Care Home: Standon Hall Care Home (The Beeches)

What the care home does well The management and staff make the people who use the service and their visitors welcome. Staff recruitment records showed us that a good system of recruitment is in place, ensuring the safety of people using the service. Staff demonstrated respect for the people who use the service, and people were addressed in an appropriate manner. Discussions with staff showed their satisfaction with the support and training they receive, and a clear determination that they belong to a committed team. What has improved since the last inspection? The Annual Quality Assurance Assessment told us about the following improvements "Information gained at pre admission assessment visit is now more in depth and thorough. Where possible the information is typed to prevent misinterpretation of information and allows for more information to be recorded within the forms. Biographical history forms are provided, where possible, to clients or famly for completion prior to admission. This allows for a baseline discussion starting point concerning past life events and interests. We have employed a second Activities Coordinator specific for The Beeches that has increased the weekly provision from 10 to 20 hours. This has aided with the development of the activities programme and has resulted in the increase of outings. Changes have been made to the menu following clients views and following completion of service user meal surveys and questionnaires. Transport to and from the local church has been developed in collaboration with the local parish council to allow client choice of having their religious service at Standon Hall or within the church itself. We have developed links with MENCAP to encourage work experience within the home. Future employment may then be gained from local residents which also encourages links within the local community. We have reviewed and improved the complaints procedure. All staff have received training relating to safeguarding adults. Care staff have completed NVQ Level 2 in care (currently 50 per cent compliance) with 20 per cent trained to level 3 or equivalent and a further 20 per cent currently undertaking NVQ level 3 programme. Staff training has been developed and provided to include NVQ in cleaning services, health and safety, COSHH, moving and handling, NVQ level 2 in care, fire safety training, fire marshal training and infection control. Domestics have now completed NVQ level 2 in domestic and cleaning services. Fire drills and fire safety training has been maintained at 3 monthy intervals for all staff. This ensures staff are fully aware of their responsibilities in the event of such an incident. The Emergency Contingency Plan has been developed further to include relevant information including the ordance survey co-ordinates of the Home due to its rural location. This aids in a swift response from emergency services. This plan is reviewed at each health and safety committee meeting. Redecoration of dining room and lounge area has been completed. New flooring has also been laid in these areas. Ramp has been fitted to allow greater access to the enclosed garden. We have developed and improved our training with the collaboration of Caring Homes training company (Training in Care Ltd). We are currently compliant with all mandatory training. We comply with minimum requirements in relation to staff trained to NVQ level 2 in care. We continue to maintain and develop links within the community to allow work experience to be undertaken at Standon Hall. This will aid with the selection and recruitment for future care staff. Management within the home and clients sense of security and enhanced wellbeing have continued to improve due to the stability, leadership and dedication of the Manager with a smooth transition period when the previous manager took up her new post and the Peripatetic Manager took over. Low care staff turnover has led to continuity of care provision and has enhanced the relationships between staff, clients and others. We have built on the relationships with other professionals to ensure an open, transparent delivery of care is achieved that maximises client choices and preferences. Specific training has been delivered to staff relating to safe use of bedrails. This ensures that all health and safety aspects are maintained and adhered to." What the care home could do better: It is not good practice to admit an individual on an urgent basis, and without firstly assessing their needs. Activities undertaken should be documented and recorded. Individuals should have a choice of whether to have a bath or a shower. A shower facility should be installed to enable individuals living at the service to have a choice. The drinks kitchen should be cleaned every day, and the level of cleanliness should be monitored daily by the care manager and or nurse in charge. There must be a Registered and Fit Person in post to ensure consistency of management, and the health, safety and welfare of the people using the service. Key inspection report Care homes for older people Name: Address: Standon Hall Care Home (The Beeches) Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN     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: Pam Grace     Date: 1 4 0 1 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Standon Hall Care Home (The Beeches) Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN 01782791555 01782791396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Standon Hall Home Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Age: Dementia (DE) age 60 years and above. The maximum number of service users who can be accommodated is: 34 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: Dementia (DE) 34 Date of last inspection Brief description of the care home Standon Hall - The Beeches is a care home providing personal and nursing care and accommodation for up to 34 older people suffering from enduring mental health problems. The home is owned by a private company called Standon Hall Homes Limited. The company own a number of other nursing and residential homes across the country. The home is located on the outskirts of the small village of Standon near to the town of Eccleshall in Staffordshire and is situated in a rural setting with views over the surrounding countryside. It is not within walking distance of any amenities and Care Homes for Older People Page 4 of 36 Over 65 0 34 0 5 0 2 2 0 0 9 Brief description of the care home transportation would be required to visit the nearest village. The home was opened in 1998 and consists of one single storey building, which was built around 1930 and was originally part of a hospital. All the bedrooms are single and have the provision of a sink. Bathing and toilet facilities are located close to bedrooms. The home is situated opposite the Standon Hall Care Home. This was previously a stately home and the two homes share the spacious grounds. The fees charged by the home range from 382.00 pounds to 550.00. The reader may wish to obtain more up to date information direct from the service. 