Care Home: St Vincent`s Care Home

Similar services:

• The Shelley
• Springfield House
• Sutton Lodge Nursing Home
• St Helier`s Residential Hotel
• St Joseph`s
• Ridgemount
• Wingham Court
• Old Hastings House

What the care home does well The home provides a relaxed and comfortable environment for residents, a programme of upgrading is underway to improve facilities, and the home is generally well maintained. There is a welcoming atmosphere within the home and relatives commented that they are always made to feel welcome in the home by staff. Residents enjoy continuity form an established and experienced team. Staff speak positively of working within a team and the support they receive from this. Residents and staff find the management team approachable and friendly. New residents are encouraged to personalize their own space to make it feel more homely and bedrooms are redecorated before new residents are admitted. Systems are in place that enable residents and relatives to express their views about the service received, and to be consulted about changes. Residents enjoy a nutritious and varied diet. What has improved since the last inspection? The AQAA informs us that since the last inspection a new medication policy has been developed, and our inspection highlighted that the home has addressed a previous requirement in respect of medication. Each resident now has an individual day book to be completed on each shift and this is kept confidential. The service has developed a reference file which includes house rules regarding personal hygiene and cross contamination, individual resident diet sheets. More regular staff meetings have been organized, a post box is provided for residents to put post in which can then be taken daily, an activity file has been implemented which staff must complete after each activity. The complaints procedure has been updated and the method of recording complaints changed to maintain confidentiality. The AQAA highlights that considerable investment has been made to upgrading and improving the facilities at the home and all residents now have en suite facilities, a new passenger lift has been installed giving residents a choice of using stair lifts or passenger lift this is much better for those residents who use a wheelchair and for the transportation of the medication trolley. A new call bell system has been installed that enables the management team to monitor call response times, the new system also means that staff must attend the point of call to de-activate it thereby ensuring residents are seen at the time of the call. Some changes to the recruitment procedure has ensured that the vetting of prospective staff is improved upon. All care staff have either completed NVQ2 or are in the process of completing. What the care home could do better: From our discussion with staff , residents and the management team and our examination of records, we consider that the home is not taking a sufficiently proactive approach to the care of those residents with more complex needs; who may not be having their health care needs fully understood or the risks they pose adequately assessed. A requirement has been issued for risk reduction measures to be clearly stated within risk information and also for an assessment of nutritional risk and skin integrity to be routinely implemented. We found that the home has not addressed issues of health and safety in regard to hoisting equipment in a timely manner to ensure the safety of residents and staff is maintained and a requirement has been issued for this to be addressed within the given timescale. Staff within the service have been trained in adult safeguarding but lack an understanding of the multidisciplinary protocols, which dictate the manner in which adult alerts are reported and managed and do not know how they can reference this information. Residents could be placed at risk if staff do not know ho to report concerns about their welfare and safety. The service has not kept the commission informed of a recent adult safeguarding alert and a requirement has been issued for all such alerts to be notified to the commission. The service is undertaking annual appraisal of staff performance but this is not supported by any regular formal supervision of staff to assess and monitor performance and practice. Residents could be placed at risk if staff do not adhere to agreed policy and procedures. Current staff issues in relation to working arrangements through health or performance issues are not recorded, and a requirement has been issued for the home to evidence the regular formal supervision of staff. We have also made some good practice recommendations where we consider current practice can be improved upon. Key inspection report Care homes for older people Name: Address: St Vincent`s Care Home Down Road Bexhill-on-sea East Sussex TN39 4HD     The quality rating for this care home is:   one star adequate 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: Michele Etherton     Date: 0 5 0 6 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 33 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 33 Information about the care home Name of care home: Address: St Vincent`s Care Home Down Road Bexhill-on-sea East Sussex TN39 4HD 01424211244 01424213739 jenny@avissoft.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St Vincent`s Care Ltd. 