benedict`s Nursing & Residential Home St Benedict Street Glastonbury Somerset BA6 9NB 01458833275 01458833402 stbenedictsnursinghome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr David Edwin Wills White Name of registered manager (if applicable) Type of registration: Number of places registered: care home 61 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 61. The registered person may provide the following category of service only: Care home with nursing - Code N 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) Dementia (Code DE) Date of last inspection Brief description of the care home St Benedicts Care Home provides nursing to older persons over the age of 65 yrs. It has been developed from a large domestic dwelling house with a two purpose built extensions. The home is now split in to two distinct areas. The Vicarage, the older part of the building which provides nursing care. The Second part is the Deanery which supports people with demetia care needs. The home is within easy walking distance Care Homes for Older People Page 4 of 31 Over 65 0 39 22 0 0 6 1 1 2 0 0 8 Brief description of the care home from the town centre of Glastonbury, although up a slight hill. Accommodation is on two floors, with a four-person lift. There is a level patio area approached from the lounge and there is a garden area to the rear. The home provides nursing care for up to 61 people . Experienced nursing and care staff deliver the care. The accommodation is maintained and experienced staff provide a full catering and domestic service. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out over one day by one inspector. The Manager was available on the day of the inspection. We would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CQC Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Information is requested from each home by us on an annual basis. Information from the homes Annual Quality Assurance Assessment, AQAA, was been used throughout the inspection process. Information held in the AQAA was confirmed during the inspection visit. Records examined during the inspection were individuals care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Care Homes for Older People Page 6 of 31 Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, quality assurance processes and staff supervision records. We also conducted a tour of the premises. Surveys were received from people living at the home. The results of the surveys are also included in the report. Current fee levels at the home range from 402 pounds per week dependent on needs and the room occupied. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Charts had been introduced for some people living at the home. These charts are used to document such things as a change of position and diet and fluids taken. Some of the charts had not been completed. It is therefore difficult to assess how these influence the care and support that is being provided by staff. During the inspection it was noted that some medication was not stored at the correct temperature. This needs to be rectified. Staff need to develop the systems for ensuring people with dementia are able to make choices and have influence over their lives. Pictures and photographs could be used to aid communication. In addition staff need to support people to maintain Independence and life skills by supporting them to complete daily tasks such as making drinks and snacks and completing household tasks. staffing levels need to be kept under review particularly in the evening in the area supporting people with dementia. Care Homes for Older People Page 8 of 31 The home manager needs to implement quality assurance systems to monitor the care, support and services provided by the home. The manager needs to submit an application to register with us. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. The home has developed has a statement of purpose and service user guide, which sets out the aims and objectives of the home and includes basic information. Admissions to the home are not made until a full needs assessment has been undertaken by a member of the senior management team. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. Evidence: The home has a Statement of Purpose and Service User Guide which provide information about the home and services offered. These documents have been Care Homes for Older People Page 11 of 31 Evidence: updated to reflect the changes in the number sof beds and services offered Care plans were examined at this inspection and these contained documented evidence that people had been appropriately assessed before a placement was offered. Assessments had also been obtained from appropriate health care professionals where available. The acting manager stated that the home were not experiencing any problems in meeting the assessed needs of people currently living at the home. This was also evidenced in care review documentation from individuals care managers. The home has a good supply of mobility and pressure relieving equipment in place and the environment is suitably designed to meet the needs of people. The home encourages people and their relatives and or representatives to visit the home prior to making a decision to move there. The first four weeks are considered a trial period thus enabling all parties to be sure that the home is able to meet the individuals assessed needs. Care Homes for Older People Page 12 of 31 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. The homes care planning systems have improved and now promote a more person centred approach to care. The homes procedures for the management and administration of peoples medication are adequate. The management need to ensure that medication is stored at the correct temperature otherwise it will not work effectively. People living at the home are