Care Home: Stamford Bridge Care Home

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What the care home does well People are assessed, and information about them collected from other professionals, before they are admitted. This helps to check that the home will have the resources to meet their needs successfully. People are provided with a range of activities that they can join in with if they wish. These include both individual and group activities. Religious services are held at the home to help people in meeting their spiritual needs. Staff aim to offer people choices in their daily lives. This means that one day does not have to be the same as the next, makes life more interesting, and helps to maintain their independence. People`s visitors can come to see them whenever people want them to. This helps to maintain important social links which are important to them. The home is clean, warm and comfortable, which makes it a pleasant place for people to live. What has improved since the last inspection? The home has looked at how it can improve the comfort of people using equipment to relieve pressure sores, so individuals receive the right care using appropriate resources, which meet their individual needs. Changes have been made to the way that the management team handles complaints both internal and external with improved record keeping and responses. Training has been given to both the staff and management around this area of care. The way that the home responds to safeguarding issues has got better with a more proactive approach being implemented. What the care home could do better: The medication records completed by the staff need to be more accurate and up to date, to ensure the health and wellbeing of people using the service is protected and promoted. Staff have reported issues around poor communication, organisation and staffing levels in the last two reports (April 2007 and September 2009). The registered person must make sure these issues are looked at and resolved as they are impacting on the continuity of the care being offered by the service. Key inspection report Care homes for older people Name: Address: Stamford Bridge Care Home Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ     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: Eileen Engelmann     Date: 1 9 0 8 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 36 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 36 Information about the care home Name of care home: Address: Stamford Bridge Care Home Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ 01759371418 01759371682 h.lewis@barchester.com www.barchester.com Barchester Healthcare Homes Ltd care home 107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 107 The registered person may provide the following category of service only: Care Home with Nursing, Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category, Code OP, maximum number of places 107 Dementia, Code DE, maximum number of places 107 Physical Disability, Code PD, maximum number of places 107 Date of last inspection Brief description of the care home Stamford Bridge Care Home is a Care Home with nursing that provides a service for older people who may have dementia or a physical disability. The home is situated in the village of Stamford Bridge and enables easy access to the local shops and public transport routes. Accommodation consists of one hundred and seven placements Care Homes for Older People Page 4 of 36 1 6 0 9 2 0 0 8 107 0 107 Over 65 0 107 0 Brief description of the care home within single and double rooms on three floors with lift access. People have a choice of six lounges and dining rooms in which they can relax and enjoy the company of others. People also have access to the grounds of the home, which are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the Statement of Purpose and service users guide. Both these documents are available from the registered manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the registered manager on request. The registered manager told us on the day of the site visit (19/8/2009) that the current weekly fees range from 500 to 800 pounds. People pay extra for hairdressing, chiropody, items from the mobile shop and the bar, newspapers and magazines, and occasional one to one escorts. Care Homes for Older People Page 5 of 36 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: Information has been gathered from a number of different sources over the past 11 months since the service had its last key inspection visit on 16 September 2008, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 9 back from staff (90 ) and 13 from people using the service (52 ). Informal chats with a number of staff and people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. Care Homes for Older People Page 6 of 36 The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have received 5 formal complaints about the service in the 11 months since our last visit. These complaints were around poor care practices and Barchester Healthcare (provider) investigated one complaint and the other four were investigated by the local Social Services Complaints team. All the complaints have been resolved, but where good practice recommendations were made these have been followed up during this inspection. Two safeguarding referrals have been made since our last visit in September 2008, these related to a specific individual using the service and their behaviour towards others in the home. These were investigated by the East Riding of Yorkshire Council safeguarding team and a best interest meeting was held to discuss how the care needs of the individuals concerned could be met and their safety assured. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 36 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. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Information in the Annual Quality Assurance Assessment completed by the manager on 3 July 2009 indicates that a copy of the Service User Guide, Statement of Purpose, the latest inspection report and Welcome booklets are available to all people in the reception area of the home. People enquiring about the home are sent out a Brochure, which includes sample menus and activity programmes, along with information on all options of care provided at Stamford Bridge Care Home. As part of our visit to the home we sent out surveys to a selection of people using the service and 13 out of 25 people responded. Ten people told us that they had received a contract and sufficient information about the service prior to their admission to Care Homes for Older People Page 10 of 36 Evidence: enable them to be confident that the home was the right place to meet their needs. We looked at the care and records held for four individuals as part of our visit and each person had a contract in place signed by the individual or their representative. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. One complaint investigated by the provider was from the relative of a person who came into the home on respite care. The complainant felt that the family had been misled during the initial assessment of need about what funding the person may be entitled to. This appears to have been a communication issue resulting in peoples expectations not being met. We spoke to one person who had been in the home for only a few days, and also to their relatives. They told us that the admission process had gone smoothly, they had input to the assessment of need completed by the home and to date they were extremely satisfied with the service. The home does send out satisfaction questionnaires to all those who have been into the home on respite care and the completed surveys we saw were positive about the service. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Care Homes for Older People Page 11 of 36 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. Personal support in this home is not offered in such a way as to promote and protect peoples privacy, dignity and independence. Evidence: Staff commented in their surveys that we receive positive support from the deputy manager and team leaders in giving personalised and holistic care to the people living in the home. They said that their training gives us enough knowledge about health care and medication, is relevant to our roles and helps us understand and meet the individual needs of the people using the service. Information given to us in peoples surveys, and during discussions on this visit with people using the service, indicates that the majority of individuals are satisfied with the care they receive and enjoy life in the home. One person said the staff are nice and I get along with them all, I am looked after well. Staff told us that they are given up to date information about the needs of the people they are looking after and that they were confident they had the right support, experience and knowledge to meet the different needs of the people in the home. However, not everyone was confident Care Homes for Older People Page 12 of 36 Evidence: about the service being delivered, one relative commented that staff need to listen to relatives for advice about the care of people (and use it), they must communicate better with people so that trust and confidence can be built between all parties. Another person using the service, when asked what the home could do better said staff could be more polite when speaking to you. We received notification of four complaints around poor care in 2009, these related to mouthcare, catheter care, nutritional care, moving and handling and toileting. Complainants felt that staff did not communicate with them about their relatives care, took little notice of any advice they gave and it took repeated complaints before action was taken by the staff. The social services team investigated each of the complaints and where recommendations to improve care were made, the manager and staff have done their best to alter practices. Staff training in customer care, person centered approach to care, food safety, health and safety, infection control and moving and handling have all been implemented in 2009. We visited the Memory Lane unit on the ground floor to see how those who need help and support with eating and drinking were looked after. The staff practices we observed on this unit let down the high quality of the food and the service offered elsewhere in the home. The Annual Quality Assurance Assessment (completed by the manager on 3 July 2009) told us that staff on the Memory Lane unit sit down with people and eat with them, which in turn encourages the people with dementia to eat. We found no evidence on this visit that this happens, the staff we spoke to were very pleasant but took a long time to serve the meal. A hot trolley had been provided by the kitchen to ensure meals were served at a good temperature (there have been previous concerns about meals being cold), however the staff had not plugged this in and the doors to the trolley and lids to the upper containers were all open. One person did not want the meal offered by the staff and as it was untouched the staff put it on the sideboard. After ten minutes approximately, the staff realised one person in their room had not had a meal and the one on the sideboard was taken down to them. This meal must have been stone cold, but no-one thought to check or offer food from the trolley which may have been hotter. One lady, whose care we looked at in detail during our visit, requires help with eating and drinking according to her care