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: The maximum number of service users to be accommodated is 25 The registered person may provide the following category of service : 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 category; Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home St Vincents is a large, detached Edwardian property, standing in its own grounds next to the parish church of St Stephens in a quiet residential area of Little Common. It is within ten to fifteen minutes walking distance from Bexhill town centre. The home is registered to provide residential care for twenty-five older people. Accommodation comprises nineteen single bedrooms and three bedrooms that can be shared at service users request. All bedrooms have en-suite toilet facilities. Assisted communal bathing and showering facilities are provided in the home. There is a lounge, a lounge/dining area, and an attractive garden for service users use. A passenger lift provides level access to the upper floors of the home. And a chair lift is fitted to the short flight of Care Homes for Older People Page 4 of 33 Over 65 25 0 Brief description of the care home stairs, leading to some of the service users bedrooms on the lower ground floor. The current fees for the service at the time of the visit range from £370 to £600 per week. Information on the Homes services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There is currently no e-mail address for the home. Care Homes for Older People Page 5 of 33 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: one star adequate 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe people who live in care home settings. For the purpose of this report, those living at St Vincents are referred to in the preferred term residents. A key inspection of this service has been conducted, this has taken account of information received about the service and from the service since the last inspection including our assessment of the service for an annual service review in 2008. We have also looked at the Annual Quality Assurance Assessment (AQAA) form submitted by the Registered Manager. We found this to have been completed to a reasonable standard, telling only some of what we needed to know about the operation of the service. This self assessment information would benefit from improved detail and content, to illustrate how the Care Homes for Older People Page 6 of 33 service operates on a day to day basis and current and future plans for service development; these shortfalls have been discussed at the site visit with the registered manager who now has an improved understanding of the level of detail future AQAAs should contain. Our inspection of the service has included a site visit on 4th June 2009 between 10:00 am and 18:00 pm. During this visit all key standards have been assessed in addition to confirming the progress made by the service in addressing previous requirements issued in respect of medication and the installation of a new call bell system, issued at the previous inspection in June 2007. We have sent surveys to the home to distribute to residents, staff, and health and social care professionals but none have been returned to date, responses received subsequent to the draft report will be taken into consideration prior to the publishing of the final report. During our visit to the service we were able to view communal spaces and some resident bedrooms, we met and spoke with four care staff in addition to the manager and deputy, we were also able to speak with a member of the ancillary staff team. We were able to speak with two visiting relatives and also spent time with seven residents during lunch and individually and made observations of other residents during time spent in the service. We also examined a sample of documentation maintained in the home for the purpose of assessing its content, and accuracy and also that it is being reviewed this includes care plans, risk information, medication administration records(MAR), staff recruitment and training information, complaints, accident and health and safety records. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: From our discussion with staff , residents and the management team and our examination of records, we consider that the home is not taking a sufficiently proactive Care Homes for Older People Page 8 of 33 approach to the care of those residents with more complex needs; who may not be having their health care needs fully understood or the risks they pose adequately assessed. A requirement has been issued for risk reduction measures to be clearly stated within risk information and also for an assessment of nutritional risk and skin integrity to be routinely implemented. We found that the home has not addressed issues of health and safety in regard to hoisting equipment in a timely manner to ensure the safety of residents and staff is maintained and a requirement has been issued for this to be addressed within the given timescale. Staff within the service have been trained in adult safeguarding but lack an understanding of the multidisciplinary protocols, which dictate the manner in which adult alerts are reported and managed and do not know how they can reference this information. Residents could be placed at risk if staff do not know ho to report concerns about their welfare and safety. The service has not kept the commission informed of a recent adult safeguarding alert and a requirement has been issued for all such alerts to be notified to the commission. The service is undertaking annual appraisal of staff performance but this is not supported by any regular formal supervision of staff to assess and monitor performance and practice. Residents could be placed at risk if staff do not adhere to agreed policy and procedures. Current staff issues in relation to working arrangements through health or performance issues are not recorded, and a requirement has been issued for the home to evidence the regular formal supervision of staff. We have also made some good practice recommendations where we consider current practice can be improved upon. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 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. Prospective residents can be confident their needs will be assessed prior to admission, although it is not always made clear in records. Assessment information does not always make clear the health needs residents may need support with. All residents are provided with terms and conditions of their residency. Evidence: Discussion with the manager, deputy, relatives and an examination of resident records confirms that a pre-admission assessment of prospective residents is undertaken, and this informs the decision to admit or not. However, there is a lack of clarity as to when written assessment information is being developed as in three out of five assessments viewed, we noted assessment dates to post date admissions to the service, which we are informed is incorrect. From examination of other records we are satisfied that the service can evidence instances where pre-admission assessment has informed a decision not to Care Homes for Older People Page 11 of 33 Evidence: admit,however, there is a need for those undertaking assessment to clearly evidence that assessment pre-dates admission and informs decision making, this is particularly important where notes are being written up retrospectively. Relatives we spoke with confirmed that they had received contracts in regard to their relatives terms and conditions at the home and we noted copies of contracts in all resident records viewed. The service does not provide an intermediate care service. Care Homes for Older People Page 12 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical, emotional and health care needs of residents with more complex needs are not being fully met or the risks fully assessed. Evidence: When we spoke with staff we found that they demonstrated a good awareness and understanding of individual residents day to day care needs and how they are to be supported, but, this information is not always recorded in care plan information. Continuity within the staff team has reduced the impact of this but there is an over reliance on some of this information being verbally passed on to newer staff by more experienced staff. From examination of records and discussion with staff and management we noted a number of omissions within care plan information in regard to individual residents health support needs. We found that only those residents who can stand on weighing scales are routinely weighed. Staff reported that other residents weights are monitored by the fit of their clothes. The lack of suitable and accessible weighing scales means accurate readings cannot be obtained and , where there are concerns Care Homes for Older People Page 13 of 33 Evidence: about low weights these cannot be monitored appropriately. Some records viewed indicated low weights amongst some residents but the service does not undertake nutritional assessments of residents and cannot evidence how risks around this are being minimized. The service has experience of a resident with a pressure area but does not routinely undertake skin integrity assessments of residents. Those residents who may be at higher risk of developing pressure areas are not identified. Care plans do not reflect risk reduction measures implemented, including the level of monitoring staff should be undertaking. At least two residents whose files we examined have some history of mental health. Initial assessment information viewed for them in addition to current support plans, gives no indication as to how this impacts upon them on a day to day basis and what indicators to breakdown might be. There is no plan of care around their mental health needs and no evidence that the service has sought external intervention in regard to behaviors that may cause concern. The manager reports that the relevant GPs have been routinely consulted but this is not clearly evidenced within support plan information, although contact with health professionals and routine appointments are recorded. Whilst discussion with relatives and some residents highlights a general level of satisfaction at the care and support provided, we are not assured from examination of resident records that those residents with more complex conditions are being satisfactorily supported and monitored. There has been a recent safeguarding issue regarding the maintenance of the privacy and dignity of one resident in particular and this has been fully investigated and addressed satisfactorily. In one file we noted that the resident has experienced a high number of falls within the home since admission, we found no evidence of falls monitoring having been implemented or referral made to the falls assessment team. In staff meeting minutes and in a recent confidential complaint concerns have been raised about the moving and handling of one resident from a position on the floor following a fall. Existing equipment lacks the necessary slings to aid staff to lift safely and appropriately, some staff have confirmed to us during our visit that in some instances manual lifts have been conducted. The manager and staff have been Care Homes for Older People Page 14 of 33 Evidence: reminded this is unacceptable and, places both the resident and staff members at risk, and does not constitute a safe practice of work. We have noted some evidence that steps are now being taken to address this issue but are disappointed that this is reactive to an escalation in concerns and does not stem from a demonstration of positive risk management, we are therefore requiring the home to ensure that equipment for the safe moving and handling of residents within the home is fit for purpose, within the given timescales in this report. The home maintains risk information and this is