treated with respect. Evidence: Care plans for three people living at the home were examined at this inspection. The layout of care plans has improved since the last inspection to ensure that they provide clear and accessible information for staff. Staff spoken with confirmed that they were encouraged to read and follow care plans. On the whole the care plans examined contained up to date risk assessments relating to the prevention of falls and pressure sores, nutrition, moving and handling needs Care Homes for Older People Page 13 of 31 Evidence: and environmental risks. Care plans had been raised to address any concerns highlighted. We were informed that one person at the home currently had pressure sores. The care plan for this individual with regard to this issue had been reviewed to ensure that clear progression of the wound was documented. Regular measurements and tracings of the wound were in place. This will help staff to ascertain if the appropriate dressings and treatments are being used. During the course of this inspection this individual was supported to change position on a regular basis in line with the care plan. A change of position is required to help in the prevention and the healing of any pressure damage. The staff had commenced charts to record the frequency of positional change and the amount of fluids and diet taken however these had not been completed consistently by staff. Charts such as these are used to assess if the care and support provided by staff is effective and adequate. The information used in the charts should influence the care and support provided. If the charts are not completed consistently therefore their use is questionable. It is advised that if charts are assessed as being required that these are then completed fully by staff in order that care can be monitored and altered if required. Care plans for all but one person contained clear information on the assessed needs of individuals and instructions for staff on how needs should be met, were clear and included the preferences of people as appropriate. The plans for one person were viewed. This individual had some mental health issues and as such could become aggressive towards staff when they delivered care. There was not care plan in place for tis aspect of the individuals support needs. The plan should be developed to ensure that all staff are clear on what action to take in these situations and that all staff are acting consistently. In addition the individual had some issues with urinary continence again there was not plan in place for this aspect of the individuals care needs. The individual had recently been admitted to the home. The assessment from healthcare professionals prior to inspection stated that this individual had a pressure ulcer. It was unclear from the documentation and care plans developed by the home if this issue had resolved and if any ongoing treatment was in place. The issues with this individuals care plan was discussed with the interim manager at the end of the inspection who agreed to rectify this issue. There was evidence that care plans had been reviewed at least monthly. The majority of people using the service would be unable to be involved in the care planning and review process. Relatives or representatives are encouraged to be involved in this process and this was evident at the time of this inspection. Care plans have been updated and included detailed information about people in relation to their social and life history and preferences. This is felt to be a positive improvement as it provides valuable and useful information for staff and promotes a Care Homes for Older People Page 14 of 31 Evidence: more person centered approach to care. Records examined demonstrated that people have access to a range of appropriate health care professionals. Details of all visits and the outcome are clearly documented in the individuals plan of care. Staff update daily records at the end of each shift so that there is a clear picture as to the health and well being of each person living at the home. Staff spoken with were positive about the the home and stated that they did not experience any problems in meeting the assessed needs of people currently living at the home. Two relatives were spoke with during this inspection and both confirmed that they were very satisfied with the care and support given to their relative. This was also confirmed in the surveys that were received prior to the inspection. We examined the homes procedures for the management and administration of peoples medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). All medicines were found to be securely stored and there were no excessive stock levels. All available MAR charts were examined and these were found to be appropriately completed. MAR charts have a photograph of individuals to aid identification. Two people were receiving a controlled medication. Stock levels and records were examined and no concerns were noted. Medicines are only administered by the registered nurses on duty. Some Staff have completed refresher training with regard medication procedures. On the day of the inspection the temperature of the fridge used to store medication was found to be low. Documentation showed that this had occurred on several occasions. There was written guidance to staff on what they should do if the temperature was outside of the normal limits. Staff however had not followed this guidance. Storing medication at the incorrect temperature may reduce its effectiveness. This was discussed with the interim manager at the end of the inspection who agreed to review this. Some prescribed creams for individuals are kept in the individuals bedrooms. Some of these had been marked with a date of opening whilst others had not. This is necessary to ensure that creams and lotions are not