plan. However, we observed staff giving her a meal but then leaving her to eat it herself. She consumed very little during our stay on the unit, however entries recorded by the staff in her care plan on previous days say ate Care Homes for Older People Page 13 of 36 Evidence: well and good diet taken. The kitchen had prepared rack of lamb which came on the bone, to the unit. Staff served the lamb as whole chops, covered with gravy, to a number of people. No-one was asked if they wished their meat to be cut up and we observed two individuals trying to eat the chops with their fingers and getting gravy down their clothes as no protective aprons were in place. We spoke to the manager about our concerns regarding the staff practices at lunch time and she assured us that she would speak to the staff concerned. The care of four people was looked at in depth during this visit and included checking of their personal care plans. Three of the four people we case tracked have dementia and two of these people exhibit challenging behaviour at times. On the whole the care plans detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. There are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and information about health and input from professionals and the outcomes for people. Reviews of care with the families, person living in the home and care co-ordinator from the local authority are taking place and minutes of these meetings are in the plans. Minutes of Best Interest meetings are available in the care plans, these take place when informed choice cannot be made by the individual and includes the views of all those involved in the individuals care. There are some areas in the care plans which could be improved and these are including more equality and diversity information within them around a persons preferences of staff gender and age for personal care and better recording of activities attended by each person. The care plans duplicate information about a person and contain unneccessary action plans, for example, one person has an action plan for breathing which clearly states they do not have any problems with their chest/breathing, and staff are evaluating the action plan monthly. One new member of staff told us the plans are quite confusing and long winded and discussion with the manager indicated that she is hoping to review the format in the immediate future. People have good access to their GPs, chiropody, opticians and other external services. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Information from the Annual Quality Assurance Assessment (3/7/09) says that one GP is responsible for each of the units in the home, and each GP visits weekly. Peoples Care Homes for Older People Page 14 of 36 Evidence: health is monitored closely by their GP and medication is reviewed on a regular basis. In two of the care plans that we looked at the people have Do Not Rescusitate information within them. However, the process is not robust and does not include input from the persons GP. We recommend that the home review this aspect of the care plan and ensure that where this decision needs to be made, it includes the view of the person concerned (if possible), the persons representative and the persons GP. Any decision made must be evaluated on a regular basis in case a persons health recovers and they wish to change their mind. At our last visit on 16 September 2008 a requirement was made that where people are unable to use the equipment made available to them to reduce the risk from pressure sores, further advice must be sought about available alternatives. This will help to make sure that risk to people is kept to a minimum by the provision of suitable equipment that the person finds comfortable and able to use. Checks at this visit found the requirement has been met. The home gave us an improvement plan following our last inspection on 16 September 2008, the responsible person said that the equipment provided for each resident will be reviewed to ensure it is suitable and meets the needs and comfort of the individual. The plan said this would be actioned by the clinical lead person in the care team and overseen by the Regional Clinical Development Nurse. The Annual Quality Assurance Assessment ( 3/7/09) says that 3 people in the home have a pressure sore, and our observation of the service indicates that pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. At our last visit on 16 September 2008 a requirement was made that the way that the medication is audited must be improved, so that anomalies in practice can be identified quickly, and practice improved upon. This will help to confirm that:People are getting their medication as prescribed. Medication is not stored or used beyond its shelf life. Peoples risk assessments are kept up to date, and relate to their current abilities and required staff support. Checks at this visit found this requirement has been partially met. Staff have been carrying out medication audits but we found a number of problems with the medication records, which questions how effective the audits are and the competence of those completing the audits. The home uses Boots The Chemist as their pharmacy supplier and has a Monitored Doseage System in place, which is is a heat-sealed, pop out medication system. Some medicines are not suitable for the heat sealed process so bottles and boxes are also used. We found that one unit has a small medication room, but it was impossible for staff to put the medication trolley into this area as there were a number of metal cabinets taking up the floor space. Staff told us that they were waiting for the cabinets Care Homes for Older People Page 15 of 36 Evidence: to be put onto the wall by the maintenance man. In the meantime the medication trolley was being