routinely updated. When we examined this we found that whilst risk documentation is able to highlight where risks exist. Information recorded on assessments is inadequate to evidence steps taken to reduce risk to residents and whether significant risks remain. When we spoke with staff we understood one resident requires two staff to help move them, but found this was not made clear within the moving and handling risk information recorded for that resident. Whilst there are good systems in place to assess environmental and individual risks to residents and these are routinely reviewed, from our discussion with the manager, deputy and other staff we noted a lack of awareness in respect of risk which individual residents may experience. This was evident when we were shown the garden area where residents are currently able to sit and walk in good weather with staff support. We noted several hazards including a metal rod sticking out of the ground, and a rotted tree stump within the lawn which could pose a trip hazard. Staff had not seen these as potential hazards and taken steps to minimise dangers to residents. We have looked at a previous medication requirement and have considered that the home has taken steps to address this. A recent concern that the medication trolley could not be used by staff has been addressed and we would urge that the manager considers designating staff to medication duties on each shift so that a proper audit of staff practice can be undertaken and monitored. We noted MAR charts would benefit from the addition of resident photographs and that a list of signatures used by administering staff is retained to enable audits to be undertaken. We noted that some staff are currently being trained to administer insulin by the district nurse, although one staff member is still to receive any formal medication training. The manager is considering implementing competency assessments routinely for staff and this is to commended, however, it is essential that staff initial training in medication administration is by someone competent and trained to do so. Any omissions in staff training in this area need to be addressed. Care Homes for Older People Page 15 of 33 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. Residents would benefit from a more stimulating and individualized programme of activities more suited their varied needs. Relatives and visitors are made welcome. Residents are supported to retain independence but where control is taken by the home documentation should be in evidence to support this. Residents benefit from a nutritious and varied menu and are offered choices about this. Evidence: When we spoke with some of the more able residents they said they thought they had enough to do with one reporting we dont want to be doing something everyday, we have to have time for visitors. Staff and residents informed us that there are usually about three activities each week and these tend to be bingo, exercise and a quiz. A staff member reported that they were compiling a music play list for residents, music sessions alternate with a religious service on a weekly basis. One resident said she missed the outings and the cream teas that had been arranged in the past and commented I dont know whats happened this year . When we looked around the home we observed that the majority of residents other than at meal times were sitting in their rooms, communal areas having only one or two residents sitting there. We observed that those residents who lack capacity to Care Homes for Older People Page 16 of 33 Evidence: occupy themselves had no stimulation in the form of a television, radio,or music on in their rooms. There was also an absence of books, magazines or papers for them to look at. We observed the home to be very quiet with limited conversations and interactions noted between residents. Relatives we spoke with expressed generally positive comments about the service. One relative reported that their relative spends most of their time in their room unable to participate in most activities which are predominantly for those with unimpaired hearing, sight or cognitive ability. Interaction with other residents has reduced along with opportunities for stimulation other than family visits. More thought should be given to developing activities that are more suited to the needs of the residents as a whole and not just the most able. The home manager acknowledges improvements are needed to the development of activities within the home and reports that there are plans for the specific recruitment of an activities cocoordinator. We have reminded the manager of the importance of employing someone to the post who has a sound understanding of the needs of residents with, sensory and cognitive problems and is able to develop a stimulating programme with these needs in mind. Where residents have capacity they are supported to retain independence and control over aspects of their daily routines. This would not seem to apply to the majority of residents who do not keep their own monies or manage their own medication. There is little evidence within support plan information that the home has undertaken capacity assessments of residents, to support the decisions that the home undertakes control of these areas from residents and these need to be implemented. Relatives we spoke with said they felt welcome at the home, could visit whenever they wanted, and were confident of raising issues with the registered person and the management team who they find friendly and approachable. From discussion with resident, relatives and examination of records it is evident that whilst the home may be good at listening to residents and relatives and providing forums for feedback, they are not always responsive