Care Home: St Vincent House

What the care home does well The house provides a comfortable, clean and welcoming home for service users to live in. The home is decorated pleasantly and fixtures and fittings are to a good standard. The pre-admission assessment and care plans are detailed and person centred and inform the practices of the care staff to enable them to meet service users` needs. The care plans are well documented and person centred and describe how service users would prefer their needs to be met. Care plans are signed by service users or relatives and reviewed appropriately. The home has a range of activities available to meet the needs of the service users. The activities are managed well, providing opportunities for residents to join in activities inside the home. Good social histories are maintained for each service user to enable the activities to be tailored accordingly. The home provides a varied and nourishing diet that gives a choices of menus at every meal time. Menus are produced in a pictorial format for those service users unable to communicate their choices verbally. Staff were seen interacting well with service users in general and were observed to be giving them choices. The home offers staff a variety of training to undertake that appertains to the service users they care for. Comments on the surveys received from service users, visiting professional and staff were complimentary with comments such as: `We are currently working on courses relevant to dementia, diabetes, equality and diversity and other relating courses`. `The service is very good at providing stimulating activities such as arts and crafts, musical movements, mini-bus outings, theatre groups and aromatherapy and massage`. `I am happy working at St Vincent House and feel that we provide a happy place for our service users and provide good care`. `The home is friendly and welcoming`. `The home records information well and we do well at caring for our clients`. `I believe the staff are all caring people and they do an excellent job in supporting and respecting a group of individual, for whom. many have great difficulty in coping with every day life`. `Great care is provided to ensure that the right medical attention is provided`. `I have settled well and was made very welcome. I am generally very content and I like the room I have been given`. `The meals are very good`. `I am very happy here`. `The care for the complex cases and their approach is friendly, approachable and caring. Service users are given respect and the families are very pleased with the care delivered in this home`. What has improved since the last inspection? The medication policies and procedures have been reviewed and the home`s practice is now safe. The home has purchased a new drug trolley that all medication is administered from. A new drug fridge has been installed in the medication room. The undergrowth has been cleared from outside room 26 which was identified last year to having to have artificial lighting on at all times. The room is now much lighter. A new person centred care planning system is being introduced, the content of which is very detailed and covers all aspects of a person`s care needs. A staff supervision programme is in process but this has been delayed by the absence of the manager from the home. The programme is now being supported by the operational manager who will be supporting the deputy manager to undertaken regular staff supervisions and appraisals. The home has a training matrix and a training plan for the coming year is in the process of being arranged by the deputy manager and operational manager as staff training needs are identified through the appraisal and supervision process. The home advertises a variety of training opportunities appertaining to the service user group they care for, to which they have the opportunity of attending. The fire alarms and fire training are all in place and there was evidence that all staff have attended fire training. The service now has a quality assurance system in place and questionnaires are distributed to service users, relatives and other stakeholders at regular intervals throughout the year and the results of these questionnaires or any issues highlighted are discussed at regular residents` and staff meetings. What the care home could do better: Service users monies held by the home must be stored in separate containers or savings accounts in the name of the service user. Ensure that the temperatures of the fridge that stores medication is monitored regularly and recorded. A controlled drugs cupboard must be installed that meets the standards of the Misuse of Drugs (Safe Custody) Regulations 1973, specifications. Care plans should be written to guide when `as needed` (PRN) medication should be offered or given to those service user who are unable to communicate effectively. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Vincent House Forton Road Gosport Hampshire PO12 4TH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Vincent House Forton Road Gosport Hampshire PO12 4TH 02392351668 Telephone number: Fax number: Email address: Provider web address: debbie-stvch@tiscali.co.uk Name of registered provider(s): Type of registration: Number of places registered: St Vincent Care Homes Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Physical disability (PD) Date of last inspection Brief description of the care home St Vincents House is a large well maintained detached house set in its own grounds; the house is a grade II listed building and has a large enclosed rear garden. There is parking at the front of the building. The home is registered with the Care Quality Care Homes for Older People Page 4 of 34 Over 65 0 34 0 34 0 34 Brief description of the care home Commission (CQC) to provide residential care for up to 34 older people 26 of which may be suffering from age related mental health problems. There are 22 single rooms and 6 double rooms and the house is situated on the main road into the town centre of Gosport and is close to local amenities. Currently fees are between £460 and £550 per week. These fees include all activities and entertainment and the aromatherapy service as well as daily newspapers. These fees do not include hairdressing, chiropody, other than diabetic service users, specific daily papers of the residnets own choice and other personal items. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit inspection to St Vincent House Gosport, which was unannounced, took place over a one day period on the 28th May 2009 and was attended by one inspector. The registered manager was not in the home at the time of this visit and the deputy manager and operational manager assisted with the inspection process. The visit to St Vincent House formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The focus of this visit was to support the information gathered prior to the visit. The judgments made in this report were made from the information gathered since the last inspection. The Annual Quality Assurance Assessment (AQAA) was submitted to the commission by the manager, information from the previous report, the service history correspondence and contact sheets appertaining to the service were also taken into consideration. Care Homes for Older People Page 6 of 34 A number of comment survey cards were sent to service users, staff and visiting professionals prior to the visit of which seven (7) service users,(two of which were completed by relatives), two (2) G.P.s, one (1) care manager and six(6) staff were returned to CQC. They were generally very positive about the care and services in the home. Issues highlighted on the surveys are discussed in the main body of the report. Further evidence was gathered on the day of the site visit. The inspector toured the home and spoke to staff and residents who gave their views on the service. Residents in general stated that they enjoyed living at the home and liked the staff. Care and other records and documentation identified in the report were viewed. What the care home does well: The house provides a comfortable, clean and welcoming home for service users to live in. The home is decorated pleasantly and fixtures and fittings are to a good standard. The pre-admission assessment and care plans are detailed and person centred and inform the practices of the care staff to enable them to meet service users needs. The care plans are well documented and person centred and describe how service users would prefer their needs to be met. Care plans are signed by service users or relatives and reviewed appropriately. The home has a range of activities available to meet the needs of the service users. The activities are managed well, providing opportunities for residents to join in activities inside the home. Good social histories are maintained for each service user to enable the activities to be tailored accordingly. The home provides a varied and nourishing diet that gives a choices of menus at every meal time. Menus are produced in a pictorial format for those service users unable to communicate their choices verbally. Staff were seen interacting well with service users in general and were observed to be giving them choices. The home offers staff a variety of training to undertake that appertains to the service users they care for. Comments on the surveys received from service users, visiting professional and staff were complimentary with comments such as: We are currently working on courses relevant to dementia, diabetes, equality and diversity and other relating courses. The service is very good at providing stimulating activities such as arts and crafts, musical movements, mini-bus outings, theatre groups and aromatherapy and massage. I am happy working at St Vincent House and feel that we provide a happy place for our service users and provide good care. The home is friendly and welcoming. The home records information well and we do well at caring for our clients. I believe the staff are all caring people and they do an excellent job in supporting and respecting a group of individual, for whom. many have great difficulty in coping with every day life. Great care is provided to ensure that the right medical attention is provided. I have settled well and was made very welcome. I am generally very content and I like the room I have been given. The meals are very good. I am very happy here. The care for the complex cases and their approach is friendly, approachable and caring. Service users are given respect and the families are very pleased with the care delivered in this home. Care Homes for Older People Page 8 of 34 What has improved since the last inspection? What they could do better: 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 set out on page 4. Care Homes for Older People Page 9 of 34 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential service users have their needs assessed and receive information about the service, prior to them making a decision to move into the home to live. Evidence: The AQAA states that prior to admission all service users are given detailed information about the home to enable them to make informed choice. Each service user is invited to spend time in the home prior to admission. The manager carries out pre admission assessments and information is also gathered from GPs, families and friends to identify specific needs. The service user or and relatives receive information about the home prior to their admission to the home. The Statement of Purpose was viewed and contains up to date information about the home. A sample of three service users pre-admission assessments were seen. These Care Homes for Older People Page 12 of 34 Evidence: evidenced that the pre- admission assessments are undertaken by the manager or deputy who will visit the persons home or the clinical area to do the assessments. In some cases, the deputy told us, that if a person chooses to have a pre-admission visit to the home for the day, the home will undertake the assessment at this time. The deputy told us that if social services have made the referral the care managers will send a copy of their care needs assessment to contribute to the assessment process. The clinical areas will share information with the home at assessment, but the hospital social workers now expect the home to send them a care plan following the assessment for them to make a decision about the placement. Families are also involved with the assessment process and the home will consult with other health professionals if necessary. The pre-admission assessments seen in the care plans were detailed and covered areas of physical, health, emotional and social care and would enable the home to assess whether they could meet that persons needs. Surveys returned from service users said that they did receive sufficient information about the home before they moved in and that they and their family were involved with choosing the home. One resident saying My son viewed three homes in the area and chose St Vincent in close consultation with me and although it is early days I have excellent support. However, a comment from a care managers survey said St Vincent do take people with severe dementia as emgerency placements and often the community do not ensure they have all the information they need. The home does not provide intermediate care. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare needs of the service users are met. Policy and procedures are in place to manage the residents medication safely and effectively. The home promotes staff working practices to ensure that residents privacy and dignity is respected at all times. Evidence: The AQAA tells us that the home now has a computerised care planning system in place, which it anticipates will improve the person centered care planning and ensure all service users needs are identified and met. The home is in the process of changing from written care plans to an electronic system. A sample three service users care plans were viewed, two being the new electronic care plans and the other on the old system. The home continues to keep a file for each service user that contains paper copies of all care plans. The new care planning system in person centered and very detailed and covers all areas of a persons needs and care. Risk assessments are in place for all service users Care Homes for Older People Page 14 of 34 Evidence: for falls, nutrition, moving and handling with care plans to support any risks identified in the assessment process. The care planning system describes how each persons needs should be met and how they prefer their care to be given with likes and dislikes documented. The daily notes are also detailed and are recorded at each shift change and describes the outcome for service users from the prescribed care and how the service user has spent the day. A comment on a staff survey returned to CQC said we are currently working with new care plans and these are being gradually introduced and will enable staff to gain access more easily to information in a better format which runs alongside the sharing of information at handover meetings It was observed that care plans had been signed by the service user or relative as evidence of their involvement with the care planning and their agreement with the planned care. Care plans were observed to be reviewed monthly. It was observed that there is literature around the home for staff to read about the new care panning system and all staff are in the process of having training to enable them to use the system effectively. Staff spoken to at the time of this visit told us that they think the new system is very good, the care plans are easy to follow and support how they care for the person. Surveys returned from service users and observations from the visit indicate that service users are happy in the home and that they get the support and the medical attention they need. Comments made said: A caring and supportive environment. I am very happy living in this home. The AQAA says that all service users have access to health care professionals of their choice. CQC have received two surveys from health professionals with very positive comments made about the home, one saying One of the best homes in Gosport. A very responsible and caring service. The deputy manager told us that service users are registered with a number of GPs and are able to keep their own GP if possible, which benefits service users when seeing a doctor they are familiar with. There was evidence in the care plans of records of all visits made by health professionals and the outcome of the visit. Care plans recorded visits from the community psychiatric nurse team (CPN) and the deputy manager told us that the home has good relationships with the team who will support them with service users Care Homes for Older People Page 15 of 34 Evidence: who may display challenging behaviours or if their moods become unstable. The records also show all out patients visits and community appointments are attended. The deputy said the home has support from the primary health team when they are caring for a person who is having palliative care. It was observed that one service user, who is now in bed at all times, has been supplied by the PCT with a profile bed and a special pressure relieving mattress to aid their comfort and prevent pressure sores occurring. We observed that she had records in her room of her daily dietary and fluid input and a record of when she was repositioned in her bed. She looked clean and comfortable and we were told she has been a resident for a number of years and the home expressed the wish to continue to care for her, with the support of the district nurse team, until her death. The report of May 2008 stated that the home had a blister pack system in place for the administration of service users medication. The home did have policies and procedures in place for the management of medication. The report of May 2008 stated that at that time some practices were not good and procedures not being followed. The AQAA tells us that the home has reviewed the policies and procedures for the management of medication and in doing so has introduced a new medicine trolley to promote good practice and a new medication fridge has been installed for appropriate storage of medication. The staff have had further training for safe administration of medicines. The home now has a new supplier for their medications and have purchased an appropriate medication trolley from which the person, who is administering the medication can take around the home and administer medication following safe practice. The medication trolley is kept in a locked room, although small, this room houses all medications. The medication fridge is in this room, which has no window or air circulation and therefore can become quite warm. A thermometer is kept in this fridges for staff to check that it is kept at