Care Home: St Werburghs House

Similar services:

• Byars Care Home
• St Marys Nursing Home
• Bramble Lodge
• Parkmanor Residential Home
• Thornham Grove
• Hunter`s Lodge
• London Road Neurological and Specialist Care Unit
• Carlton Care Home

What the care home does well Records were in place within people`s care files to demonstrate that their needs had been assessed prior to admission. There was information within the records seen to demonstrate that the staff at the home had made efforts to gather life histories from people and their families to enable them to address each person`s social interests and hobbies. Visitors that were spoken with on the day of this visit said that their relatives were looked after well by the staff team. One person said, "I`m more than happy with the care my mum receives" Information within the surveys received from people using the service and their representatives said that the staff demonstrated a "friendly and caring attitude to residents " and that the staff were "helpful and ready to listen to families and residents". The information from the needs assessment was used to develop the care plans. The care plans seen instructed the staff team of the level of support that was needed to ensure each person`s needs were met. Records were in place to demonstrate that peoples health care needs were met by the appropriate health care professionals.Information within the surveys received from health care professionals indicated that individual`s health care needs were monitored by the staff and that they sought advice when needed. Comments included, "the staff are helpful and cooperative when arranging and doing an assessment and they usually follow up any issues identified" Safe medication practices were in place which ensured that people received their medication as prescribed. What has improved since the last inspection? At the last inspection visit, observations were made that showed us that some aspects of care did not fully maintain people`s dignity, such as personal hygiene not being maintained, people`s clothes being creased or stained. At this visit the people using the service were observed and their clothing appeared clean and they appeared well groomed. Relatives spoken with felt that the people using the service were treated respectfully and their dignity was upheld. At the last inspection visit some infection control hazards were identified, such as the use of old wooden commodes that needed replacing as they couldn`t be effectively cleaned. The majority of commodes have now been replaced and the acting manager confirmed that the remainder were to be replaced within the near future. What the care home could do better: The written information about the home needs to be kept up to date, as this is the information available to people who are considering using the service. Information within the surveys recieved and comments made on the day of this inspection visit indicated that people knew how to make a complaint and felt their concerns would be addressed by the service. However this was not clearly reflected in the records that were kept regarding some complaints/ concerns that had been raised. Key inspection report Care homes for older people Name: Address: St Werburghs House Church Street Spondon Derby DE21 7LL     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: Angela Kennedy     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Werburghs House Church Street Spondon Derby DE21 7LL 01332280037 01332200644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: European Care (Derby) Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: European Care (Derby) Limited is registered to provide nursing and personal care to service users whose primary needs fall within the categories of: Old Age, not falling within any category, (OP) - 35 The maximum number of service users to be accommodated at St Werburghs House is 35 Date of last inspection Brief description of the care home St Werburghs is a two-story detached house, which has been adapted and extended as a care home. It is a listed building and sits in its own grounds behind the local church. It is situated in Spondon close to local shops and a bus route. The home opened in 1989. The home provides nursing and personal care for persons aged 65 years and over with physical health needs. The home has 3 lounges areas and a dining area on the ground floor. The large garden is accessible to service users. The acting manager told us that the weekly fees for the home ranged between 340.00 GBP and 525.00 GBP. Extra charges are made for Hairdressing, chiropody and Care Homes for Older People Page 4 of 34 Over 65 35 0 2 2 1 0 2 0 0 8 Brief description of the care home toiletries. The most recent inspection report was available in the office at the home. 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: 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: This was an unannounced key inspection that took place over 1 day. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service.The inspection was focused on assessing compliance with defined key National Minimum Standards. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers that is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. Two people were case tracked. Case tracking is a method used to track the care of Care Homes for Older People Page 6 of 34 individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at support plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. One person case tracked was able to express their views of the service and the support it provided. Other people living at the home that were not case tracked were also spoken with. Their views of the service and the care and support provided are included within this report. Two members of staff were spoken with at some length and their views and opinions of the care provided, the support and training given to them is included within this report. Discussions held with relatives at this inspection visit and comments provided within the surveys received from the people living at the home, relatives, staff and health care professionals that visit the home are also reflected throughout this report. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The written information about the home needs to be kept up to date, as this is the information available to people who are considering using the service. Information within the surveys recieved and comments made on the day of this inspection visit indicated that people knew how to make a complaint and felt their Care Homes for Older People Page 8 of 34 concerns would be addressed by the service. However this was not clearly reflected in the records that were kept regarding some complaints/ concerns that had been raised. 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the service to help them in making a choice however, this information may not be clear . To ensure individuals needs can be met their needs are assessed before admission is agreed. Evidence: The acting manager provided a copy of the Statement of Purpose and the Service User Guide. These documents provided information about the services that the home provides. In the providers self assessment information, it was stated that the Statement of Purpose and the Service User Guide have been updated and that they are in the process of developing new brochures and updating the group website. However some of the information contained within these documents was incorrect and some could be misleading to the reader. For example it was not clear regarding who was managing the service , in section three of the Statement of Purpose it stated that Care Homes for Older People Page 11 of 34 Evidence: the acting manager was the registered manager, in section 4 it gave the name of manager currently registered as the manager, however this person has not been managing the service since April 2009. Other areas of the Statement of Purpose , such as in section 5 stated that the service cared for people suffering from different forms of Dementia, unless their assessment shows that specialist care is required. In section 15 of the statement of purpose there is reference to services provided for people with Dementia, such as referrals to community psychiatric nurses and teams. However the service is not registered to admit people whose primary care need is Dementia. Other areas within these documents needed amendment such as the number of qualified nurses that worked at the home, as the numbers have increased. The Mental Capacity Act was summarised in the service user guide and there was information regarding Independent Mental Capacity Advocates and independent advocacy services. This information stated the home could provide information on how to access these services and directs the reader to speak with manager, deputy or nurse in charge. At this inspection visit the acting manager confirmed that there was information regarding Independent Mental Capacity Advocates but no documents were available regarding independent advocacy services. She agreed that she would request some leaflets regarding these services to display within the home for anyone that may be interested in using them. The service user guide also stated that a bar chart of the latest service user surveys was included in the guide and that these were issued to the people using the service every six months. However there was no bar chart in the copy of the service user guide provided. In their surveys returned from the people using the service and their representatives they told us that they were provided with enough information about the service before they moved in so that they were able to make a decision about whether the home was right for them. In the providers self assessment information it was stated that people were encouraged to visit before admission. It said that they were invited to stay for a meal but if they were unable to do so a senior member of staff will visit then to undertake a pre admission assessment. Two peoples care files were looked at in detail and both had records in place to Care Homes for Older People Page 12 of 34 Evidence: demonstrate that their needs had been assessed prior to admission. One person had been at the service for several years and their initial assessment was on file and this information had been updated. The other persons needs assessment was dated and demonstrated that their needs had been assessed before admission to the home. Both people had assessments that had been undertaken either from Health care or social services as relevant. The information contained within these assessment addressed health and personal needs. There was information within the records seen to demonstrate that the staff at the home had made efforts to gather life histories from these individuals and their families. This enabled them to address each persons social interests and hobbies. 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. Information within care files ensured the staff team were able to meet individuals needs in a safe way. The medication practices in place ensured that people were able to take their medication as prescribed. Evidence: Visitors that were spoken with on the day of this visit said that their relatives were looked after well by the staff team. One person said, Im more than happy with the care my mum receives Information within the surveys received from people using the service and their representatives said that the staff demonstrated a friendly and caring attitude to residents and that the staff were helpful and ready to listen to families and residents. In the providers self assessment information it was stated that, plans of care give details and actions that are required to deliver care and are reviewed monthly or sooner if needed. In the two care files looked at both had a plan of care in place. The Care Homes for Older People Page 14 of 34 Evidence: information from the needs assessment was used to develop the care plans. The information provided instructed the staff team of the level of support that was needed to ensure individuals needs were met. Although there was evidence in both files seen to demonstrate that staff had detailed information on the level of support the individuals