Care Home: St Clements Nursing Home

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What the care home does well People thinking of moving into the home were given useful information to help them to make a decision about whether it was the right place for them. The manager carried out an assessment with new people to make sure that their needs were fully understood and could be met at St Clements. The residents who completed surveys and those we spoke to were satisfied with the care and support they received. One resident said, "They are very caring and they look after me very well." A family member told us that their relative`s health had improved since being at the home. When necessary people were referred to other professionals, such as the GP, physiotherapist and speech and language therapist. Residents were offered a varied diet with choices at each meal. The residents who completed surveys said that they liked the meals, although one person commented that they were, "too much." Another resident told us "The food is nice, we get a choice and there is plenty to eat." There was a clear complaints procedure that showed the service had a positive attitude to complaints. Residents we spoke to said they would feel able to talk to staff if there was anything wrong and a visitor said they were confident that any complaints would be dealt with appropriately. The procedures to safeguard residents from harm and abuse were clear and staff had received appropriate training in safeguarding. This helped to ensure that staff had the skills to recognise and respond to any reports of abuse. There was a good programme of training for new staff, which helped to make sure that they had the basic skills to understand and meet residents` needs. Staff who completed surveys told us that they received ongoing training that was relevant to their role and helped them to keep up to date with good practice. What has improved since the last inspection? Overall there had been improvements in care records since our last inspection. Residents and their families were consulted about their care plans, which meant they could talk to staff about how they wanted their care to be provided. Care plans were more detailed and told staff how to provide care that matched residents` wishes and helped to maintain their independence. Plans were kept under review but they were not always updated when there were minor changes in the residents` needs. The assessments to identify risks to residents` health and safety had also improved but staff must make sure that the assessments for new residents are carried out in a timely way. After the last inspection we made a requirement that portable electrical appliances must be tested to ensure they were safe for use. This had been carried out. Other equipment in the home, such as the fire system and gas appliances were serviced regularly to protect the health and safety of people living and working in the home. What the care home could do better: The plans to tell staff how residents should be moved must be more detailed to include information about equipment to be used. Staff must always use the appropriate equipment to prevent injuries to the resident or themselves. After the last inspection we made a requirement that there must be accurate records of medicines administered to residents. The records of oral medication were much improved but prescribed creams were still not being recorded properly, which made it difficult to tell whether they were being administered. Residents did not have individual plans to support them to meet their social and recreational needs. There was a programme of group activities, which some residents chose to attend these but there was a higher proportion who did not wish to, or were not able, to join in. Those residents told us there was little for them to do all day and that care staff did not have time to spend with them. One said, "Staff spend what time is needed to work on me but they don`t have time for anything else." A member of staff who completed a survey also commented that residents may benefit from more activity. We talked to the manager about residents` perception about there not being enough staff to spend time with them. He agreed to look into this. At the time of our visit the conservatory was too cold for residents to use, which restricted the amount of communal space available to them. We made a requirement that all areas for residents` use must be accessible and warm enough. On the lower floor there was only one communal toilet for use by residents, which was not sufficient. Key inspection report Care homes for older people Name: Address: St Clements Nursing Home 170 St Clements Hill Norwich Norfolk NR3 4DG     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: Jane Craig     Date: 1 5 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 Clements Nursing Home 170 St Clements Hill Norwich Norfolk NR3 4DG 01603427487 01603789407 govinden@providencehealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Providence Health Care Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One person under the age of 65 who will be named in the Commissions records. Date of last inspection Brief description of the care home St Clements was built in 1947 and sits within close proximity to Norwich city centre. An extension was built to increase the accommodation in 1989. The well-tended garden extends out to the back of the property in approximately half an acre. The home provides nursing and personal care for up to 25 older people. The home comprises two floors, with access to the first floor via a passenger lift. The home is suitably adapted to cater for people with varying disabilities in either double or single bedrooms. There is a combined lounge and dining room, with an added conservatory. A library, hairdresser and chiropodist visit the home on a regular basis. Information about the home is sent out to anyone making enquiries. The latest inspection report is on display in the home. Information about the fees and any extra charges is available from the manager. 0 9 0 3 2 0 0 9 0 Over 65 25 Care Homes for Older People Page 4 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: The last key inspection on this service was completed on 9th March 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 15th December 2009 by one regulatory inspector. At the time of the visit there were 21 people resident in the home. We met with some of them and where possible asked about their views of St Clements Nursing Home. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the proprietor, who is also the registered manager, visitors to the home and members of the staff team. We looked around the home and viewed a number of Care Homes for Older People Page 5 of 31 documents and records. As part of the key inspection, surveys were sent out to people living and working at St Clements. Most residents were assisted to complete the surveys by family members. Information from surveys has been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The plans to tell staff how residents should be moved must be more detailed to include information about equipment to be used. Staff must always use the appropriate Care Homes for Older People Page 7 of 31 equipment to prevent injuries to the resident or themselves. After the last inspection we made a requirement that there must be accurate records of medicines administered to residents. The records of oral medication were much improved but prescribed creams were still not being recorded properly, which made it difficult to tell whether they were being administered. Residents did not have individual plans to support them to meet their social and recreational needs. There was a programme of group activities, which some residents chose to attend these but there was a higher proportion who did not wish to, or were not able, to join in. Those residents told us there was little for them to do all day and that care staff did not have time to spend with them. One said, Staff spend what time is needed to work on me but they dont have time for anything else. A member of staff who completed a survey also commented that residents may benefit from more activity. We talked to the manager about residents perception about there not being enough staff to spend time with them. He agreed to look into this. At the time of our visit the conservatory was too cold for residents to use, which restricted the amount of communal space available to them. We made a requirement that all areas for residents use must be accessible and warm enough. On the lower floor there was only one communal toilet for use by residents, which was not sufficient. 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 8 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 9 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 admission process helped to reduce the risk of unsuitable placements. Evidence: The service users guide was comprehensive and informative. Anyone thinking of moving into the home was provided with a copy, which helped to give them an idea about the home and its facilities, before they made a decision about living there. There was also a copy of the guide in each bedroom for residents and their families to refer to. The guide was available in large print format on request. People who returned surveys indicated that they received enough information about the home to assist their decision. Anyone who wished to move in to St Clements was assessed by the manager before being offered a place. This helped to ensure that the persons needs were understood and could be met at the home, which helped to reduce the risk of failed placements. The assessment identified the persons main health and personal care needs with Care Homes for Older People Page 10 of 31 Evidence: regard to various activities of living. The ones we saw provided little information about the person, or their likes, dislikes and preferences for care. For example, information about cultural and social needs had not been completed on one of the assessments we looked at. However, these assessments were usually supported by information provided by health and social care professionals who were involved in the persons admission. Staff also carried out another assessment on admission, which provided more detail about the individual and was used to draw up initial care plans. Care Homes for Older People Page 11 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. Residents health and personal care needs were met and medication was administered safely. Evidence: As part of the case tracking process we looked at the care plans and associated records for three residents. Overall, there had been improvements in the care plans since our last inspection. Plans to address health care needs focused on nursing interventions to monitor and relieve ongoing conditions and did not contain a great deal of person centred information. Residents hydration, nutrition and pressure relief were being monitored. Care plans to assist residents with personal care were more detailed and directed staff to support the resident in a way that maximised their independence and gave them personal choice. There was sufficient detail on these plans to ensure that staff provided consistent care that met the residents personal preferences. The annual quality assurance assessment (AQAA) told us that people using the service Care Homes for Older People Page 12 of 31 Evidence: and their relatives were fully involved in designing their care plans. The plans we saw had been signed by the resident or their relative to show their agreement but there was no evidence that this was an ongoing process. Most of the health care plans we saw had been written some time ago. They were reviewed every month and, although changes in the residents health status or needs were recorded in the review notes, the plans were not always amended. This could result in the information being lost in reams of notes and staff not being aware of the care they needed to give. In cases where there were major changes in the residents needs, care plans had been rewritten to ensure that staff were given up to date directions. Assessments to identify risks to residents health had improved but there were still some shortfalls. Everyone had a moving and handling assessment and plan. These indicated how many staff the person needed but some did not state the equipment to be used. In the case of transfers by hoist, the plans did not specify the type of hoist or size of sling to be used. We observed a resident being moved by staff without the equipment specified in the plan, which could cause injury to the resident and the staff. However, another resident told us that staff always used the hoist or a special sheet to help her to move in bed. There were risk assessments with regard to falls but they did not identify specific risk factors, which meant that strategies to minimise the risk were sometimes vague and did not focus on the needs of the individual resident. We had identified this at the last inspection but there had been no improvement. The three people we case tracked all had bedrails in place. One