to issues raised. With evidence that these are sometimes repeated at successive meetings,and improved feedback to residents and other stakeholders is needed. Residents enjoy a varied and nutritious diet and were observed to be provided with good sized portions, eating as much as they wanted. Residents confirmed they could have an alternative to the main meal if they wished. Specialist diets are catered for and those residents with a need for soft or pureed diets are accommodated. We noted one resident whose food is all pureed together in keeping with individual preferences, Care Homes for Older People Page 17 of 33 Evidence: but, this is not made clear within support plan information and therefore not reviewed as to whether the resident still wants this to happen. Several residents commented that we had been provided with brown bread during lunch and reported that this was not something they were offered. In discussion with the cook and other residents, it is apparent that some residents do receive brown bread as they requested this upon admission to the home. There is little facility for varying such decisions once made and this needs to be addressed. Care Homes for Older People Page 18 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and significant others feel confident of raising complaints with the home but improvements are needed to the process of managing complaints and feeding back outcomes to residents. Staff have an awareness of adult safeguarding and receive training but lack understanding of the multi disciplinary protocols for managing alerts. Evidence: From our discussions with residents and relatives it is clear that they feel confident of raising issues with the home manager and staff. An examination of the complaints record indicates residents and other stakeholders concerns are recorded, however complaints records do not make clear the process of investigation and how complaints have been resolved. There is no indication if complaints are being formally managed, with correspondence from the home to the complainant either acknowledging complaints or finalizing complaint outcomes. We noted a number of opportunities for residents and relatives to express their views and concerns through resident meetings and resident reviews. Our examination of minutes and records indicates that whilst residents may be listened to and offered opportunities to express concerns, feedback or action in response to this may often be slow, or not happen at all precipitating repeat expressions of concern at a later date. There is a need for the home to provide feedback on actions taken to residents and staff in respect of issues raised. Care Homes for Older People Page 19 of 33 Evidence: Staff reported they had received adult safeguarding training and that this is repeated routinely. In discussion with individual staff they were able able to demonstrate an awareness of the forms in which adult abuse can manifest and their reporting responsibilities under adult safeguarding. All staff spoken with had a limited knowledge of the local multi disciplinary safeguarding protocols and whether a copy existed in the home for reference. This needs to be addressed by the manager with the relevant training organization and also to make available a copy of the protocols for staff to refer to. A recent adult safeguarding alert has been raised and investigated by the older persons mental health team from St Annes and this has now been closed. The Commission have not been formally advised by the service of the safeguarding alert, and we require that all future alerts are made known to the commission in addition to other relevant agencies. Recruitment procedures within the home are better and we have made further suggestions for improvement. We have been made aware of a restriction imposed on a resident who wanders that informs staff of when the resident leaves their bedroom. This ensures staff monitor the residents whereabouts at all times. We found no evidence that this restriction and the need for it has been discussed and agreed within a multi disciplinary meeting, or a review date given to monitor its effectiveness. The home has not checked whether this constitutes any infringement to the liberty of the resident, and whether it needs authorization under that legislation, and are advised to do so. Systems are in place for the safe management and recording of resident monies, two records and cash balances were checked for accuracy and found to be satisfactory. Care Homes for Older People Page 20 of 33 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. Residents live in a comfortable environment that will benefit from proposed upgrading and required and suggested improvements Evidence: There has been considerable investment by the provider, and a new lift has been installed in addition to a new call bell system. A programme of upgrading is in place and a service development plan focused around improvements and developments in the environment has been established. There are proposals for a change to the category of registration. Plans are underway to ensure the external environment provides a more secure setting for residents with more complex needs, this should also include a revision of existing hazards already within the garden area to ensure all residents are kept safe from harm. Fire alarm and equipment and servicing is the responsibility of the maintenance person. Good records are maintained of this including regular fire drills. Good records are also maintained of individual room health and safety assessments, water temperatures and, procedures for minimizing Legionella. A hoist used for the moving and handling of residents is currently without the necessary slings to enable residents to be lifted