needed, some of this information was not written as a care plan. For example on person had specific needs regarding the level of support required at meal times. There was detailed written information that clearly instructed the staff on this persons support needs, however this was written on note paper at the front of the persons file and had not been incorporated into the care plan regarding eating and drinking. This would ensure that this information was reviewed regularly and any changes in this support noted. Care plans seen referred to how each persons privacy and dignity was to be met in providing the support required. The providers self assessment stated that risk assessment tools were used in care planning. All of the care plans seen included a base line assessment and there were risk assessments in place that linked with care plans to ensure that the support provided was done so in a safe way.The risk assessments seen addressed mobility and any moving and handling equipment required. There was also assessment in palce that looked at risk of falls, skin care, weight, dietary needs, continence and bed rail assessments. Specialist equipment was seen around the home to support individuals needs such as profiling beds to promote skin care needs. Comments in one relative survey confirmed that people had the specialist equipment they needed. They wrote prompt referrals are made for equipment needed. There was some written evidence such as signatures from relatives, to demonstrate that they had been involved or consulted regarding the care plans in place. However this was not seen on all records.One visitor that was spoken with confirmed that her family were consulted regarding their relatives care and said that they were invited to care reviews that took place. Records were in place to demonstrate that peoples health care needs were met by the appropriate health care professionals. This included records of doctors visits and referrals and assessments from health care professionals, such as speech and language therapists, district nurses ,chiropody and dental visits. Visitors spoken with also confirmed that their relatives health care needs were met. Information within the surveys received from health care professionals indicated that individuals health care needs were monitored by the staff and that they sought advice Care Homes for Older People Page 15 of 34 Evidence: when needed. Comments included, the staff are helpful and cooperative when arranging and doing an assessment and they usually follow up any issues identified The medication practices for the two people case tracked were looked at and indicated that safe practices were in place. Medications were stored correctly and the medication recording sheets had been signed correctly and corresponded with the medications held. Neither of the people case tracked were prescribed any controlled drugs. Therefore the records and medication for another person that was prescribed controlled drugs was looked at and indicated that safe practices were in place. The acting manager confirmed that the homely remedy policy that was not included on the homely remedy protocol at the last inspection visit has now been included. This protocol was not looked at during this visit. Other records that related to medication practices were looked at, such as records of cold storage medications and room temperature records for the medication room. This ensures that medications are stored at the correct temperature to ensure they work effectively. The acting manager stated that none of the people using the service were self administering their medication. She confirmed that if anyone wished to administer and store their own medicines they would be assessed to ensure they were safe to do so. Relatives spoken with felt that the people using the service were treated respectfully and their dignity was upheld. On the day of this inspection visit the people using the service were observed and their clothing appeared clean and they appeared well groomed. Information within the surveys received indicated that people were treated with respect and their dignity is upheld by the staff team. The relationship between the staff team and the people using the service was observed at this inspection visit and appeared positive. There was detailed information within one persons care files regarding their wishes after their death.This demonstrated that their thoughts and feelings were respected regarding their wishes. Care Homes for Older People Page 16 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. Peoples social needs are supported but could be further enhanced through their community presence. Evidence: In the providers self assessment information it was stated that a weekly plan of activities are organised by the coordinator. The coordinator offers a wide range of activities and looks at the pre admission information to assess cost, so that if necessary extra staff are rostered on shift to support people with complex needs. Activities include one to one time. The activities coordinator confirmed that she worked 16 hours a week at the home. She confirmed that she chaired meetings for the people that used the service. These were held every three months and records of these meetings was seen to confirm this. Minutes of meetings were seen and demonstrated that actions from the ideas/ discussions held were recorded, this demonstrated that people using the service were encouraged and supported to be involved in the running of the home. Newsletters were produced and these were sent out every three months following the meetings, this was to to incorporate the minutes from the meeting and also covered events and what was happening within the home. Care Homes for Older People Page 17 of 34 Evidence: It was confirmed that efforts had been made to involve the relatives and friends of the people living at the home but there had been a poor response. The activities coordinator said that although dates for the meetings were advertised on the notice board she was unsure if they were noticed, she said that she plans to incorporate the dates of meetings