did not have an assessment to show that bedrails were appropriate. Another had an assessment but it did not look at whether the rails were suitable for the type of bed. The third had a complete assessment. Two of the residents we case tracked had MUST assessments, which is a universal screening tool to highlight needs associated with poor nutrition. Staff had not completed the tool for the third resident even though one of their main needs was around eating and nutrition. Despite this omission, staff had drawn up a care plan to support the resident with regard to nutrition, which incorporated specialist advice from the speech and language therapist. The surveys we received from residents/relatives indicated that they received the care and support they needed and that staff made sure they got the medical care they needed. When asked what the home does well, one wrote, My mothers personal hygiene, medical side and everything for my mothers well being. Residents we spoke to also told us that staff looked after them very well. One said staff were good at assisting them with their personal care in a way that avoided embarrassment. Another said staff looked after their health and if they were unwell they were referred for Care Homes for Older People Page 13 of 31 Evidence: medical attention. A relative told us that their mothers health had improved greatly since being at St Clements. She said that staff at the hospital had not taken the time to help her to eat but staff at St Clements were very good and her mother was gaining weight. One of the families we spoke to said they had confidence in the staff and they were kept informed if there were any concerns about their relatives health. We saw evidence that residents had access to health care professionals. There were records of appointments with a variety of health professionals for treatment and advice. The advice was not always transferred to the residents care plan to ensure that it became part of everyday care and support. For example, the physiotherapist had advised some armchair exercises for one resident but this had not been added to their care plan. However, the nurse told us that she discussed it with staff during handover and reminded them to help. We were told that staff were providing a palliative approach to the care of one resident. There were documents signed by the residents family, GP and staff at the home, agreeing that the resident should remain at the home for end of life care. At the time of our visit there was no formal end of life care model in place. Promoting core values such as privacy, dignity and independence were included in the induction training for all staff. The service users guide also told residents the service was committed to upholding these basic rights and several care plans made reference to how the residents privacy and dignity could be maintained during care. On the day of our visit we observed staff talking to residents in a polite and respectful way and residents confirmed they were always like that. One told us, They treat me well, noone is ever rude or impolite. However, we did observe some care practices that compromised residents privacy and dignity. For example, we witnessed some staff members entering residents bedrooms without knocking on the door. We also saw one member of staff watching TV whilst assisting a resident to eat their lunch in their bedroom. The staff member was turned away from the resident and so prevented any attempts at conversation. The AQAA told us that the service was planning to provide more staff training in dignity and choice, which should help to improve these practices. We looked at the storage, recording and administration of medicines. All medication was managed by registered nurses. We observed part of a medicine round and found practice to be safe and hygienic. Medicines were stored safely and there were no excess stocks. There were complete records of medicines received, disposed of and of any stocks of Care Homes for Older People Page 14 of 31 Evidence: medicines carried over from the previous month. These records contributed to the audit trail and helped to ensure that prescribed medication was always available. We checked a small sample of medicines and found that the stock matched the records. This was a good indication that residents were receiving their medication as it was prescribed. The weekly medication audits evidenced that nursing staff were generally diligent in signing for medicines they had administered. However, there were gaps on medication administration records (MAR) charts where care staff administered prescribed creams, which made it difficult to tell whether they were being administered consistently. As we had recommended after the last inspection, the staff had drawn up criteria to alert staff to give medication that was prescribed when required. These medicines included painkillers and laxatives. None of the residents were prescribed sedatives to be given at the discretion of staff. Some people were prescribed medicines to be given in a variable dose. Staff recorded how much had been administered, which helped to ensure that residents did not receive too much and also the effects of the medication could be evaluated. There were some handwritten entries on MAR charts. These had been witnessed to reduce the risk of transcribing errors. Controlled drugs were stored, recorded and administered according to legislation and good practice guidelines. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service did not meet the social and recreational needs of a number of people using the service. Evidence: Residents families were asked to bring in life histories but they were not available for all the residents. We were told that they helped staff to get to know the person, especially people and events that were important to them. The AQAA stated that the home had introduced Pabulum Blue Books in order to collect life history information to help them to further understand the needs of the residents. One of the residents we spoke to had been given a book but had not had any support to complete it. She said, They sent round a book to ask what I would like to do but staff dont have any time to spare. The AQAA indicated that everyone had a capability assessment which helped staff to design activities but we did not see these for the residents we case tracked. Despite a recommendation we made after the last inspection, none of the residents had a plan to direct staff how to support them to meet their social and recreational needs. The home employed an activities co-ordinator