applied after their use by date. Those without an opening date need to be replaced. We observed staff interactions with people living at the home throughout the day. Interactions were noted to be kind and respectful and people appeared to respond positively to staff. Staff were observed knocking on peoples doors before entering their bedrooms and staff were observed offering people choices throughout the day. Those people who were able to express a view were positive about the staff. Relatives Care Homes for Older People Page 15 of 31 Evidence: spoken with said that the staff were marvelous and that they could not do enough to help. When we spoke to staff they said that the atmosphere at the home was positive and that the atmosphere was relaxed. They said that they worked as a team and that this had a positive outcome for people living there. Staff said that they had the opportunity to spend quality time with people living there. Other people told us however that due to the increase in numbers of beds there was an increase in the numbers of staff required. Some people told us that they did not feel that these staffing levels were at the correct level and that this was impacting on the care at certain times of the day but particularly in the evening. Care Homes for Older People Page 16 of 31 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. People have the opportunity to join in with a range of activities and staff have an awareness of peoples social history and preferences. Visitors are made welcome at the home. Evidence: The care planning system has been updated and reviewed since the last inspection. This has been proactive in ensuring that peoples social historys and preferences are obtained. Detailed information was available in the three care plans examined. Information provides staff with very useful information about peoples lives, interests and preferences. Staff spoken with said that they found this information very helpful and that it gave them a better understanding of the people living there. This is a positive improvement. The home employs an activities co ordinator. The home has a programme of activities and a copy was made available to us. This offered a good range of group activities and also offers one to one time with people. Individual records are maintained for people relating to activities undertaken. Surveys returned to us prior to the inspection Care Homes for Older People Page 17 of 31 Evidence: however stated that people living at the home would appreciate a wider range of opportunities being made available to them. The management need to consider this. The home also displays a list of forthcoming events. Throughout the day we spent time observing staff interactions with people living at the home. The activities co ordinator was not on duty on the day of this inspection but we observed staff spending quality time with people. The atmosphere was relaxed and unhurried and it was apparent that people can choose where and how to spend their day. Despite this activities in some areas need continued development. The communal areas in the dementia care unit have been equipped with small kitchen areas. One lady living at the home was observed to go to the kitchen area and ask everyone who wants tea. A staff member took the cup of her and said You sit down I will make the tea. There would be no reason why staff could not have supported the individual to make a pot of tea. In addition during the inspection it was noted that staff set the tables for lunch. Again there would be no reason why people living at the home could not have been supported by staff to help with this task. Research into dementia has shown that being supported to continue to complete daily tasks such as making tea, snacks and setting tables helps to support a sense of well being, Independence and skills. In other areas good practices were observed. During the lunch time meal in the area supporting people with dementia staff were observed to sit down with people living at th home to have a meal. This encourages positive relationships between staff and Pepe living at the home. Consideration should be given to extending this to all areas of the home. Relatives spoken with informed us that they were always made to feels welcome at the home and could visit at any time. They told us that they were offered refreshments and could have meals with their relative if they chose to. During this inspection we were able to observe the mealtime experience. The mealtime appeared to be relaxed and unhurried. Staff were observed assisting people in an appropriate and dignified manner. Tables were attractively laid with tablecloths and condiments. Choices of refreshments were available. The days menu was available in each area of the home. again this needs to be developed in the area providing support to those with dementia. People with dementia may not be able to make verbal choices about the meal that they would like. The staff need to consider developing aids such as photographs and pictures to aid communication. A range of snacks is available at any time. One person who had lost weight recently was observed to have appropriate supplements supplied by staff. The lunchtime meal looked very appetising and plentiful. Soft diets had been Care Homes for Older People Page 18 of 31 Evidence: attractively presented. Hot trolleys are used to ensure that meals are served at an acceptable temperature. The home has a new kitchen which is small but well equipped. The kitchen staff told us that they had recently attend training with regard to supporting older people with nutrition. The home has recently bought new napkins and are using these instead of clothes protectors. This reduces the institutional feel of the meal times. Staff informed us that the quality of food had greatly improved since the new cook