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: This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the acting care manager, and comments received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. Observation of the environment was also undertaken. At the end of our inspection feedback was given to the acting care manager, outlining the overall findings of the inspection, and giving information about the Care Homes for Older People Page 6 of 36 recommendations that we would make. We observed people who were unable to communicate. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been two complaints made to the home, since the previous inspection, and two Adult Protection Safeguarding referrals made to Social Services. Complaints had been dealt with in a timely way under the homes complaints procedure, by the acting care manager. One complaint and one Safeguarding referral was in progress at the time of this report. There were no requirements, and 6 recommendations made as a result of this unannounced inspection. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? The Annual Quality Assurance Assessment told us about the following improvements Information gained at pre admission assessment visit is now more in depth and thorough. Where possible the information is typed to prevent misinterpretation of information and allows for more information to be recorded within the forms. Biographical history forms are provided, where possible, to clients or famly for completion prior to admission. This allows for a baseline discussion starting point concerning past life events and interests. We have employed a second Activities Coordinator specific for The Beeches that has increased the weekly provision from 10 to 20 hours. This has aided with the development of the activities programme and has resulted in the increase of outings. Changes have been made to the menu following clients views and following completion of service user meal surveys and questionnaires. Transport to and from the local church has been developed in collaboration with the local parish council to allow client choice of having their religious service at Standon Hall or within the church itself. We have developed links with MENCAP to encourage work experience within the home. Future employment may then be gained from local residents which also encourages links within the local community. We have reviewed and improved the complaints procedure. All staff have received training relating to safeguarding adults. Care staff have completed NVQ Level 2 in care (currently 50 per cent compliance) with 20 per cent trained to level 3 or equivalent and a further 20 per cent currently undertaking NVQ level 3 programme. Staff training has been developed and provided to include NVQ in cleaning services, health and safety, COSHH, moving and handling, NVQ level 2 in care, fire safety training, fire marshal training and infection control. Domestics have now completed NVQ level 2 in domestic and cleaning services. Fire drills and fire safety training has been maintained at 3 monthy intervals for all staff. This ensures staff are fully aware of their responsibilities in the event of such an incident. The Emergency Contingency Plan has been developed further to include relevant information including the ordance survey co-ordinates of the Home due to its rural location. This aids in a swift response Care Homes for Older People Page 8 of 36 from emergency services. This plan is reviewed at each health and safety committee meeting. Redecoration of dining room and lounge area has been completed. New flooring has also been laid in these areas. Ramp has been fitted to allow greater access to the enclosed garden. We have developed and improved our training with the collaboration of Caring Homes training company (Training in Care Ltd). We are currently compliant with all mandatory training. We comply with minimum requirements in relation to staff trained to NVQ level 2 in care. We continue to maintain and develop links within the community to allow work experience to be undertaken at Standon Hall. This will aid with the selection and recruitment for future care staff. Management within the home and clients sense of security and enhanced wellbeing have continued to improve due to the stability, leadership and dedication of the Manager with a smooth transition period when the previous manager took up her new post and the Peripatetic Manager took over. Low care staff turnover has led to continuity of care provision and has enhanced the relationships between staff, clients and others. We have built on the relationships with other professionals to ensure an open, transparent delivery of care is achieved that maximises client choices and preferences. Specific training has been delivered to staff relating to safe use of bedrails. This ensures that all health and safety aspects are maintained and adhered to. 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. Care Homes for Older People Page 9 of 36 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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 considering using the service and their representatives are provided with information, which helps them decide if the service will be suitable to meet their needs. No person moves into the service without firstly having their needs assessed. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: The home has excellent links with both Social Services and the NHS funding team. Prior to admission in depth, comprehensive reports are obtained. Significant time and effort is taken so that that these reports, along with our own pre admission assessment policy, ensures that all prospective clients are given information about the home and are reassured that their needs can be fully met. This information is given at the pre admission visit undertaken by the manager or senior member of staff. All clients receive this type of visit before admission. Family members also provide details Care Homes for Older People Page 12 of 36 Evidence: relating to the prospective clients. Prospective clients are encouraged to visit the home and spend some time meeting other clients, meeting the staff and generally soak up the atmosphere of the home. Clients are offered the opportunity of having a respite short term stay placement prior to making the commitment permanent. Clients are able to receive visitors at their own leisure. There is also a smoking room available for client use. Clear information relating to contract terms and conditions is provided prior to admission, including the trail period offered. The full range of fees and other charges is included within the Service User Guide and discussed and agreed prior to admission. A copy of the Statement of Purpose is also given to all prospective clients and where clients require assistance with financial matters, a family representative is given these details. Leaflets from SAGA and Symponia are available for privately funded clients highlighting services relating to long term management of finances. These are not endorsed by the home but where used favourable feedback has been received. Staff are skilled in care provision and training is frequently updated to ensure that the care they provide is of a high standard and relevant to the service. The staff turnover at Standon Hall The Beeches is historically low so staff have built up excellent relationships with the clients and their families. Staff are aware of all aspects of each clients individual care needs and are vigilant to changes. All staff receive briefing regarding any new client and a full needs assessed care plan is implemented. All clients receive the same pre admission assessment and attention to detail relating to their individual care files regardless of funding arrangements. Standon Hall is not registered for intermediate care provision. We were given a copy of the Statement of Purpose and Service User Guide, these had been reviewed and updated in December 2009. We looked at three pre admission assessments, two of the assessments contained appropriate information to enable a decision to be made as to whether the service could meet the persons needs. The third assessment had been undertaken by the Local Authority Social Services, and the person had been admitted to the service on an urgent basis. This was subsequently highlighted and discussed. The assessments gave information about the persons needs across all activities of daily living examples being, cognitive awareness, confusion, risk assessment including nutrition, falls, bathing, moving and handling and fire safety. We were told by the service that they sometimes use Local Authority Social Services assessments to inform their own care planning process, and that they maintain good links with them, and with other health care professionals. The care manager told us that during the assessment process, they would always involve relevant others, therefore the family and or a representative. Care Homes for Older People Page 13 of 36 Evidence: Intermediate care is not provided in this home. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Care plans are kept up to date. Medication administration systems are regularly monitored and audited to ensure the health and safety of people using the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We have comprehensively assessed working care plans that instruct all levels of staff on how to look after individual clients and to ensure that all their assessed needs are met. Individualised care plans are clear, holistic and comprehensive, of good quality and are reviewed at least monthly by the Named Nurse or Carer. A quality auditing system is in place to ensure that this is maintained and the content relevant and accurate for each client. Feedback is also gained through our service user questionnaires and quarterly client and relative meetings. However, all clients are encouraged to discuss and express their needs on an ongoing basis where possible. Care Homes for Older People Page 15 of 36 Evidence: An open door policy is in operation and all clients and family members benefit from this personal service. Clients and their families are encouraged to participate in the care process and provide feedback on the care provision received. They, or their representaive, signs that they agree to the prescribed care plan. We have a strong ethos of involving all clients in every aspect of their care where possible and this is evident within the plans written and through discussion with the clients. Where family involvement in care is not available an advocacy service can be contacted should the client wish to use this service. Details regarding this service is displayed within the home and details given to new clients on admission. These details are also contained within the Service User Guide. Each client has comprehensive risk assessments completed that are monitored continuously and reviewed at least monthly. These take into account the clients ability and their aspired level of independance. These include care related issues as well as financial issues. Clients are encouraged to be as independant as possible. This has a positive effect on the client and ensures optimum self esteem and dignity. Clients have full access to outside healthcare professionals of their choice. For example, through discussions with their GP they are able to state which hospital they wish care to be undertaken. Clients are encouraged, where possible, to retain all previous healthcare professionals involved in their care prior to admission and optimise continuity. This allows for a greater understanding of the clients particular care needs. If this is not possible staff discuss the options available with the client to ensure that the correct services are sought. Our system for storage and administration of medications is robust and all aspects from ordering to administration is checked regularly. The