the right temperature. There was no evidence that the fridge is kept at appropriate temperature as no record were being kept of this. This was discussed with the deputy who said she would ensure that there would be an ongoing record of the fridge daily temperature. The medication administration records (MAR) sheets were looked at by us. Each MAR sheet displayed a photograph of the service user. The MAR sheets were recorded appropriately and are audited on a daily basis by the deputy manager. The medication that is prescribed on an as needed basis (PRN) did not record any guidance or care plan to describe the circumstances in which these medications should be administered, Care Homes for Older People Page 16 of 34 Evidence: if the service user is unable to communicate their needs verbally. This was discussed with the deputy manager who agreed to ensure that a care plan was written to guide when PRN medication should be administered. The deputy manager co-ordinates the ordering and receiving of the medications and there was evidence in the records of the medication returns having been signed for by the community pharmacist. The controlled drugs records were viewed. These had been maintained appropriately and signed by two staff members as evidence of their administration. The balance in the records matched that of the stock being held. It was observed that the controlled drugs(CD) cupboard, although attached to the wall and housed in another cupboard, was not metal and did not meet the specifications that meets the standard set in the Misuse of Drugs (Safe Custody) Regulations 1973. This was discussed with the deputy manager who was informed that there would be a requirement made for the home to obtain the appropriate cupboard within a given timescale. Other cupboards and the medication trolley were viewed and all were clean and tidy and there was no evidence of large stocks of medication being stored. It was observed that there was no hand washing facilities in this room, which was so small that it would not be possible to house a washbasin. The deputy told us that staff wash their hands in the facilities close to this room and that a hand gel dispenser is housed just outside the door of this room on the wall. The AQAA states that the service users privacy is respected and that a cordless phone is available to them to take or make phone call in the privacy of their room. It was observed throughout the day that service users dignity and privacy was being being respected. The interaction between staff and service users was good and staff were obviously familiar with the service users routines of the day and demonstrated respect by knocking on their bedroom doors before entering and generally addressing them in their preferred form of address when talking to them. Preferred gender of carer is also documented in care plans and respected. The deputy manager told us that information and instruction on the core values are discussed at induction and it was observed that there was literature around the home to reiterate those values. Privacy screens were observed to be present in the double rooms to ensure privacy. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for service users, which meets their expectations and their religious and recreational interests. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with a wholesome and balanced diet in pleasant surroundings of their choice. Evidence: The AQAA states that the home provides activities to meet the service users recreational needs such as arts, crafts, board games and musical movements and outings. The activities programme was displayed on the notice board. The programme showed that there is a variety of activities taking place for the service users to participate in if they wish and are able to. The craft lady continues to visit the home three times a week and the service users, who were able to communicate, told us they do enjoy this. The products of these classes were displayed about the house. The home hires a bus once a month and service users can go out on a trip. The residents also are offered the opportunity of having reflexology or a massage from Care Homes for Older People Page 18 of 34 Evidence: a trained reflexologist who visits the home and this is well received. The home has an activities file, which gives details of what activities have been provided and who takes part. Service users spoken to were happy with the activities provided. The home also provides one to one time and activities for those who do not wish to participate in group work. Care plans documented how service users wished to meet their religious beliefs. The home receives visits from the local clergy for those wishing to continue to follow their faith and who wish to take communion. The home holds a garden party in the summer and this is well received by the service users and their families and staff told us that this is always well attended. The care plans demonstrated that detailed social histories are recorded for the service users. The deputy manager told us this information is gained from the service user or their relatives as soon after admission as possible and some social history is recorded during the assessment process. Service user surveys returned to CQC indicated that there are activities available should they wish to join in. The records of the residents meeting and a comment on a survey indicated that service users would like more activities for health and more musical entertainment. The deputy manager told us that the home is looking to employ an activities coordinator purely for this role, within the coming months. The home has no restrictions on visiting times and friends and relatives are welcome any time. The visitors book demonstrates that the home has regular visitors. The home is visited by a gentleman who brings in his dog, which is welcomed by the service users. Another gentleman just comes to the home to sit and chat to the service users. At the time of this visit three entertainers visited the home and although one had been booked by mistake and the other two had been pre-booked, all three sessions went ahead and the service user were heard to be joining in with all the old songs from the war period. There are restrictions on some service users being able to go out of the home