had been employed. Care Homes for Older People Page 19 of 31 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. Appropriate systems are in place to allow people to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to people living there. Evidence: The home has a complaints procedure available in the home. We were informed that the home had received three complaints in 20098. These complaints have been investigated in line with the homes complaints procedure and appropriate remedial action had been taken. One formal complaints have been raised with the Commission. The home holds regular carers meetings for relatives/representatives where their views are encouraged. Relatives, staff and people spoken with during the inspection, did not express any concerns. Relatives and staff stated that they found the acting manager very approachable and would not hesitate in raising concerns if they had any. At the time of this inspection the home was taking appropriate steps to reduce the risk of harm or abuse to people living there. Staff are aware of how to raise concerns and Care Homes for Older People Page 20 of 31 Evidence: have access to a range of appropriate policies and procedures including whistle blowing and adult protection policies. Staff have been provided with training in these areas. Abuse training is also covered during the induction period. One person at the home is currently restiricted under the Deprivation of liberty safeguards. This is being managed and reviewed by the local authority. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and well maintained environment and people are encouraged to personalise their bedrooms. Parts of the home have recently been refurbished to a good standard. There is a range of specialist equipment available including adjustable beds for all people who have nursing needs. The home takes appropriate steps to reduce the risk of the spread of infection. Evidence: Since the last inspection an extension, called the Deanery, has been completed. This provides care for people who have dementia. The Deanery has 22 bedrooms over two floors, 20 have ensuite shower room facilities and two have ensuite toilet and wash hand basin. The size and shapes of the rooms vary with a minimum size of 12 sqm and maximum of 15.1sqm. All the rooms have a profiling bed with pressure relieving mattress; additional air mattresses are available All soft furnishings are coordinated. Each floor has a Lounges/dining room which also contains a small kitchenette. As this area supports people with dementia some signage and orientation aids were available. It is recommend that the environment continues to be developed in line with dementia research. There is one bathroom and one shower room on each floor in the Deanery. Care Homes for Older People Page 22 of 31 Evidence: Outside space is limited but fully accessible from the ground floor. The space consists of a patio area with ramp to garden area where it is intended that raised flower beds will be built in the summer. A new kitchen has been built in The Deanery to provide meals for St Benedicts. The home is registered with environmental health services. A new laundry facility has been built in The Deanery to serve the whole home. It has sufficient equipment but limited space. The laundry is staffed seven days a week. The new extension was presented and felt very homely, thought had been given to the size and layout of the building. The main building, The vicarage has significantly not changed in its layout although some redecoration and up dating have now been commenced. It is hoped that this will be completed in the near future. The acting manager confirmed that the home has sufficient pressure relieving equipment and hoists. Profiling beds are now available in all bedrooms. In addition to en-suite facilities in some of the bedrooms, the home has an appropriate number of assisted toilet and bathing facilities. During this inspection we were able to view a number of bedrooms and all communal areas. All areas seen were comfortably furnished and well maintained. The home was clean and there were no malodours. It was evident that people living at the home were able to personalise their bedrooms to meet their own needs and choices. As previously mentioned, all areas of the home viewed were clean and free from malodours. There are cleaners on duty each day in addition to laundry staff. The home takes appropriate steps to reduce the risk of the spread of infection. Staff have access to a good supply of protective clothing and appropriate hand washing facilities and foot-operated bins are in place. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear adequate to meet the needs of the people living at the home although these are being kept under review by the home manager. People living at the home are protected by the homes robust staff recruitment procedures. Newly appointed staff follow an appropriate induction period. The majority of staff have received all mandatory training. Some staff have an NVQ. Evidence: Due to the increase in the number of registered beds the staffing structure at the home has changed. There are now two heads of units in addition to the home manager. One for the general nursing area and one for the area providing support to people with dementia. Feedback both from the inspection visit and from the surveys received demonstrated that some people felt that the staffing levels in the dementia area were not adequate at some times particularly in the evening. We discussed this with the interim manager and the provider. They agreed that staffing had been an issue. The dementia care unit once opened has been very successful with beds filling quicker than anticipated. Due to this the correct numbers of staff had not been recruited prior to the beds being filled. Agency staff have been used