kept in a locked paper store, to which the nurse held the key. The manager should ensure the medication room is made suitable for use before the end of August 2009. The registered manager was told of a number of issues, found when we checked the medication records, which need to be put right. Staff are not signing in the quantities of antibiotics received for individuals, which makes it difficult to audit and see if the individuals have been given the full course. One persons erythromycin suspension doses only added up to 85mls at the time the course was completed, which could mean the individual didnt finish a course or that staff were giving too much at each administration. Where medication is to be given on an as and when basis (PRN) there needs to be detailed information from the pharmacist or doctor about how the medication is to be given and under what circumstances should it be given. We found one person was written up for Haloperidol 0.5 ml twice a day, but there were no signatures from staff to say this had been given and nothing to say if it was a PRN medication. Another person was written up for Paracetamol PRN and when staff gave this they signed on the back of the sheet instead of on the front where the instructions and administration records are written. We saw that one person was prescribed dispersable aspirin to be taken once a day, but for some reason staff had crossed out alternate days on the medication record and this person did not receive the asprin daily. Two weeks into the cycle of medication, staff suddenly started to give it daily. There was no information on the sheet to indicate if this change was due to a Doctors instructions or whether staff had made a mistake and having realised this had corrected the dose. Where staff are handwriting medication onto the MAR sheets (transcribing) there should be two staff initials against the information to show that two people have checked that what is written (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. This is good practice to ensure no mistakes are made when putting the information onto the medication sheet. Information from the Annual Quality Assurance Assessment (3/7/09) says that all nurses in the home have an annual medication competency assessment, the training Care Homes for Older People Page 16 of 36 Evidence: matrix given to us on 19 August 2009 also shows that staff have undergone clinical assessment and training on the MDS system. Given that medication mistakes were highlighted in the last report (16 September 2008) and that we have found others during this visit, the manager should evaluate how effective the medication competency assessments and training have been and look at how she can improve staff practices. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. One person told us that the staff let me do as much for myself as I can, but are always there to give me help when I need it. Our checks of the care plans showed that the home completes risk assessments for activities of daily living to ensure people are kept as safe as possible, whilst accommodating their decisions. This positive aspect of care was let down by the practices we saw during the lunch time meal on the Memory Lane unit, when we witnessed how a lack of thought from staff resulted in vulnerable people struggling to cope with their meals and being given cold food to eat. During our visit it has become apparent that there remain some communication issues within the home and staff are not always thinking first before carrying out care tasks (see information above). Barchester Healthcare (the provider) has given staff access to a wide range of training, however there should be clear systems in place to show how practice is monitored to ensure the care delivered by staff is consistent and always to a high standard. Care Homes for Older People Page 17 of 36 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. Policies, procedures and guidance promote individual independence and the right to live in a flexible environment where their choice of routines and activities are met when possible. Evidence: On the day of our visit the home was celebrating a Best of British event that was organised by the two activity co-ordinators, staff and management of the home. A large display stand showing what was happening during the day was situated in the entrance hall, and staff had decorated the home with bunting and flags. Activities taking place included bingo in the morning and in the afternoon there was a Punch and Judy show in the gardens, raffles, games, quizzes and ice-creams. A special lunch menu was on offer and there was a good attendance by relatives and visitors. People we spoke to were very excited about the whole event and everyone looked to be enjoying themselves. On a daily basis the home has a programme of activities and information about these is put up in the entrance hall, in addition to this the home gives everyone using the service their own copy of forthcoming events. People who responded to our surveys said there activities arranged by the home that you can take part in, I like the Care Homes for Older People Page 18 of 36 Evidence: musical concerts and joining in with activities, There are plenty of activities to do if we choose, generally happy with my care, I enjoy the activities, staff are nice and I get along with them all and we get trips out, plenty of food and a good variety, nice staff who look after us. The home has a minibus, which allows people the freedom of getting out and about. There are weekly in-house church services, one week it is Methodist and the next it is Church of England, and the catholic priest will visit anyone, wishing to take communion, on request. Information in the Annual Quality Assurance Assessment indicates that