from the floor if they fall. This is a Care Homes for Older People Page 21 of 33 Evidence: shortfall that the home has been aware of some months placing the resident and staff at risk. As a result of a complaint the home is now taking action to address the issue, and we require evidence that the hoist is now fit for purpose. Security of a side door has recently been improved in response to concerns raised by a resident and relative. During our visit we visited some bedrooms and observed these to be personalized by or for residents, with a mix of personal possessions to make them feel more at home. Residents are able to lock their rooms if they wish. Communal spaces are comfortable and well maintained, carpeting is due for replacement in the planned upgrading. The general appearance of the home was clean with odours noted only in some rooms where continence issues are present. We observed that in some bedrooms window surrounds were dirty and dust had collected, this could harbor infections. It is important for the maintenance of good infection control that a robust cleaning regime that includes less routine areas is sustained throughout the home. Quality assurance feedback indicates there are ongoing issues in the management of laundry, that remains a source of irritation in respect of misplaced items of clothing in particular. There is no evidence that improvements in this area are being monitored to ensure they are sustained. Care Homes for Older People Page 22 of 33 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. There are enough well trained staff to support residents. Recruitment procedures are more robustly applied but would benefit from further improvements in recording to evidence this. Evidence: Discussion with residents and staff highlights that at the present time staffing levels are satisfactory to meet the needs of the current resident group. This should be kept under review as needs change and residents with more complex needs may be admitted. The home encourages staff to undertake NVQ training and more than 70 of the staff team has achieved this and are to be commended. When we examined staff recruitment files we noted an improvement in content and that new staff are now employed at the home only after receipt of satisfactory references and a CRB check. The home has not been robust in seeking references from previous care employers. There is still a need for the home to evidence that gaps in employment, and reasons for applicants leaving previous care roles are verified with them, and can be evidenced. This was discussed with the manager during our visit. Staff we spoke with confirmed access to routine updating of all mandatory training, Care Homes for Older People Page 23 of 33 Evidence: there has also been some specialist training in respect of e.g Dementia, insulin administration training relevant to the needs of specific residents. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views and interests of residents are taken account of but shortfalls in practice in regard to promoting and protecting the health and welfare of residents undermines this Evidence: The manager has a satisfactory level of qualifications and experience to manage the service and has successfully done so for the last 15 years. She has an awareness of the need to develop systems to monitor practice and compliance with the plans, policies and procedures of the home but more work is needed in this area. Staff speak positively of working at the home and the team work ethos promoted by the manager and deputy. Staff find the management team approachable and friendly and feel able to raise issues that may concern them. Examination of records and discussion with the manager and deputy has highlighted a reactive rather than proactive management style. Omissions in recording around the Care Homes for Older People Page 25 of 33 Evidence: health and care support of some residents with more complex needs, has highlighted some gaps in knowledge and awareness of the management team in regard to good practice, and assurance that resident and staff safety is protected. The service has submitted a completed AQAA within timescale and this gives us a reasonable picture of the current situation within the service, but would benefit from more supporting evidence particularly in areas where they still need to improve. We were unable to find supporting evidence during our visit to the home for some of the information provided in the AQAA and it is important that this information is accurate at the time of sending. The service currently undertakes surveys of residents annually and this information is analyzed. Residents are also offered a six monthly review at which time residents or their relatives can raise issues regarding service quality. From discussion with the manager and deputy we could find no evidence that residents are provided with information about outcomes of survey feedback. At an individual level six monthly reviews indicate that some issues raised come up time and again, these are not reflected upon in subsequent meetings to establish whether they have been satisfactorily addressed. we found one example where the home had acted upon a resident and relative concern around security. Mechanisms are not currently in place that would enable the service to undertake an internal review and audit of systems and this needs development. Some stand alone quality audits are in place, these need to be incorporated into overall quality assurance for the service. The registered person is undertaking regulation 26 visits, but there is a need to ensure that documentation other than complaints is reviewed. Also that the registered person can evidence which staff and residents have been spoken with in private during