Clinical Manager and Registered Nurses are responsible for the administration and recording of medication. A quality assurance auditing system is in place that monitors if medication administration is carried out effectively and accurately. Full communication between staff, GP and pharmacist is undertaken to ensure that all medications given are appropriate and effective. Each Registered Nurse has completed an Administrations of Medication Competency Assessment and their working practice is regularly reviewed by the the Manager or Clinical Manager. The home has a sustained record of Care Homes for Older People Page 16 of 36 Evidence: compliance with the receipt of medications and the administration, safekeeping and disposal of medications. We looked at three care plans. These identified needs in regard to the activities of daily living for those individuals. Care plans contained clear and comprehensive instructions for staff on exactly how to care for those individuals, including behavioural assessments, guidance and support. Risk assessments were up to date, and showed an improvement upon the previous inspection report, in regard to identifying where a care plan is required, we were told that a new system of care planning had been implemented since the previous inspection. Care plans did include personal choices and preferences of people in respect of activities of daily living. This was in the process of being further developed by the use of a social history for each individual, and with help from family members or representatives. Staff are trained to manage challenging and difficult behavior. Evidence of health professionals involvement was seen, including General Practitioner, Community Psychiatric Nurse, District Nurse, Tissue Viability Nurse, Dentist, Optician and Chiropodist. People who were not able to communicate, looked cared for, and were comfortable in their surroundings. Staff were heard to address individuals in a respectful and dignified manner. We spoke with one person who had recently moved into the service, he told us that he was happy with the staff, theyre ok, they look after me. We observed people being helped with breakfast, drinks mid morning and then assisted to eat their lunch. Nutritional needs and weight are assessed and monitored at the home. We looked at the Medication Administration system. Including Controlled Medication, Medication Administration Sheets, storage, ordering and returns of medication. These showed no anomalies. We were told that the District Nurse would attend individuals who are residential level of care, if they required dressings, records would also be kept by the Nurse. Tissue viability is assessed each month, we were assured that the advice of the tissue viability Nurse Specialist would be sought if needed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service should be able to make choices about their life style and are supported to develop their life skills. Social, educational, cultural and recreational activities should meet individuals expectations. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Daily menu is displayed within the dining room. Client daily choices in relation to menu choice are maintained and kept within the kitchen. Service user meal surveys and questionnaires are located within the Managers office in the Service User Information file. Specific care plans relating to client care preferences is located within the client individual care files. The Policies and Procedures Manual is located within the Nurses office. This provides instructions on differing faiths and the care needs in relation to this should a client require this. An up to date list of client social preferences is located within the Activity Coordinators file. Activities and social occasions are recorded within the individual client care files found in the Nurses office. Forthcoming activities are displayed on the notice board close to the Nurses office. Minutes of client and relative meetings are available within the Managers office (Meetings file). The latest is also displayed on the notice board within the reception Care Homes for Older People Page 18 of 36 Evidence: area. The Standon Hall Newsletter is available within the reception area. Copies of which are provided to all clients. The latest copy of the Statement of Purpose and Service User Guide is displayed on the main notice board in the reception area on The Beeches. All clients have also received a copy of these. Records relating to client financial affairs is maintained in the Administrators office. Personal allowance accounts are maintained for all clients and individualised records are found within the Service User Personal Allowance file. Individual risk assessments concerning financial affairs is found within each clients individual care file within the Nurses office. We were told by staff that only one bathroom in the unit is used, because it is the only one which has an assisted bath. We saw that this was poorly decorated. We observed that this bathroom was quite cold, despite there being a radiator in there. The Beeches does not have a shower, which means that individuals do not have a choice of either a bath or a shower. The general environment is institutional, and not conducive to a persons well being, this has been the reason why the service remains adequate. We note that the providers intention is to ultimately build a new unit, but that this has been put on hold. We observed that people using the service were sat at the dining tables eating and drinking and conversing with each other. Meals served were brought over on a hot trolley from the main hall kitchen. In the morning we saw that cooked breakfast was on offer, including bacon, egg, sausage. Some people preferred toast and cereal, but both of those options were available. Lunch was also sent over by hot trolley, and looked nutritious and appetising, this was meat, potatoes and vegetables, followed by a pudding. We were told that menus are changed seasonally, and that peoples preferences are taken into account. Staff told us that they listen to what people want. Peoples preferences are documented in their care plans and letters are sent out to families requesting information to help compile a biography of the person. Forthcoming events and activities are displayed on the notice board and the home