into the newsletters to ensure that everyone was aware of these meetings. The activities coordinator confirmed that an activities diary was advertised every week. The types of activities included armchair exercises twice a week, word/ ball games that promoted hand eye coordination, bean bag olympics, skittles, group reading, quizzes, karaoke and seasonal crafts such as halloween decorations.It was confirmed that a hairdresser visited one day a week Records were seen to demonstrate one to one time with each person using the service. These records for one person case tracked showed that they often declined these sessions but there were occasions recorded when they had consented to them. The activities coordinator said the activities undertaken varied dependent on the individual,but for some people this could be just sitting with them and providing some contact such as hand stroking. Manicures and nail painting were also undertaken for those that enjoyed this.This demonstrates that everyone using the service was given an opportunity to participate in some form of activities or social interaction that suited them. The activities coordinator stated that several trips had been organised throughout the summer but that several of these trips had been cancelled due to either illness of the staff or people using the service, or there not being enough staff that volunteered to support people on trips. It was confirmed by the activities coordinator that external entertainers visited the home once or twice a month. The records showed that an external entertainer was booked for the following day and one was booked for the 30th October. It was confirmed by the activities coordinator that at Christmas school choirs visited and parties were held at the home. Observations on the day of this visit showed few group activities taking place. The activities coordinator reported to the acting manager that she had attempted to undertake group activities but stated that no one wanted to join in. She therefore spent one to one time with people. Care Homes for Older People Page 18 of 34 Evidence: In surveys from relatives it was indicated that acidities were provided. One staff survey stated that more outings are needed . Discussions with relatives on the day of the visit indicated that they had observed some activities taking place. One of the people case tracked spent their time in their bedroom due to their health care needs. They confirmed that this was their preference and it was respected by the staff team. Records showed that this person was given additional times at meals and that meal times for this person suited them rather than the home and as stated above, there were records in place regarding one to one time with this person for social interaction. Most people spoken with and surveys received confirmed that the meals provided at the home were enjoyed.Comments included, the meals are very good and provide good quality food and snacks. One person said they did not enjoy the meals provided to them. This person required a specialist diet because of their health requirements and this was further limited by their preferences within this diet. The member of staff cooking on the day of this visit was a member of the care team but it was confirmed by the acting manager that this person also helped out with the cooking when needed. However the acting manager could not confirm if this person had a valid food hygiene certificate, which should be in place for any person working in a food preparation area. A Menu blackboard was on display within the home but this had not been updated since the previous weekend. Records were kept in the kitchen of the meals provided. This showed that there was 2 options available at lunch and a variety of sandwiches plus hot dishes such as corned beef hash, macaroni cheese or scrambled egg. Jellies and cakes were also available at the teatime meal. The acting manager confirmed that the practice for ascertaining each persons preferences was that the kitchen assistants and care staff discussed with each person the choices available on a daily basis. Preferences were also discussed as part of the admission procedure and this was seen in the records of the people case tracked. The acting manager also confirmed that the kitchen staff helped to give out the food at meal times and used this time as an opportunity to get feedback about the meals. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recording and management of complaints did not demonstrate that peoples concerns were clearly addressed and that actions were taken to put thing right. Evidence: In the providers self assessment information it was stated that the policy regarding complaints was on display in the entrance and in office and that all complaints were investigated and acted upon. The complaints policy was on display as stated and was also included in the service user guide and statement of purpose about the service. Information within the surveys received and comments made on the day of this inspection visit indicated that people knew how to make a complaint and felt their concerns would be addressed by the service. Staff that completed the surveys confirmed that they knew what action to take if someone has concerns about the home and the staff spoken with on the day of this visit were clear on their role regarding complaints. The acting manager held records for formal complaints and informal complaints. The acting manager said that she understood formal complaints to be those that were made to Social Services or the Care Quality Commission. She stated that any Care Homes for Older People Page 20 of 34 Evidence: complaints made to the home were classed as informal. The records of complaints that were seen included two formal and seven informal complaints. Both the formal and informal complaints seen did not always demonstrate that complaints were always responded to completely, such as contacting the complainant regarding their concerns or recording what actions had been taken when a complaint was upheld. Within one complaint there was reference to an incident that should have been recorded