independently and this is documented within a risk assessment care plan and also depends on the level of risk and if there are staff available to escort on a one to one basis. The AQAA states that the home is looking for activities held in the local area that the service users can attend. Care Homes for Older People Page 19 of 34 Evidence: Service users assessment document the service users preferences about diet and how they like to undertake the activities of their daily living. It was observed that service users were able to wander about the home as they please. Service users spoken to said they could do as they wish throughout the day. We observed that the interaction between service users and care staff was good and the staff were very responsive to the service users wishes and choices. The AQAA states that the home prepares and serves home made meals daily and offers a choices to service users. The AQAA says it is reviewing the menus and are in the process of preparing new menus in accordance with guidance by the Food Standards Agency. The chef was spoken with and showed us the menu planning for the coming weeks. There was a choice of menu at each meal time and he told us he would accommodate peoples preferences and was aware of their food likes and dislikes, which are documented in the care plans. The home operates a four-week rolling menu. The menu was observed to be on display in the dining room and there was also large pictures of the meals being offered that day on display on the notice board to enable those with communication problems to make a choice from the pictorial menu. The meals are served in a pleasant dining room and those choosing to, can eat in the lounge area adjoining the dining room. The lunch time meal was viewed by us and was observed to be wholesome and well presented. The service users told us that they thoroughly enjoyed the meal and generally the food was very good. There was evidence of this by empty plates, some service users saying that was lovely. Surveys returned to CQC from service users indicated that they like the meals at the home with no negative comments made. The chef told us that there are a number of service users who need a soft or pureed diet, which he does in separate portions to ensure that colours and textures can be enjoyed by those who have communication problems. He told us there is only one service user that needs a special diet and he was in the process of arranging a menu to meet her needs. The kitchen was visited and found to be clean and well organised For service users who needed assistance with their eating, carers were observed to be assisting them in a respectful manner giving them time and attention. Care Homes for Older People Page 20 of 34 Evidence: There was evidence in the care plans that service users are nutritionally risk assessed and plans of care put in place to manage any identified risks. Service users are weighed on admission and at regular intervals, for which records were observed to be maintained in care plans. It was observed that baskets of biscuits and fruit were on display and available throughout the home for service users to help themselves to snacks as they wished. Care Homes for Older People Page 21 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place and service users and their relatives are confident that their complaints will be listened to and acted upon. The policies, procedures and training of staff ensure that service users are safe. Evidence: The AQAA says that the home has clear and accessible complaints policy that all service users are made aware of. This is contained in the Service User Guide and service users and families are encouraged to voice their concerns. The AQAA reports no complaints have been received in the past year and one safeguarding adults investigation has taken place. The complaints policy and procedure is stated in the Statement of Purpose and every service users or their representative receive a copy of this. The complaints log was viewed by us and evidenced that no complaints had been received in the past year. The deputy manager told us that most complaints are easily rectified by being dealt with at the time of the issue being raised. The home has a Safeguarding Adults policy and procedure in place. One safeguarding investigation has taken place over the past year and this has now been resolved and issues addressed. Care Homes for Older People Page 22 of 34 Evidence: A member of staff has received training to enable her to train staff on the safeguarding policy and procedure and the principles of reporting any incidences that constitute abuse. This is also part of the induction programme and annual mandatory training updates. Staff surveys returned to CQC and staff spoken to indicate that they understand the process of reporting any incidences they have concerns about. One staff member saying We have a procedure that we can refer to relating to any concerns about the home. A care manager survey returned said that the management is very responsive to any concerns and have, as a result improved the provision of service. The service ensures that checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Aduts (POVA) register have been received before employment commences to ensure the safety of the service users. Care Homes for Older People Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe and well-maintained environment and have access to comfortable indoor and outdoor facilities. The home is clean, pleasant and hygienic and free from offensive odours. Evidence: The AQAA says that the home is kept and maintained very well and that a team of maintenance people are employed. The home also employs a company to maintain the gardens and other outdoor areas. The home employs housekeepers to keep the house clean on a daily basis. The AQAA says that the home could do more to creating a dementia friendly environment. We looked around the home with the deputy manager and the operational manager. The home was very clean and there was a team of housekeepers undertaking the cleaning and a person employed to undertaking all laundry. The laundry was seen to be fit for purpose and well organised by the gentleman who undertakes laundry duties. When spoken to he showed a good understanding of the principles of infection control and