the activity co-ordinators evaluate all activities by discussing them with the people who attended, a summary of this is given to the manager each month. We spent some time on the Memory Lane units (dementia care) during our visit, individuals there were included in the celebrations and those who wanted a more quiet time were able to stay in the lounges. Information in the Annual Quality Assurance Assessment (3/7/09) says that staff in the Memory Lane communities are specially trained to support and assist people to get involved in moments of meaningful activity and life skills rather than organised events. The training matrix shows that some staff have attended Dementia Awareness courses and two nurses have completed training in leadership skills matter in person centred dementia. Since our last visit in September 2008 additional communal space has been provided on the Memory Lane unit downstairs, with a more spacious lounge area being built. The lounge leads out onto a secure garden area where people can sit out in the sunshine. There is a range of memorabilia from days gone by for people to touch, talk about or just hold and boxes on people bedroom doors include photographs and pictures which are meaningful to them. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen to take part in the lunch time meal and those who spoke to us said they were always made welcome whenever they came to the home. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although Best Interest Meetings are held for individuals who do not have capacity to consent to care. There is information leaflets available for staff, visitors and people using the service around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). The training matrix given to us on 19 August 2009 shows that the manager and four nurses have attended Deprivation of Liberty training and we were told the home trainer delivers the Equality and Diversity training for staff. This type of Care Homes for Older People Page 19 of 36 Evidence: training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances; they are satisfied that they can access their personal allowances when needed. The menu on the day we visited the home was based around the Best of British theme, starters included lobster or soup, the main meal was rack of lamb, meat pie or poached fish and followed by a variety of puddings. In the main dining room on the ground floor people were seen to be served their meals by hostesses from the kitchen. Food was chosen from the menus on the tables and brought straight to the tables to ensure it was hot and fresh. Those people we spoke to in this dining room were full of praise for the meals on offer saying excellent food and presentation from the kitchen, and the lamb is delicious and tender. We then visited the Memory Lane unit on the ground floor to see how those who need help and support with eating and drinking were looked after. The staff practices we observed on this unit let down the high quality of the food and the service offered elsewhere in the home (see information in the health section of this report). Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Peoples survey responses showed the majority of individuals have a clear understanding about how to make their views and opinions heard. At our last visit in September 2008 a requirement was made that the complaints of those living at the service must be treated with the same level of seriousness as those of others who raise their concerns. This is so that people who live at the home can have confidence that their concerns are listened to and acted properly upon. Checks at this visit found that the requirement has been met. Information from the improvement plan provided by Barchester Healthcare (22/12/08) said that people would be offered the opportunity to voice any concerns at review meetings, staff training needs would be identified, verbal complaints would be logged along with the action taken to resolve and an action plan would be produced following the results of peoples satisfaction surveys, and made available to people and their families. We found that the manager has a record of all complaints received and that a written response to the complainant and the action taken to resolve the issues are also Care Homes for Older People Page 21 of 36 Evidence: recorded. Information from the Annual Quality Assurance Assessment says that the home has received 14 complaints in the past year, and none were upheld. We received four complaints in the past year which were passed onto the Social Services to investigate. Issues were raised around poor communication between people, families and management/staff, the need for people to repeat requests to staff in order for action to be taken about concerns and an overall lack of thought regarding basic care. A number of good practice recommendations were made as part of the outcomes of these investigations and we have seen some evidence that these have been taken on board. At our last visit in September 2008 a requirement was made that Allegations of abuse must be reported swiftly to the correct authorities for investigation.This will make sure that the allegations are investigated following agreed safeguarding procedures, by the right people at the right time. This in turn will protect people from risk. Checks at this visit found the requirement has been met. In the improvement plan provided by Barchester Healthcare (22/12/08) it was stated that the regulation manager would be visiting the home and spending time going through the safeguarding process with the registered manager, to ensure appropriate referrals are made, and that employee relations and safeguarding of adults from abuse training for managers would be carried out. We have been notified of two safeguarding referrals in 2009 relating to the behaviour of one person using the service against others in the home. These have been investigated by the local authoritys safeguarding team and resolved. A best interest meeting was held for one person who does not have the capacity to consent to care. Information from social services indicates they are satisfied with the way the home is making the referrals and that this aspect of practice within the home has improved. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The staff training matrix given to us on 19 August 2009 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training and that 67 members of staff attended this in the past year. Care Homes for Older People Page 22 of 36 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. The standard of the environment within this home is good, providing people with a spacious, attractive and safe place to live. Evidence: Walking around the home it is clear that the environment is spacious, welcoming and decorated/furnished to a high standard. Most of the home has been refurbished with new attractive, comfortable seating and soft furnishings. The home comprises of four different units titled The Terrace (ground floor) for older people, Memory Lane (ground floor) this is a dementia unit, The Circle (first floor) for older people and Memory Lane (second floor) this is a dementia unit. Since our last visit in September 2008 the part of the home which was the original Manor House has been closed due to the need of refurbishment. In the past year the home has created eight additional dementia beds on the ground floor, by refurbishing 6 older peoples bedrooms and creating two new bedrooms. Additional lounge space has been built onto the downstairs dementia unit, this work was completed in December 2008. The Memory Lane communities have themed areas to evoke memories. All the corridors have items of interest and many of the people have pictures/memory boxes on their bedroom doors to assist them in identifying their room. Care Homes for Older People Page 23 of 36 Evidence: The majority of the rooms in the home have en-suite facilites and people have a choice of communal bathing facilities with hoists fitted for assistance into and out of the baths. Throughout the home there is a mix of large and small communal areas giving people options of where they wish to sit and a chance to enjoy quiet times as well as company. The lounge on the ground floor has a licensed bar, where people can sit and enjoy a drink by themselves or with friends. People are very satisfied with the environment and they told us that the home is kept clean, tidy and mostly odour free, laundry is well cared for, washed and ironed well. Rooms are bright and clean with plenty of space, and the home is always spotlessly clean. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 19 August 2009 indicates that infection control training is part of the rolling programme of training and that 37 staff attended this in the last 12 months. Care Homes for Older People Page 24 of 36 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. People using the services are generally satisfied with the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. Evidence: At our last visit to the home on 16 September 2008 a requirement was made that Staff must be organised so there are sufficient of them organised in such a way that there is stability and continuity of carethroughout the home.This is so people get a consistent service from suitably skilled staff who know and understand their needs. Checks at this visit found this requirement was partly met. The majority of people (92 ) who filled out our surveys commented that they always or usually received the care and support that they needed, however 30 of those who answered said that staff sometimes or never listened to them and acted on what they said. When asked the question are staff available when you want them two people said always, eight said usually and three said sometimes. Individuals commented that they need more staff because I feel rushed at times, the staff need to answer the bell quicker and there should be more staff on duty, we need more staff to spend time with myself and others and I wish the staff had more time to talk to us, they are always rushing due to lack of time. One relative told us staff need to pay more attention to peoples individual needs, it is the small things that matter Care Homes for Older People Page 25 of 36 Evidence: most. It was very clear from talking to staff and observations made during the visit that staff had a good understanding of peoples needs. Care staff clearly described what they did to help different people and it was evident they treated them as individuals. Staff who spoke to us or responded to the surveys also said that a lack of staff made their roles stressful and that it impacted on the quality of care they could provide. Information gathered from the Annual Quality Assurance Assessment completed by the manager on 3 July 2009 indicated that in the past year 39 members of staff have left the service, which is 44 of the workforce in total. Agency nurses/care workers have been used for 10 shifts in the past 3 months. On the day of our visit one nurse was having to run betweeen two units on different floors, due to another nurse phoning in sick. Discussion with the nurses on duty indicates that this is happening on a regular basis and although the staff do their best to cope it impacts on the time they have to supervise staff and oversee work on the units. Comments from the staff surveys indicate that individuals feel communication between units and staff/management needs to improve and that the service needs to recognise those staff who are doing well at their jobs and