on an accident incident form. However there was no record of this and the acting manager stated that she was not aware of any accident record being completed. No records were seen to demonstrate that complaints were audited. This would provide the acting manager with an opportunity to identify any patterns or complaints of a similar nature that needed to be addressed. Since the last inspection there have been four safeguarding alerts made. Three of these were made by the service and all have been investigated and the appropriate action taken. The fourth safeguarding alert was under investigation at the time of this inspection visit. The staff training records were not fully up to date (see staffing section of this report). However from the records that were seen it was confirmed that seven staff had undertaken safeguarding training in 2008, two staff in 2009 and five staff were booked onto this training with Derbyshire County Council on the 29th October 2009. Staff that were spoken with demonstrated that they had a clear understanding of the safeguarding practice that should be followed, in the event of any allegations or concerns. Documents were available in the office regarding the safeguarding policy and the Governments No Secrets document. This ensured that staff had the relevant information they needed to keep the people using the service safe from abuse. Care Homes for Older People Page 21 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. A comfortable environment was provided for the people living at the home. Evidence: A partial tour of the building was undertaken. In the surveys received from the people using the service and their relatives it was indicated that the home was generally kept fresh and clean. One person did write that some of the carpets in communal areas of the home needed cleaning or replacing. It was noted on the day of this visit that some carpeted areas looked stained and would benefit from cleaning. In the providers self assessment information it was stated that there continues to be improvements to the decor of the home, examples given were the sitting rooms and corridors have been redecorated and the carpets are being replaced in these areas. There are three lounges at the home and a conservatory that is used as a dining room. One survey from a relative stated that the small lounge gets very hot in summer and more fans are needed. However this could not be established on the day of this inspection due to the weather.One survey that was completed by Health Care Professional said that some specialist chairs need replacing. The providers self assessment also stated that bedrooms are redecorated on a rolling programme and fixtures and fittings continue to be replaced in bedrooms. Some Care Homes for Older People Page 22 of 34 Evidence: bedrooms were viewed and of those that were seen some rooms had been refurbished.Four bedrooms did have an odour of urine. The acting manager did confirm that three of the rooms were having new flooring fitted the day following this visit. She also stated that the other room identified as having an odour would be cleaned. Some of the bathrooms were seen. One bathroom had shelving that had bed linen and quilts on. This linen looked untidy and creased. It was confirmed by the acting manager that this was not used on the beds and that this linen had been in this bathroom for sometime. All of this linen was removed by end of this inspection visit. One bathroom had pipework exposed and the paint work was peeling off the pipes. The acting manager stated that this bathroom was not used. However exposed pipe work does have the potential to scald if touched. There was a call system used at the home. The acting manager confirmed that the system used was very old but worked. The acting manager confirmed that plans were in place to purchase a new system as the present call system had a zone alert rather than a room alert. This means that the staff had to go to the zone to then find the room within that zone area. A stair chair lift was in place on the three steps on the first floor by bedroom 26. This chair lift appeared very old. The acting manager stated that this chair lift was not used. She stated that she was not aware of this chair lift being serviced. However as this chair lift was in place it was agreed that this chair lift should be serviced, to ensure it was safe to use if needed. The acting manager has confirmed since the inspection visit that this chair lift has now been serviced. On the day of this inspection visit there was only one member of the housekeeping team on duty due to staff sickness. The rotas showed that this would impact on the cleaning regime for the following two days as only one member of the housekeeping team would be on duty rather than two.The acting manager stated that she would attempt to cover these shifts with an additional member of staff. Since the last inspection most of the old wooden commodes used have been replaced with new plastic ones which can be cleaned more effectively. The acting manager stated that all of the old commodes are to be replaced to ensure infection control measures are enhanced. The providers self assessment stated that eighteen staff have completed or nearly completed the pandemic flu/ infection control at National Vocational Qualification level 2. Staff that were spoken with confirmed that they were Care Homes for Older People Page 23 of 34 Evidence: undertaking this training. The laundry area was seen. The laundry area housed the appropriate equipment to enable clothes to be laundered to meet disinfection standards. It was noted that the laundry floor was concrete and there was loose bits of brick in the corners and behind machines that would be difficult to clean. The walls in the laundry had been recently plaster boarded and were to be painted. There was an iron and ironing board, however there was no ironing press. The acting manager confirmed that the laundry hours have been increased from 4.5 to 5 hours a day for extra ironing. A rack was seen in the laundry room with very creased clothing such as cardigans. The acting manager stated that these clothes were to be ironed before they were returned to individuals. From observations on the day of this inspection visit the clothes worn by the people living at the home were clean and well pressed. Comments were made in one relatives survey regarding the laundry service. They wrote need press for clothes. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are supported by staff that are safe to work with them but this safety may be compromised if staff are not updated in current practices. Evidence: The providers self assessment stated that in the last three months ninety nine nursing shifts had been covered by agency or bank staff. However on discussion with the manager and from examining the rotas it was confirmed that these figures referred to staff that worked for European care but did not have a permanent contract to work at St Werburghs, such as the acting manager who did work full time at St Werburghs and other nurses that work at other homes owned by European Care, who also work regular shifts at St Werburghs. It was confirmed that at the time of this inspection visit there was five full time and four part time nurses working at St Werburghs and 15 care staff. The rotas showed that throughout the day there was two nurses on duty until 3 or 4 pm and 1 nurse on duty from this time throughout the remainder of the day. Five care staff were rostered on duty throughout the day however there was several days that showed there was often four. At night there was a nurse and two care staff on duty. Comments made on the day of this inspection visit and in the surveys received were generally positive regarding the staffing levels, however there was a few comments Care Homes for Older People Page 25 of 34 Evidence: made both by staff and relatives stating that staffing levels could be better. The acting manager confirmed that four new carer staff had recently started employment at the home and that she was awaiting the required recruitment documentation for eight more part time staff. It was confirmed that this will equate to four more full time care staff. Comments made from relatives and health care professional regarding the staff were positive. Such as, staff are caring and friendly towards residents and they are cooperative when doing assessments and respond positively to any issues or recommendations. The providers self assessment stated that staff training is assessed at appraisal and through supervisions. The staff training records were not fully up to date. The acting manager confirmed that she was in the process of asking staff to bring in their training certificates, to confirm the training they had done and what needed updating. The training matrix was in the process of being developed. Records that were completed showed that the catering staff had either completed or where booked onto food hygiene training, it also showed that five staff had completed this training in 2008 and six in 2009. However the training matrix did not confirm if the member of staff that was cooking on the day of this visit had undertaken this training. The acting manager stated that she was not able to confirm if this person had an up to date food hygiene certificate. Fire training records showed that some of the staff team had undertaken training in October 2009 and that some staff were booked onto this training on the 15th and 22nd October 2009. However not all staff had dates recorded for this training such as the housekeeping and catering team.The acting manager stated that she was waiting to see which staff came to the training on the 15th October and she then planned to chase up any staff that had not attended or put their names down for the training on the 22nd October. Other training that was due to take place was also seen in the office such as Moving and Handling training. The training matrix did not have any dates regarding when this was last undertaken for seventeen of the staff team. The training that was due showed that the majority of these staff were booked onto this training which was due to take place the following week. The acting manager stated that the remainder of the staff had done this training in August and September 2009 and that the training matrix had not yet been updated with this information. Care Homes for Older People Page 26 of 34 Evidence: There was no information on the training matrix regarding first aid training. However in three staff files looked at all had valid first aid certificates in place. The acting manager has since the inspection visit, completed a first aid risk assessment for the home. This assessment has been seen and demonstrates that there is a suitable plan regarding the first aid provisions in place for the people using the service. It was confirmed by the acting manager that thirteen members of staff had started infection control training at NVQ level 2. Some of the staff spoken with confirmed that they were undertaking this training. Staff that were spoken with said that they were kept up to date with training. They were aware that the training matrix was not up to date and confirmed that they had been asked to bring in their training certificates. The providers self assessment stated that out of fifteen care staff eleven had a National Vocational Qualification at level 2. However as already stated, as the training matrix was not up to date it did not confirm this. The providers self assessment stated that a rigorous recruitment and selection policy was in place. The recruitment files for two members of staff were looked at and both had all information in place, that is required by law.This demonstrates that the service ensures to the best if their ability that the staff employed are safe to work with the people living at the home. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home ensures the views of the people using the service are heard . But the lack of records in areas such as complaints and staff training demonstrates that their are shortfalls in some areas of management. Evidence: The providers self assessment stated that the acting manager now in post had previously worked at the home for four years as the deputy manager. Both the acting manager and the deputy manager have completed a management qualification. It also said that there is improved administration time, which allows the acting manager more time to work with staff. In the surveys received from staff, people using the service, relatives and health care professionals positive comments were made regarding the management of the service. Such as The new matron seems to be improving things at the home and one staff survey said that since the management has changed the home is a lot better run is happier and run more efficiently, staff can approach management with Care Homes for Older People Page 28 of 34 Evidence: problems. There were various quality assurance systems in place. As stated in the providers self assessment questionnaires were sent out twice a year to the people using the service and their representatives.As stated earlier in this report regular meetings were held for the people using the service and records of these meetings were seen to confirm this. This gave people using the service an opportunity to have their say in the running of the home and in the planning of future events. Comments both within surveys and from discussions held on the day of this visit confirmed that relatives were kept informed of any changes or events at the home. Moneys were held in safe keeping by the home for one person case tracked. The financial transaction records for this person were looked at and corresponded with the monies held. Two signatures were in place for each transaction which promotes safe working practice and safeguarded this persons finances. Supervision records were seen in the staff files looked at. This demonstrated that the staff team were supported within their work and that they were monitored on a regular basis. Staff that were spoken with stated that they had supervision sessions every two or three months with either a nurse or team leader. They also confirmed that appraisals are done annually and stated that they felt well supported in their job. The providers self assessment stated that the maintenance of equipment within the home was maintained.As stated earlier in this report there were plans to update the call system within the home. It was also identified earlier in this report that staff training records were not up to date, which means that it could not be confirmed that the staff team were up to date with their training and therefore working to current practice. A good example of this was the member of staff that was cooking the lunch time meal on the day of this visit. This person was a member of the care team who helped out with the cooking when needed. However the acting manager could not confirm if this member of staff had a valid food hygiene certificate. This means that this member of staff may not have knowledge of up to date food hygiene practices, which could have compromised the food hygiene practices in place. As stated earlier in this report the acting manager has completed a first aid risk assessment for the home. This assessment has been seen and demonstrates that there is a suitable plan regarding the first aid provisions in place for the people using the service. Care Homes for Older People Page 29 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 30 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 1 4 The statement of Purpose must be updated to reflect the current staffing levels and management structure. Information regarding the registration of the home should be clear to ensure the reader, such as prospective residents and their representatives understand To ensure the information provided is up to date and clear. 14/05/2010 2 16 22 Complaints made should be fully investigated. To ensure peoples rights are upheld 14/01/2010 3 16 22 Any person making a complaint should be informed within 28 days after the date on which the complaint was made, or such shorter period as may be reasonable in the 14/01/2010 Care Homes for Older People Page 31 of 34 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 circumstances, of the action (if any) that has been taken. This is to demonstrate to the complainant that the concerns they have raised are being addressed. 4 26 13 The exposed bathroom pipes 14/01/2010 identified at the inspection should be covered To eliminate the potential risk of scalds. 5 30 18 Evidence must be in place to 14/12/2009 demonstrate that staff have received all mandatory training and that this training has been updated as required. This will demonstrate that staff have the necessary skills and knowledge to undertake their duties safely following up to date practice. 6 38 16 Staff working in food 14/12/2009 preparation areas must have undertaken the relevant food hygiene training and have evidence of this. To ensure they are working to current safe practice. Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 All information that instructs staff on the level and type of support required for an individual, should be incorporated into a care plan. This will ensure support needs are met and any changes in need are reviewed and addressed as required. Additional staff should be rostered on shift to enable community activities such as trips out to take place. A member of staff, such as the cook or kitchen assistant on duty should be allocated the responsibility of completing the blackboard menu each morning. This will ensure people using the service and any other interested parties such as visitors can see the meal options available each day. Complaints records should include the investigation undertaken to address the complaint, the actions that have been taken and the outcome of the complaint and any correspondence with the complainant.This is to evidence that the complaint has been fully investigated and the correct actions taken. An ironing press should be purchased to enhance the efficiency of time spent on pressing linen and clothing. Consideration should be given to laundry floor surface to ensure it is suitable in meeting infection control standards. 2 3 12 15 4 16 5 6 26 26 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!