has a monthly newsletter sent around. We were told that people are asked for suggestions at resident and relatives meetings. We were told that arrangements are in place to transport anyone wishing to attend the local Church services, and regular services are held in the home which most Care Homes for Older People Page 19 of 36 Evidence: people prefer. The care manager told us that visitors are welcome at any time and that there are plenty of facilities to visit in private, including the seating areas in the gardens. We were told that there was a four star rating applied to the kitchen, via a visit from the Environmental Health Officer in 2009, and no recommendations were made by their department at that time. We were told that there are now two activities coordinators employed at the home. We noted that one of those coordinators has been appointed, with particular responsibility for providing a service at The Beeches. Staff told us that there had been trips out to local venues since the last Key Inspection, however, these are undertaken during the better weather. Evidence was seen of trips out in the form of photographs. People spoken with could not remember when they had last gone out on a trip. From the records contained in care plans, we could not identify whether individual hobbies and interests are being promoted at the home. There was insufficient information available to identify what people like to do and what they are interested in. We were told that the staff are making attempts to obtain more information from relatives and representatives on admission in the form of a biography. We did see staff interacting with people using the service, however, this was on a basic communication level, therefore basic care needs were being met, assistance to eat and to drink, toileting, prompting, supervising etc.. but little evidence of actual activities happening, and stimulation for the people sitting around the lounge area. If you were a visitor to the unit, visiting for the first time, you would gain the impression that there was nothing happening for people in the lounge area at all, apart from watching television. Activities undertaken should be documented and recorded. Some people were watching the television and others were holding items which are important to them. 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. People using the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us Standon Hall has a clear, concise complaints procedure that is prominently displayed, robust and easy to follow. Full details are also recorded within the Service User Guide. Clients and family members are actively encouraged to complain about the service provision should they find it inadequate for their needs. Clients and their families are also encouraged to make suggestions on how the service can be improved. Clients, where possible, and family members are aware of who to complain to should they feel this is necessary. The Manager and Clinical Manager operate an open door policy and this makes it easier for clients and family members to feel at ease discussing anything they feel is appropriate to them. It also prevents minor problems from escalating. There is also a whistleblowing policy prominently displayed should anyone feel that this is a necessary course of action. Any complaint is dealt with immediately to ensure that all parties are confident that their complaint is taken seriously and acted upon. Full records are maintained and all interested parties are informed of the outcomes within a 28 day period. An action plan is devised that highlights any requirements to prevent the repetition of the complaint. All staff are then made aware of any changes Care Homes for Older People Page 21 of 36 Evidence: to current practice if necessary. Should a complaint be made that requires the involvement of other services (GP, CQC, local adult protection teams) these are informed immediately and open and honest discussions take place to clarify steps to be taken and decisions to be made. We ensure that all staff comply with the policies and procedures relating to client protection and the safeguarding of adults policy. This is achieved through training, clinical supervision and the monitoring of working practices. All clients state that they feel safe and secure and are supported by the Manager, Clinical Manager and the care team. This is evidenced in the recent service user questionnaire and through discussions with clients and their families. A thorough, comprehensive recruitment system is in place. All staff are assessed and verified by the Criminal Records Bureau before commencement of employment. Clients are encouraged, where possible, to maintain the right to vote in local or general elections. Some clients refuse to participate in this process but others do take up to option to use the postal voting system. Advocates are encouraged when family involvement is limited. Details of this service are displayed within the home and also within the Service User Guide. Clients are encouraged if possible to maintain links with the local church and attend services when they wish to. We saw that the complaints procedure was displayed in the main entrance to the home. We were told that larger print versions would be made available if required. The care manager confirmed that people who use the service and or their representatives are provided with a copy of the homes complaints procedure during the admission process. There had been two complaints and two Safeguarding referrals made in regard to the service, since the previous inspection. One complaint had been partly upheld and amicably resolved, and the other complaint was in progress at the time of this report. The home has a policy on Safeguarding and the Protection Of Vulnerable Adults (POVA) and all staff are made aware of this and receive training in this area. The acting care manager has the support of a Regional Manager who visits the home regularly. We were told that staff are carefully selected to work at the home and undergo the required checks including Criminal Records Bureau (CRB) checks. We saw evidence of this in the staff files we examined. Staff spoken with, and records seen confirmed that staff receive training in regard to Safeguarding and the Protection of Vulnerable Adults, and are aware of the action to Care Homes for Older People Page 22 of 36 Evidence: take in the event of reporting abuse. The acting care manager told us he is familiar with the local safeguarding policies. The service has a Whistle blowing Policy in place so that staff who want to report abuse and bad practice are protected. Care Homes for Older People Page 23 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides only a very basic level of comfort for the people living there. The whole building is in need of modernisation in order to offer people a homely and comfortable place to live. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us We encourage clients to see Standon Hall as their home. All necessary adaptions required to meet specific client care needs are provided. These include hoists, adapted bath hoists and variable height beds. This allows clients to maintain an optimum level of independance within the home. Full servicing records of all adaptions are maintained. The home meets the requirements of the Disability Discrimination Act and is applicable to the needs of the client group. All rooms are accessible to all as the unit is at ground floor level. Standon Hall The Beeches is set within extensive grounds. The grounds are well maintained and are easily accessible to clients via the main entrance. There is also an enclosed garden accessible only to clients on The Beeches. There is one large communal lounge, which we have split into separate groups by use of furniture. This allows for separate activities to be delivered without involving all Care Homes for Older People Page 24 of 36 Evidence: clients. The dining room is large and spacious and offers a relaxed atmosphere to dine. Clients are able to entertain their guests in the communal lounge, reception area or within their own rooms. There is a smoking room available for client use. All bedrooms are for single occupancy and exceed the minimum standard required for size. Clients are able to choose if they wish to have a lock on their bedroom door to maximise privacy. New clients are also asked for their preference and should a lock be required this is adhered to. The nurse call system is maintained and serviced accordingly. These are strategically placed for easy accessibilty by clients. Staff attend promptly to any call for assistance. Adaptive baths are available. There is plenty of hot running water and the temperature is maintained within required health and safety levels. Records of water temperatures, maintenance of the heating system and boilers are well maintained. The home is clean and tidy and smells fresh. An effective laundry system is in place. Domestic and laundry staff have completed NVQ level 2 in cleaning and domestic services. All staff have received training in relation to infection control. Clinical waste is disposed of correctly and working practices ensure that cross contamination is minimised. Annual visits from Environmental Health are carried out and any requirements made are actioned. No requirements or recommendations were made at the last visit in January. A full fire risk assessment is maintained and any remedial work required following a Fire Officer visit is actioned. The last Fire Officer visit identified all required actions had been completed. An Emergency Contingency Plan is maintained and updated accordingly. This includes comprehensive information relating to any interruption of service. All general risk assessments are reviewed annually. The Health and Safety Committee meet every three months to discuss issues and plan action accordingly. Minutes for these are available within the Managers office. The Annual Quality Assurance Assessment confirmed the following improvements made since the previous inspection: Staff training has been developed and provided to include NVQ in cleaning services, health and safety, COSHH, moving and handling, NVQ level 2 in care, fire safety training, fire marshal training and infection control. Domestics have now completed NVQ level 2 in domestic and cleaning services. Fire drills and fire safety training has Care Homes for Older People Page 25 of 36 Evidence: been maintained at 3 monthy intervals for all staff. This ensures staff are fully aware of their responsibilities in the event of such an incident. The Emergency Contingency Plan has been developed further to include relevant information including the ordance survey coordinates of the Home due to its rural location. This aids in a swift response from emergency services. This plan is reviewed at each health and safety committee meeting. Redecoration of dining room and lounge area has been completed. New flooring has also been laid in these areas. Ramp has been fitted to allow greater access to the enclosed garden. We observed the environment during a tour of the service, accompanied by a staff member. The dining area was well laid out, with tables and chairs, tablecloths and table mats were in use, making the area feel warm and homely. We saw individuals using the smoking room during our visit. Two of the five toilets used were out of order. This was highlighted during our visit, and both toilets were repaired straight away. We saw that there was plenty of hot running water. Staff told us that the assisted bathroom is the one used mostly by individuals. However, this is in urgent need of refurbishment, the decor and the floor was shabby and tired, and the radiator was only luke warm on what was a very cold day with snow on the ground. We highlighted and discussed this with the care manager. There is no shower for people to use at The Beeches, this means that there is no choice other than a bath, for individuals preferring to have a shower. The drinks kitchen which is in regular daily use, needed a good clean. The floor was wet, surfaces were dirty and the microwave was dirty, it looked as if it had not been cleaned properly for some time. The kitchen bin was overflowing. We highlighted this, and a staff member set about cleaning it whilst we visited. We were told by staff that they had received appropriate training in infection control. Carpets in some bedrooms need replacing, and the en suite bathrooms need shelving to be fitted, to enable people to appropriately store their toiletries. Bedroom vanity units were in need of replacement, they looked very tired and worn. The enclosed garden was difficult to view because of snow that had