to cover any Care Homes for Older People Page 24 of 31 Evidence: shortfalls. This has not been ideal as staffing in this way does not provide consistency. Although the agency has sent the same staff whenever possible. The manager stated that this was being rectified as staff recruitment was on going and new staff were coming on board as checks (CRB and POVA) have been received. As this is a new service with a range of new people living at the home initially the management could only estimate the staffing numbers required. The manager stated that it had become evident that during the evening time in one area staffing was not sufficient. As a result a new twilight shift was being introduced. It is hoped that this will ease the staffing numbers at this time and support the night staff in helping people settle for the night. This will be kept under review by the manager. People living at the home and relatives spoken to stated that they did not have to wait for too long if they rang the bell for assistance. The staff training matrix was viewed this showed that the majority of staff had completed all mandatory training. The training matrix showed that some staff have completed an NVQ. We examined the homes procedures for the recruitment of staff. Four recruitment files were examined for staff recruited since the last inspection. Records were well maintained and contained all required information. There was evidence that staff had not commenced employment until all required information, including criminal record and vulnerable adult checks had been received. We looked at induction programmes for the staff detailed above and there was evidence that staff follow an appropriate induction programme, which is in line with the Skills for Care Common Induction Standards. We spoke with some staff recently employed and they told us that the induction programme covered everything they needed to know. Staff confirmed that they had received the training they needed to enable them to meet the assessed needs of people living at the home. Care Homes for Older People Page 25 of 31 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. The home does not currently have a manager registered with us. The home is run with the service users best interests safeguarded by policy, practice and procedures. Some quality assurance systems need to be introduced. Attention to the health and safety of service users and staff is of a good standard. A system of staff supervision is in place. Evidence: The Care Home Regulations state that all care homes have to have a manager who is registered with us. This registration process ensures that only people who are fit are employed to manage care homes and ensures that the manager has the appropriate skills and competencies to fulfill the job role. The home has a new manager who is not registered with us. This registration process needs to be completed in the near future. Although this is the Ms Barclays first job as a manager she has numerous years Care Homes for Older People Page 26 of 31 Evidence: experience in the social care field. Ms Barclay is a registered nurse. Ms Barclay told us that she intends to enroll on a management course in the near future to give her a greater understanding of her job role. As the home has been without a consistent manager for a time some areas of the homes quality assurance systems have not been completed. For example all accidents are recorded but theses are not audited. Auditing of accidents is important as it can show patterns of accidents occurring and can be used to influence staffing levels for example at particular times. The manager agreed that quality assurance systems need to be reintroduced as soon as possible. Regular meetings are held for relatives and carers and staff where views are encouraged. We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people on request. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives or representatives as appropriate, on a monthly basis. A system of staff supervision is in place. Documented evidence was available and staff spoken with confirmed that they were supported. The AQAA submitted to us prior to the inspection detailed procedures and maintenance relating to health and safety. All were found to be satisfactory Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plan for the individual identified during the inspection needs to be updated to reflect all care needs and give clear guidance to staff. This should include pressure area and wound management, continence care and how to handle aggression The home needs to ensure that all medication and drugs are stored at the correct temperature at all times. Staff need to be reminded of the guidance/ policy on what to do if the fridge temperature is outside normal limits. The staff need to support and encourage people especially those with dementia to develop and/or maintain daily living skills such as setting the tables, making snacks and drinks. The staff need to develop systems which allow people to express choices and preferences. This could include the development of pictures and photographs. It is recommended that the garden area be developed over the next few months so that this can be enjoyed over the Summer period. It is recommended that the environment in the Deanery continues to be developed in line to include additional Page 29 of 31 2 9 3 12 4 14 5 19 6 19 Care Homes for Older People 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 signage and orientation ques. 7 8 9 27 31 33 staffing number must be kept under review particularly in the evening in the areas providing dementia care The manager must submit an application to register with the Care Quality Commission The manager must reintroduce the quality assurance systems Care Homes for Older People Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!