for four sessions per week. She had not had any training for the role but was booked to attend a reminiscence course in the new Care Homes for Older People Page 16 of 31 Evidence: year. The activity co-ordinator told us that there was a programme for group activities but this had been suspended for the Christmas period while there were various celebrations taking place. A relative commented that one of the things the home did well was parties and fetes. On the day of our visit there was a small group of residents playing bingo and we were told that there were other group activities, including, drawing, exercises to music and other games. A resident told us, I like to read and watch TV but sometimes join the activities, it depends on what is on. Another said they sometimes went into the lounge and could join the games if they wanted. A large number of residents did not go to the lounge. The activity co-ordinator said that she tried to spend one to one time with them as often as possible but her time was limited, especially as she continued to assist with some personal care. On the day of our visit she was called away from the bingo game a number of times to answer the doorbell and carry out other tasks. Care staff did not generally take responsibility for activities and occupation. A relative who completed a survey indicated that there were never any activities their family member could take part in. When asked to comment on what the home could do better, they wrote, Have a person residents can talk to so they dont get so lonely. Staff dont seem to be able to stop and talk with them for any length of time. Residents we spoke to also told us that staff were too busy to spend any social time with them. One said, I just stay here watching TV or sleeping; I am used to it but I would like to have a chat with someone. Another told us, Staff spend what time is needed to work on me but they dont have time for anything else. A third said, It is absolutely boring, I am not used to inactivity. The activity records for one resident indicated that they had recently enjoyed a hand massage but this was the only activity in the week. A member of staff who completed a survey commented, Residents may benefit from more activities. Staff told us that residents rarely had the opportunity to go out except in the garden in summer, or with relatives. One member of staff said they thought this was one of the things the home could do better. On the day of our visit a member of staff came in on her day off to take a resident out for a walk. The AQAA told us that the service planned to increase the variety and periods of activities over the next year. There was open visiting at the home, which helped residents to be able to stay in touch with their family and friends. Visitors we spoke to said that staff made them feel welcome. There was four week rotating menu. The cook told us that residents had input into choosing meals but very often chose things that the majority did not like. The records showed that residents were offered a varied diet. Residents we spoke to were generally happy with the meals and the choice they had. One told us, They are going to send out for something tomorrow because there is nothing on the menu that I Care Homes for Older People Page 17 of 31 Evidence: fancy. Another said, The food is nice, we get a choice and there is plenty to eat. A third said, There is enough variety, I eat a lot of salads because I enjoy them. One resident, who needed a soft diet said they enjoyed their lunches but were fed up with soup every night. We discussed this with the manager who said they would look into it. Since our last inspection new dining tables had been purchased and a small number of residents ate their meal around the table instead of from individual tables next to the lounge chairs. This helped to create a more social atmosphere at lunchtime. We also noted that the indiscriminate use of plastic feeding beakers had ceased and residents were offered hot drinks from cups that suited their abilities. There were still a number of staff led routines in the home, such as bathing rotas and toileting times but residents told us that things like times for getting up and going to bed were up to them. Care Homes for Older People Page 18 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. Complaints were dealt with appropriately and procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: The complaints procedure was on display in the home and residents received a copy in their service users guide. The procedure confirmed the service had a positive attitude to complaints. It was clear and explained how complaints would be dealt with. There were contact details for other agencies who may be able to assist in the complaints process. Everyone we spoke to said they had no complaints at the time but would feel comfortable speaking to staff if they were unhappy about anything. One said, I wouldnt be frightened to speak out. Residents who completed surveys indicated that they had someone to talk to if they were unhappy about their care. A visitor told us they were confident any complaints would be dealt with. They had spoken to staff regarding concerns about their relatives medication. Staff had contacted the doctor and the issue had been resolved. The complaints records showed there had been one formal complaint since the last inspection. The manager had investigated the issue. He said the complainant had been informed verbally of the outcome of the investigation but there were no records of the conversation. Staff received safeguarding training during induction and NVQ training and were Care Homes for Older People Page 19 of 31 Evidence: expected to attend regular updates. Staff we spoke to were confident that they would be able to recognise if a resident was the victim of abuse and said they would report it to senior staff. They were also aware that they could report it outside the home if they were not satisfied with the response they received. One said, I would go to CQC if there was no action, I would make sure it wasnt left. Following a recommendation at our last inspection, the safeguarding policy for the home had been revised. It provided senior staff with clear guidance about how to report any suspected or alleged abuse to social services. Staff also had the Norfolk Social Services guidance to refer to. The manager and registered nurses had received training about the Mental Capacity Act and associated legislation. The AQAA told us that residents had mental capacity assessments but those we saw were brief cognitive assessments which made a judgement about the persons intellectual impairment and did not relate to their capacity to make a decision about a particular issue. The manager told us that none of the current residents were in need of a full mental capacity assessment. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all parts of the home were comfortable and there were insufficient lavatories on the ground floor. Evidence: From looking around the building it was apparent that the home was generally well maintained. There were safety measures, such as low surface temperature radiators. Most areas were decorated and furnished to a satisfactory standard. There was an annual development plan, which prioritised areas for redecoration and renewal. It showed that the work planned to date had been carried out. The AQAA indicated that the old, metal windows were to be replaced in the next year. On the day of our visit the conservatory, which formed part of the required communal space, was too cold to use. There was a portable heater, which staff said warmed the room but it was not switched on. This meant that residents did not have a choice of seating areas and anyone not wanting to remain in their bedrooms only had the lounge/dining room, which was also being used for a group activity. Other areas of the home were comfortably warm and the residents we spoke to all said their bedrooms were warm enough. One said they had asked the staff to turn the heating off because they were so warm. Most residents had personalised their rooms with ornaments and pictures, which Care Homes for Older People Page 21 of 31 Evidence: helped to make them more familiar and homely. Everyone we spoke to commented favourably about their rooms. One said, I am happy with my room, I wouldnt have come if I couldnt have my own toilet. Another told us, I share a room and it is nice to have someone with me. All shared rooms had privacy curtains. Following a recommendation after the last inspection, staff had stopped using the bathrooms as storage areas, which meant that residents had a choice of assisted bathing facilities. However, two of the three communal toilets downstairs were marked for staff use only. This only left one toilet for use by residents who were in the lounge, as well as three residents in the downstairs bedrooms, who did not have en-suite facilities. Furthermore, the toilet door was partially glazed with no curtain, which meant that residents using the toilet would not be completely private. The AQAA indicated that staff had training in prevention and control of infection. We noted that staff wore protective clothing when providing personal care to residents and there were suitable hand washing facilities around the home. There had been no outbreaks of infection in the past year. On the day of our visit the home was clean and fresh smelling. A resident told us that his room was always nice and clean. Two of the residents we spoke to said the laundry service was good. One said, They do the washing every night and we always get it back, they have never ruined anything. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices did not provide complete safeguards. Evidence: Residents who completed surveys stated that staff were always / usually available when they needed them. However, a number of the residents and visitors we spoke to said that they did not think there were enough staff. Residents said that when they pressed their bell for attention staff would come in and tell them they would be with them as soon as possible but they could then be waiting for a long time. When we asked one person what they thought the service could do better, they responded, It could be improved by taking on more staff, it would mean I wouldnt have to wait half an hour. Other people told us that staff sometimes took a long time to answer the bell so they pressed the emergency alarm and staff came quickly. The manager said that staffing levels were calculated by looking at the amount of help residents needed but staff thought that they were linked to the number of residents in the home. Staff who completed surveys indicated there were usually enough staff to meet the needs of the residents. Staff we spoke with during our visit confirmed that most of the time there were enough staff but that evening shifts could sometimes be hectic because there were only three care staff. They said that residents did not miss out on essential care but they would like to be able to spend more time with them, not just to do personal care. Care Homes for Older People Page 23 of 31 Evidence: The duty rosters we saw showed that the usual staffing levels were, one registered nurse and four care assistants in the morning and one registered nurse and three care assistants in the afternoon and evening. We discussed with the manager the low ratio of nursing staff compared to the number of residents who had nursing needs. The manager said that, although he worked in a supernumerary capacity, as a registered nurse he provided assistance when necessary. Some of the registered nurses also had supernumerary time, for example, to help with organising residents medication. There were ancillary staff to cover catering, cleaning and maintenance. Care staff were responsible for doing the laundry. On the day of our visit we did not see any evidence that people were kept waiting for their bells to be answered or that they were not receiving health or personal care. However, as mentioned previously in this report, residents perceived that staff were too busy to spend time with them. One resident told us, I would like to walk up and down the corridor but I need supervision and there are not enough staff. The manager agreed to review staffing levels and to talk to residents about their views during the next residents meeting. We looked at two staff files. Both had an application form which provided a full employment history and reasons for leaving previous care jobs. Both staff had started work before their CRB disclosure was returned but they had POVA first checks. These showed that neither person was on the list of people deemed unsuitable to work with vulnerable adults. One member of staff had started work before they had two written references. This meant that the manager did not have all the required information on which to base their judgement that the person was fit to work at the home and residents would be protected. There was a good induction training programme that met the Skills for Care, common induction standards. Most staff who completed surveys indicated that the induction programme