the course of the visit. Staff we spoke with reported they receive an annual appraisal and also have staff meetings. The regularity of these would seem to be six monthly unless issues arise that demand additional meetings. Minutes of meetings are recorded. We noted that staff concerns in respect of hoisting equipment have been discussed previously in February and april 2009 and yet these matters have not been resolved. They have continued to date to be a source of concern for some staff and a failure to Care Homes for Older People Page 26 of 33 Evidence: address poor practice. Discussion with staff and the manager indicates that formal recorded supervisions are not conducted. We discussed the importance of these as a management tool for monitoring the performance and development of staff, currently the home is unable to evidence this through any other records it maintains and a requirement has been issued for this. Systems are in place for the safeguarding of resident monies. The home has reported that all policies and procedures have been reviewed but has not been proactive in developing procedures where specific need arises. We noted that a staff member had received a needle stick injury, but no procedure had been developed to inform staff what action they needed to take in the event of this occurring. The AQAA tells us that all health and safety checks and servicing have been completed and we viewed a random sample of these during our visit and found these to be satisfactory. We noted that accident recording is happening ,but, not all admissions to accident and emergency of residents are routinely being notified to the commission as required. We have discussed these omissions with the manager as some confusion exists as to what they felt they should be referring. It is also noted that the home failed to report an adult alert to the commission. Care Homes for Older People Page 27 of 33 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 33 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 7 13 The Registered person shall 08/07/2009 make suitable arrangements to provide a safe system for moving and handling service users Equipment for the safe moving and handling of residents including hoists that enable residents to be lifted from the floor must be made available for staff to use when residents have fallen All staff must be trained in safe moving and handling of residents by a suitably qualified and trained person. Regulation 13(5) The registered person shall make suitable arrangements to provide a safe system for moving and handling service users Care Homes for Older People Page 29 of 33 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 2 7 13 The registered person shall ensure that: unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Risk assessments must make clear risk reduction measures in place. Risks which may be present through care or health needs should be assessed particularly those relating to poor nutrition, skin integrity, and falls Regulation 13(4)(c) The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated 08/07/2009 3 18 37 The registered person must ensure that the commission is kept informed of all adult alert raised by the home in addition to other relevant agencies Regulation 37 (1) The Registered person shall give notice to the Commission without delay of the occurrence of 08/07/2009 Care Homes for Older People Page 30 of 33 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 (c) any serious injury to a service user (d) serious illness of a service user at a care home at which nursing is not provided (e) any event in the care home which adversely effects the well-being or safety of any service user (2) any notification made in accordance with this regulation which is given orally shall be confirmed in writing. 4 36 18 The registered person must ensure that care staff receive formal recorded supervision a minimum of six times per year and this should cover aspects of care practice, training and development needs in addition to performance management issues Regulation 18 (2) The registered person shall ensure that persons working at the care home are appropriately supervised. To ensure that staff practice and performance is routinely monitored to ensure residents are safeguarded 08/07/2009 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Pre-admission assessment information which is used to inform decisions about prospective residents admissions must be clearly dated where this has been undertaken prior to residence Current photographs of residents should be provided within medication records to enable staff to ensure the right resident receives the right medication. A register of administering staff with sample signatures should be maintained to inform medication audits of staff practice. 2 9 3 12 Residents with sensoryu impairments and congnitive problems need improved stimulation and an activities programme needs to be developed to include the needs of these groups. The complaints process should be formalized and complainants given clear feedback of actions to be taken. Complaints records should make clear the process of investigation used to resolve the complaint and whether complainant is happy with outcome A copy of the multi disciplinary adult safeguarding protocols should be available within the home for staff reference and safeguarding training should ensure staff are fully aware of these The home should ensure that regulation 37 notifications are forwarded to the commission in respect of serious events that occur in the home and this should include admissions to hospital by residents and adult alerts raised by the home 4 16 5 18 6 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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!