fallen that week. But we were assured that it continues to be well used by the people using the service, weather permitting. The windows in the lounge area allowed for people to see and Care Homes for Older People Page 26 of 36 Evidence: enjoy the views of the garden and the wildlife. The Beeches unit still retains an institutional appearance and feel, the outcome for people using the service is an oppressive atmosphere, and an environment which is not conducive to a persons well being. There had been few environmental changes, which was in line with previous reports. We were told that the plans to replace the existing unit with a new building had been placed on hold by the Provider. Care Homes for Older People Page 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and skilled, and are in sufficient numbers to safely support the people who use the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us We ensure that a fully robust recruitment procedure is maintained and staff are recruited to enhance the care provision delivered at the home. All new staff members are assessed and verified by the Criminal Records Bureau prior to commencement and two references are also obtained. Each member of staff has a clearly defined job description and this highlights their responsibilities within the team. Standon Hall has a strong ethos of staff training and development in order to maximise care provision within the home. All new staff members complete a Skills for Care full induction that includes all areas relevant to client care and health and safety issues in order to maximise safe working practices. This is developed during their employment and relevant training is provided on an ongoing basis. Staff are also encouraged to attain external qualifications to further their personal development as well as optimise care for the clients. We encourage all care staff to complete an NVQ level 2 in care, of which we are currently at 50 per cent rate. 20 per cent of care staff are trained to NVQ level 3 or equivalent. A further 20 per cent of staff have commenced the NVQ level 3 programme and are expected to complete by the end of the year. All Care Homes for Older People Page 28 of 36 Evidence: permanent care staff are expected to commence NVQ level 2 in care following completion of a probationary period. We have a Regional Training Manager through our training company (Training in Care Ltd.) who assists the Manager in facilitating training through in house sessions or by sourcing external courses. We now have the facilities at Standon Hall to access e learning courses. This assists with the compliance of mandatory training and induction of new staff members. We are currently compliant with all mandatory training. Training that has occurred this year includes: Fire safety (three-monthly intervals) Infection Control Manual Handling Food and Nutrition Health and safety COSHH Safeguarding Adults Medication Administration and Competency Assessments Dementia Care Awareness Conflict Management Safe Use of Bedrails All domestic staff have successfully completed an NVQ level 2 in cleaning and domestic services. We looked at four staff recruitment files. These evidenced that the service has a robust and safe system of recruitment for new staff. Documentation included an application form, two references and appropriate Criminal Records Bureau and Protection of Vulnerable Adults checks. This ensured the welfare and safety of the people using the service. Staff spoken with, said that they were happy with the management of the home, although they acknowledged that this seemed to be regularly changing. They confirmed that they had received training in dementia care, updates in regard to mandatory training, including moving and handling, health and safety, Fire and Medication. They were satisfied in regard to the training, support and supervision they received, staffing levels, and their workload. Training records evidenced this. We spoke with a new member of staff, he confirmed that he had previously worked at the service, and had returned, he was undergoing an induction programme which was in line with Skills for Care, and is recognised as an appropriate induction. Records seen during our visit tallied with the rota for that day. We looked at the staff rota for 16th to 29th January 2010. This showed that staffing levels were being maintained. Staff confirmed that they were receiving regular, formal supervision by their line manager, and that they had attended regular staff meetings. Minutes of those meetings were available for us to view. Care Homes for Older People Page 29 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. There needs to be consistency of management oversight for this service. The overall rating of adequate reflects the poor environment and poor outcomes for people using the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us Standon Hall is a privately owned care home within the Caring Homes Group providing personal and social care. The previous General Manager at Standon Hall had been in post for over four years and has recently gained promotion to Regional Manager. The current manager is a Peripatetic Manager who has over twelve years experience as a Home Manager is RMA qualified. She has the relevant expertise to manage the home effectively providing good value for money. She is able to provide strong leadership and support to her team to ensure high standards of client care are achieved. She is committed to ensuring that the health and welfare of the clients is optimised. The Regional Manager visits the home at least monthly and supports the Care Homes for Older People Page 30 of 36 Evidence: manager in her role. There is a recognised support network within Caring Homes that also assists the Manager in any aspect of her role. The Manager attends regular care providers meetings. This provides the Manager with information relating to client care issues and therefore she is able to implement change quickly and effectively if required. This has also assisted in optimising the profile of the home. The Manager has excellent relationships with other professionals and members of the multi disciplinary team to enhance the care delivery at Standon Hall. This has resulted in treatments being provided that are appropriate and effective for individual client needs. The Manager operates