described how he dealt with soiled linen and clothing. The rooms visited were personalised with service users own belongings and the decoration, fixtures and fittings were in a good state of repair. The deputy manager Care Homes for Older People Page 24 of 34 Evidence: said there is an ongoing programme of redecoration and repair. There are three bedrooms in the basement area, one double and two single rooms. These rooms now look out onto freshly painted walls that have been adorned with art work and makes for a more interesting outlook which is much brighter. The AQAA states that over the past year the home has replace flooring in the hallways, dining room and conservatory with wood effect safety flooring. The undergrowth that caused one room to be very dark with the necessity to have the light on all the time, has now been cut back making the room much lighter. The surrounding walled gardens are pleasant with seating areas around the garden, which the service users enjoy in the better weather. Service users also have the opportunity to participate in some gardening if they wish to. The home has purchased some adjustable beds to enable the hoist to be accommodated under the bed if a service user has mobility problems. Currently the hoist is not being used for any service user. Residents spoken with and surveys returned told us that service users are happy with their accommodation and that the home is kept clean, one comment from a relatives said The home is very well kept even having regard to the difficulties of coping with many of the clients There are hand washing facilities in bathrooms and toilets and hand wipe gel throughout the home, with disposable aprons and gloves available for staff to use to aid infection control. Staff have received training in infection control and this is one of the mandatory trainings that take place yearly. The staff training matrix on the wall evidenced that most staff have received this training but does not state dates this took place. The team of housekeepers at the home at the time of this visit confirmed that they understood the principles of the COSHH regulations and how to use and store chemicals that are hazardous to health Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 mix gender of staff who have a range of skills and who are on duty in sufficient numbers to meet the needs of service users. Service users benefit from a staff team that have received training to enable them to meet the needs of service users. The homes recruitment policy and practice supports and protects service users. Evidence: The homes staff rota showed that staff are contracted to do set hours each week stating days and hours to work. The deputy manager told us that newly employed staff are expected to work more flexible hours and that existing staff are very accommodating in changing hours or working extra if it is needed. The AQAA shows a small amount of hours had been covered by agency staff in the past month. The home does employ a mixed gender staff group and service users are asked at assessment if they have objections to being cared for by the opposite sex. Some of the service users have voiced their preferences and these are recorded in their care plans. At the time of this visit there were 24 service users in residents. The off duty rota evidenced that there were four carers and one senior carer on duty that day. There were four housekeepers, 1 chef and 1 laundry person. The maintenance man was not in the home that day. The deputy manager and operational manager were in the home and both assisted with the inspection process. Care Homes for Older People Page 26 of 34 Evidence: From observation of the day and speaking to staff it would appear that there were sufficient staff on duty to meet service users needs. The staff were observed to be interacting with service users and giving them time and talking to them. Staff surveys returned indicated that usually there are sufficient staff on duty to meet the needs of the service users. However, one comment said I think we could benefit from having extra staff to assist with paperwork which is causing a big increase in recording and audits so we are limited to the time we can spend with service users. It is always our priority to provide the appropriate care for our service users. The AQAA states that 14 of the 26 staff have achieved their NOV level 2 and above. The AQAA says that the home provides extensive in-house training to promote awareness and gain skills. Although the manager had on display a large training matrix it did not identify the date the training took place and was difficult to identify which staff have done what training. This was discussed with the deputy manager and operational manager who said that she and the deputy were in the process of devising a new training plan on the computer that would identify all training needs, all the mandatory training and stating which staff have undertaken this and when updates are due. Other training dates will be identified on this plan, as evidence of when it took place or the date it is planned to take place. Various training certificates were evidenced in personnel files and there was evidence of moving and handling, health and safety, medication and challenging behaviours. There was also a wide variety of training dates being advertised on the staff notice board on subjects associated to the client group i.e. dementia care. Staff surveys say and staff spoken to at the time told us that the home provides good training opportunities, staff feel well supported with their training needs and that they are encouraged to undertake the NVQ qualifications. Training needs are identified through supervision. The manager and deputy have received training in appraisal and supervision and are in the process of undertaking this with all staff. Some appraisal and supervision notes were observed but the deputy manager told us that the manager has not been in the home for some weeks and the supervision programme is taking longer. Staff spoken to said they were receiving supervision from their line manager. The operational manager told us that she would be supporting the deputy manager with this whilst the manager was not in the home. The home has an induction programme. This is undertaken under the supervision of Care Homes for Older People Page 27 of 34 Evidence: an outside training organisation and is based on the Skills for Care induction programme. Three new staff are undertaking this currently. New staff undertake a short initial induction as an introduction to the home where they undertake the moving and handling training and other associated health and safety training before they commence shadowing a more experienced staff member, for one week. The AQAA states that the home has robust policies in place for recruitment and all staff are vetted prior to their staring work. The home has policies and procedures in place with regard to staff recruitment. A sample of three recruitment files was viewed for the most recently recruited staff. The home retains its staff well and the turnover of staff is low. The files demonstrated that all the required information of CRB and POVA check and two references had been received before the person commenced employment. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of service users and the homes manager is experienced. The home obtains the views of service users, relatives and visitors and this benefits both the home and its service users. The home accounting and financial procedures safeguard service users and service users financial interests are protected and they control their own money wherever possible. Not all staff at the home have received supervision on a formal basis at regular intervals. The health, safety and welfare of service users and staff are protected. Evidence: The AQAA says that the company run the home in the best interests of the service users who are the primary focus. The home has a qualified and experienced registered manager in place. The AQAA acknowledges that the home are planning to make changes to give those with dementia a better standard of living and it is acknowledged Care Homes for Older People Page 29 of 34 Evidence: that the management team may need further personal development and clinical knowledge to better contribute to the outcomes for these people. The registered manager was not present in the home at the time of this visit and had been absent from the home for some weeks. The deputy manager had been taking on the management role whilst she was absent and the new operational manager was attending the home to support her in this role. The registered manager is experienced and has been at the home for some 13 years and she has completed NVQ 4 and the registered managers award, she also has a deputy who has considerable experience and has a dedicated management role and who has gained the NVQ level 3. Both she and the manager have achieved their level 2 certificate in dementia care. The staff spoken to and staff surveys told us that the staff feel well supported by the management team. One comment said Our managmenet is very approachable and listens to any points we would like to discuss or any views on ways we can improve our service. We have the opportinity to raise issues at supervisions and through team meetings. However, one comment said We wish there was more communication between the domestic staff and management concerning the residents, another said that Communication could be better between staff and managers regarding changes in clients medicaiton and moods. The home sends out quality surveys to service users, relatives and other stakeholders. These are distributed every three months with a different focus for each questionnaire distributed. The outcomes from these questionnaires are analysed and discussed at the relatives, service users and staff meetings that are held at regular intervals and for which records of the minutes are kept. The analysis and outcome of the previous questionnaires was an excellent rating. The deputy manager undertakes her own audits of care plans monthly, at the time they are reviewed. She checks the MAR charts daily to ensure they have been documented appropriately and generally checks menus and the cleanliness of the home on a daily basis. The accident book was viewed. The reports are left in the recording book and not audited. This was discussed with the deputy as to how she should take the reports out and file them in the appropriate persons file and take a copy herself to be kept secure and from which she can identify how many accidents are happening per month and if there are emerging themes that she has to investigate. This would also meet with the Care Homes for Older People Page 30 of 34 Evidence: Date Protection Act for confidentiality of service users and staff information being secured. The home does keep some service users monies in the home and records of the balance of monies left together with receipts were seen for each service user. The money is currently not being stored separately and is kept in one container. The administrator told us that there are only small amounts of money at any one time. This was discussed with she and the operational manager who agreed that the separate containers would be purchased and service users monies stored individually. The AQAA states that the home employ an outside specialist firm to provide advice and guidance on the health and safety systems. Fire safety checks have been reviewed and updated and a new training programme to improve fire training is now in place. A sample of servicing certificates were viewed and were found to be current. The fire log was viewed and this had been tested and recorded at the appropriate intervals. The kitchen was visited and was clean and well organised and cleaning schedules were in place and appropriate records maintained in the Making Food Safety manual that was supplied by the Environmental Health Officer. There was evidence in the staff files and on the wall chart that staff have undertaken the mandatory health and safety updates. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person will 30/09/2009 ensure that a controlled drugs cupboard that meets the standard set in the Misuse of Drugs (Safe Custody) Regulations 1973 is installed in the medication room. The law now says that all care homes must now keep controlled drugs in a metal cupboard of specified gauge with a double locking mechanism and be fixed to a solid wall that has a steel plate mounted behind it fixed with Rawl or Rag bolts. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!