making a difference. In our report of 19 April 2007 we said poor communication and time management issues were factors that resulted in staff feeling frustrated and misunderstood. Two years on staff still say they are having the same problems. At the time of our visit (19 August 2009) the staffing levels within the home were as follows, on the early shift there are four nurses and fourteen care workers, on the late shift there are four nurses and 10 care workers and at night there are two nurses and six care workers for 70 residents. Using information about dependency levels provided by the manager at the this visit and staffing hours stated in the Annual Quality Assurance Assessment, checks against the residential staffing forum guidelines for an older persons home shows that the home is meeting the minimum recommended staffing hours. Information in the Annual Quality Assurance Assessment completed by the manager indicates that staff receive supervision and appraisals, monthly staff newsletters are given to all staff to keep them up to date with issues within the home and there are 10 minute daily briefings with the Heads of departments, with relevant information communicated to the teams. Given that the home is being adequately staffed and meetings are being held with staff, the registered person should be looking at why the people they employ continue to feel undervalued, short staffed and unable to spend quality time with the people using the service. Care Homes for Older People Page 26 of 36 Evidence: The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. The staff training files and the training matrix we looked at on 19 August 2009 show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that staff have access to a wide range of training subjects including basic mandatory safe working practice training, and the majority of staff are up to date with their training or booked to attend courses in 2009. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. We have discussed within this report the need for the home to have clear systems in place for checking care practices, as we have seen evidence during this visit of inconsistencies in the care being provided. The registered person should make sure there are robust systems available for monitoring the effectiveness of the training being given and the impact it has on the quality of care being provided. Care Homes for Older People Page 27 of 36 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 manager is skilled and experienced in managing the home and is aware of the improvements required, however the way staff are supported and supervised is ineffectual meaning that people do not always get the right care. Evidence: Mrs Helen Lewis is the registered manager of Stamford Bridge Care Home; she has been in post since 2002 and is a Registered Nurse and has an active registration with the Nursing and Midwifery Council. She has completed her Registered Managers Award and attends regular training updates within the company. Information in the Annual Quality Assurance Assessment completed by the manager indicates that she meets with the Heads of Department on a daily basis and monthly, with monthly meetings also being held with the Registered Nurses. We were told by the manager that each unit head has meetings with the care staff and information is cascaded down to them. We noted at our last visit in September 2008 that staff had lost faith in the manager Care Homes for Older People Page 28 of 36 Evidence: and felt that they should have more meetings so they too could know more about what is going on and be able to give their views about how the home runs. They think that this would make communication better. From information gathered at this visit (August 2009) little seems to have changed with the way meetings are being held and staff continue to feel left out and under appreciated. Staff members told us that there is a need to improve communication with staff about decisions in the home and between units. Discussion with the manager indicated that the company has recognised there is a problem and staff have received training in effective communication, but this was back in 2007/8; we recommend that the registered person ensure that all staff have this training and that feedback processes are put into place to monitor what impact it has on improving how people talk to one another. The lines of communication need to be made clear between the registered manager and staff, so that the process of managing and running the home is clear and transparent. This will help to make sure that the home continues to run in the best interests of people who live there. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and a development report is produced as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. We have seen where the service has made improvements over the past 12 months, especially around complaints and protection issues, however there still remain concerns in this report about management of the home, staff practices for care giving and support, medication and promoting privacy and dignity for all individuals. The registered person must ensure these aspects of the service are improved to ensure that the aims and objectives within the statement of purpose are met and people can be confident of receiving a high standard of care to meet their needs. Discussion with the administrator indicates that the home does not hold any personal allowances for people and where an individual is unable to handle their own monies Care Homes for Older People Page 29 of 36 Evidence: then a family member or representative is asked to do so. The person dealing with each individuals finances is billed at the end of the month for any additional services used such as newspapers, chiropodist or hairdresser. People are provided with lockable facilities within their rooms to keep money and valuable safe. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Care Homes for Older People Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18 Staff must be organised so 30/11/2008 there are sufficient of them organised in such a way that there is stability and continuity of care throughout the home. This is so people get a consistent service from suitably skilled staff who know and understand their needs. Care Homes for Older People Page 31 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 The registered person must 01/12/2009 ensure that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. So people in the home can be confident that their health and well being is promoted and protected by the practises of the home and its staff. 2 10 12 The registered person must 01/12/2009 make sure that the way staff deliver care and support to the people using the service, respects that persons rights to privacy and dignity at all times. So people using the service feel they are treated with respect and their right to privacy is upheld. Care Homes for Older People Page 32 of 36 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 3 27 18 The registered person must 01/12/2009 ensure that the skill mix of qualified/unqualified staff is such that there are sufficient capable leaders to organise and oversee the workforce, and appropriate numbers of staff on duty to ensure that the people using the service receive continuous care of a high standard, which meets their assessed needs. So people can be confident that their needs will be met by staff who are focused on improving outcomes for people using the service. 4 33 24 The registered person must review and improve the quality of care provided at the care home. So that the aims and objectives within the statement of purpose are met and people can be confident of receiving a high standard of care to meet their needs. 01/12/2009 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 The manager should ensure that information about peoples Care Homes for Older People Page 33 of 36 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 preferences regarding staff age and gender for giving personal care, is recorded in the individual care plans. 2 7 The manager should ensure that the care plans contain sufficient information about activities undertaken by a person, so staff can evaluate if their social needs are being met. The manager should review the format of the care plans to ensure they are only contain information and action plans pertinent to the current care needs of each person. The manager should review the Do Not Rescusitate information in the care plans to ensure the documents are robust and include the viewpoint of all those involved in the persons care. These should be evaluated on a regular basis to ensure any changes to a persons health and/or wishes regarding their end of life care are taken into consideration when deciding if the instructions are still valid. The manager should ensure that where staff are handwriting medication onto the MAR sheets (transcribing) there are two staff initials against the information to show that two people have checked that what is written (medication name, strength of medication, type of medication such as tablet or liquid, and how it is to be administered) is clearly and correctly recorded, and matches what is on the medication packet or bottle from the pharmacy. The manager should ensure that where medication is to be given on an as and when basis (PRN) there is recorded information from the pharmacist or doctor about how the medication is to be given and under what circumstances should it be given. The manager should evaluate how effective the medication competency assessments and training have been and look at how she can improve staff practices. The manager should ensure the medication room is made suitable for use before the end of August 2009. The manager should ensure that staff practices around serving of meals and assisting with eating on the dementia units are reviewed and changes are made to improve the temperatures that meals are served at, and ensure people get the support they need to meet their nutritional needs. 3 7 4 8 5 9 6 9 7 9 8 9 9 10 Care Homes for Older People Page 34 of 36 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 10 10 The registered person should ensure that where changes to practice are needed, then clear systems are in place to show how the practices are monitored to ensure the care delivered by staff is consistent and to a high standard. The registered person should talk to the staff and assess why the people employed within the care home continue to feel undervalued, short staffed and unable to spend quality time with the people using the service. The registered person should make sure there are robust systems available for monitoring the effectiveness of the training being given and the impact it has on the quality of care being provided. Clear systems should also be in place for checking care practices. The registered person should ensure communication within the home is effective and efficient by giving staff the right training and using a variety of feedback systems, to monitor and evaluate what impact the training has had and if communication within the home has improved. The lines of communication need to be made clear between the registered manager and staff, so that the process of managing and running the home is clear and transparent. This will help to make sure that the home continues to run in the best interests of people who live there. 11 27 12 30 13 31 14 31 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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