an open door policy that encourages an open and positive communication between clients and their families and staff. Clients are encouraged, where possible, to take an active role in the running of the Home and make choices to enhance their own lifestyles. Client and relative meetings are held every three months. The Manager ensures that working practices are monitored and that policies and procedures are implemented and adhered to. The Monthly Manager Report (quality assurance audit) performed provides evidence that this is maintained and monitored. These include areas such as medication administration, care planning, Service User Questionnaires, meal surveys and catering audits. The Manager undertakes monitoring and reviews of all health and safety issues within the home. This includes areas such as accidents and incidents, planned preventative maintenance and reactive responses. All ensure that safe working practices are achieved. The SMO (Site Maintenance Operative) completes specified checks on all health and safety aspects of the home. The Manager ensures that these are complete and relevant. Quarterly health and safety committee meetings are maintained and practices reviewed accordingly. General risk assessments and the Emergency Contingency Plan are discussed and reviewed at the meetings. The Manager also ensures that all substances in use are included within clear and concise COSHH risk assessment and data sheets available. Copies are available within all departments of the Home. The Manager ensures that staff have received the training relevant to the needs of individual clients and that training relating to health and safety is provided and updates completed accordingly. We are currently compliant with all mandatory health and safety training. The Manager attends training regularly to enhance her own knowledge and leads by example. She has a recognised teaching qualification and the Registered Managers Care Homes for Older People Page 31 of 36 Evidence: Qualification. Quality assurance audits are carried out by the Regional Training Manager to ensure compliance and relevance of the training delivered. The Manager ensures that a clear, transparent audit trail is available in relation to individual client finances. The Administrator supports the Manager in this role. All records are available and can be viewed by clients at any time. Clients who are able to manage their own financial affairs are encouraged and supported to do so. Risk assessments are available within each clients individual care file highlighting their involvement and level of independence in this regard. We found that there is a new acting care manager Alan Mauger in post, the previous peripatetic manager who was in the process of inducting him into the role, has subsequently left and returned to her previous position. The new manager is aware of the history of The Beeches, and the need for a new building to replace the existing one. He told us that he is will be applying for Registration with the Care Quality Commission, and is committed to the needs of the individuals in his care. There must be a Registered and Fit Person in post to ensure consistency of management, and the health, safety and welfare of the people using the service. We received a complaint about the quality of care at The Beeches, which was subsequently discussed with the care manager, and was in progress at the time of this report. There had previously been one complaint, which had been partly upheld and amicably resolved. There had also been two Safeguarding referrals made to social services since the previous inspection. One of those was in progress at the time of this report. We receive Notifications from the service as appropriate. The Annual Quality Assurance Assessment was well completed, and clearly told us the areas that the service wanted to improve upon. We confirmed that Provider visits under Regulation 26 are still being undertaken, reports were available for us to view. We were told that the ISO 9001 Standard, had been met by the service, with no requirements. The organisations clinical auditing team also visited in September and November 2009. This resulted in the service scoring 90 per cent. Staff training continues to be the organisations strong point, with supervision, appraisals and staff meetings happening regularly for staff. Staff appeared very satisfied with the level of support and training they received from the organisation. Care Homes for Older People Page 32 of 36 Evidence: Staff and resident meetings are regularly held. The organisation encourages their managers to undertake regular monitoring and auditing of all aspects of the service, including quality assurance and health and safety. There is a quality assurance programme in place at the service, we were told that audits are processed and compiled by the organisation, and then put into written format, for people to see. These were available for us to view. We were told that the manager has an open door policy, and prefers to speak face to face with people using the service and or their relatives to resolve any conflict or concerns straight away. We did not spot check individual finances for people using the service on this occasion, as we were assured that the same system is in place, and that there had been no previous issues raised. The service has an administrator who deals with this. Care Homes for Older People Page 33 of 36 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 34 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 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 2 3 4 5 4 12 15 21 26 It is not good practice to admit an individual on an urgent basis, and without firstly assessing their needs. Activities undertaken should be documented and recorded. Individuals should have a choice of whether to have a bath or a shower. A shower facility should be installed to enable individuals living at the service to have a choice. The drinks kitchen should be cleaned every day, and the level of cleanliness should be monitored daily by the care manager and or nurse in charge. There must be a Registered and Fit Person in post to ensure consistency of management, and the health, safety and welfare of the people using the service. 6 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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