covered everything they needed to know, very well. Staff received mentorship throughout the 12 week programme and were regularly appraised to check they were making progress or highlight areas where they needed further help. Following induction, staff joined the rolling programme of mandatory training. The central training record showed that there were some gaps in the refresher training for moving and handling and other safe working practice topics. It was not clear whether the record had not been updated or whether staff had not attended courses. Staff had opportunities for other training relevant to their role and registered nurses were offered courses to meet the requirements of their registration. A staff member who completed a survey commented that the service, Provides training for all staff to improve skills and knowledge. The AQAA indicated that over half of the care staff held Care Homes for Older People Page 24 of 31 Evidence: a National Vocational Qualification (NVQ) at level 2 or above in health and social care. This helped to ensure that they had the basic knowledge and skills to meet the needs of the residents. 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. Residents and staff benefited from a well managed home. Evidence: The registered manager is a registered nurse with qualifications in management and teaching. With the exception of one shift per week, the manager had supernumerary status. Although the time the manager spent at the home equated to full time, or more, his planned hours were not recorded on the duty roster. This meant that staff were not always certain about when he would be at the home. This was apparent on the day of our visit. However, staff are able to contact the manager at any time in case of emergency. Staff who completed surveys indicated that they regularly met with the manager. One commented that they received, good support from the management side. Another wrote that one of the things the service did well was, strict management. The manager returned the AQAA when we asked for it. All sections of the self assessment had been completed but some areas were very brief. It did not give us a Care Homes for Older People Page 26 of 31 Evidence: clear picture of how the service is performing and their plans for development over the next year. The last quality survey undertaken by the home was in June 2009. Residents, relatives and visiting professionals had been invited to take part and there had been a good response. The results had been collated and published in a report. Although there were a number of positive comments about all aspects of the service, there were some areas that could be improved upon. The manager had not drawn up an action plan to rectify these areas but he told us that most issues had been resolved. There were a number of monthly audits to ensure that procedures in the home were being followed, for example, medicines management. There were others which were used to inform care practices, for example audits of accidents, pressure sores and infections. There were regular staff meetings where good practice issues were discussed and staff could make suggestions for improvements. Records of residents meetings showed little discussion, although individual residents were asked to make comments about their experience of the service and to voice any concerns. Residents who were not able to manage their own finances had families or other representatives to assist them. A number of residents had small amounts of money held at the home for safekeeping. There were secure facilities and senior staff kept receipts and clear records of all financial transactions, to ensure there was a full audit trail. We checked a small sample and found them to be correct. The records were checked regularly to ensure that any errors in calculations would be quickly identified. Staff received regular fire safety training and had practice drills to show they understood the procedure to be followed in the event of a fire. Fire safety equipment and appliances had been serviced. The manager told us that all previous recommendations from the fire risk assessment had been actioned and the assessment was due to be reviewed next month. The home had recently appointed a new fire marshall who had just completed their training. There were certificates to show that other installations and appliances were maintained and serviced, which helped to protect the health and safety of residents and staff. As we required after our last inspection, portable electrical appliances had been tested to ensure they were safe to use. 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 1 8 13 Moving and handling care plans must specify equipment to be used and staff must always follow the plan. To prevent injuries to residents and staff. 31/01/2010 2 9 13 Staff must keep accurate 31/01/2010 records of prescribed creams administered to residents. This is in order to promote residents health and safety. 3 12 16 Residents social care needs 31/03/2010 must be assessed and a plan drawn up to support each person to meet their need for social inclusion and recreational activities. To promote health and well being. 4 19 23 There must be adequate heating in all parts of the home used by residents and 31/01/2010 Care Homes for Older People Page 29 of 31 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 there must be sufficient lavatories in close proximity to the communal areas. To promote residents comfort and choice. 5 29 19 New staff must have two written references before starting work at the home. This is to provide safeguards for residents. 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 31/01/2010 1 7 Advice from health care professionals should be recorded on residents care plans to make staff aware and ensure the advice is incorporated into everyday care and support. Assessments to identify risks to the residents health and safety should be carried out within the first few days of a new resident being admitted. This would include risks associated with poor nutrition and the use of bed rails. All staff should receive training with regard to the Mental Capacity Act and related legislation. Staffing levels and the deployment of staff should be closely monitored to ensure that there are always sufficient staff on duty to meet the health, personal and social care needs of the residents. The central training records should be brought up to date and any shortfalls addressed. 2 8 3 4 18 27 5 30 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. 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