Care Home: Stansfield Hall

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What the care home does well Residents,their relatives and other visitors to the home made positive comments about the quality,values and attitude of the staff and management.One visitor stated,"the residents are clean and well cared for,and the staff are courteous toward them". The work that staff do to improve a residents situation was commented on with one relative stating that,"The staff look after her very well and she is eating now".Whilst another relative highlighted that,"Encouragement with eating is done well and calmly and consistently". Residents are supported to take the correct medication so that they stay well.To make sure that medication is given correctly, a medication administration system is used to record all aspects of managing medication.Good links are maintained with community based medical services. This means residents have access to appropriate and timely medical intervention. The procedure for administering medication is followed well, which enhances the health and safety of residents. The environment was bright and clean that looked and felt comfortable.A comment made by a relative said, "the home provides a warm,welcoming home like environment".With a number of communal areas,residents have the flexibility and choice of where and with who they spend their time or could have the privacy of their own bedrooms".The home was seen to be very clean in all bedrooms,communal areas,bathrooms and toilets that we looked in. What has improved since the last inspection? The Statement of Purpose has been reviewed to make sure that residents have access to the right information about the home. Decoration and refurbishment had continued. The manager told us that the requirements and recommendations of the last inspection have been fully addressed. Key workers now input weekly in care plans. Senior staff review care plans monthly and are more involved in ensuring that records are filled in by care staff.The manager told us that, "Team work has improved between day and night staff and there is now more cooperation from the night team". We were told, "many things have changed. Manual handling is now in place. Baths are done on a daily basis. Life at the home is more organised" New Health and Safety checklist includes regular check of designated smoking rooms. All staff are having training for the Mental capacity Act and the Deprivation of Liberty What the care home could do better: Care plans must fully reflect residents needs in all aspects of their life and it is recommended that the support provided is based on a more person centred approach to how the resident themselves wants to be supported. Improvements to the way in which the dates weights were being recorded.eg. May 2009 needs to be amended.The actual day on which the weight is taken should be recorded,to accurately alert staff to the exact period of significant weight loss or gain.We also recommend that the directions in the care plan to weigh residents at the regularity indicated is followed so residents can be confident that staff will regularly monitor their wellbeing in relation to nutrition and weight. Residents general and specific health needs and interventions need to be fully recorded in the care file. Residents and/or their representative should be fully involved in the care planning process and that this is clearly evidenced by signatures in the care plan. To find out how residents and other relevant people feel about the quality of the service a system of quality assurance should be used to gather these views and other relevant information that will help to find out about the quality of service being provided and where the service may need to be improved. The manager needs to make sure when handwritten medication is indicated in the medication administration records that this is signed by the person making the entry and signed as verified by a second member of staff to confirm the accuracy of this record. When controlled drugs are prescribed to residents these must be double signed in the medication administration records as confirmation of administration in line with controlled drugs administration procedures. When medication has limited shelf life staff need to indicate on the box and bottle the date the medication was opened as an additional check that the medication is within date. The manager needs to liaise with residents and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available and who has taken part. Revise the menus so there is some variety to the meals each day and the meals are not repetitious. Maintain an individual record of all food served to residents in such detail that anyone looking at the record could see if the diet is sufficient in terms of nutrition. Provide residents with a menu,in the dining room for example,that they can see easily and can refer to which tells them what they are having for their meals on the day. The manager should ensure that the Commission is notified promptly of incidents affecting the welfare and safety of people living in the home. This will ensure that the wellbeing of residents can be monitored. The manager needs to arrange for all staff to attend protection of vulnerable adults training so they have the knowledge to recognise signs and symptoms of potential abuse. The manager needs to look at the whistle blowing procedures and re enforce through supervision and team meetings that if staff were to whistle blow they would not fear detriment as a result. It is strongly recommended that the manager attends the local authority safeguarding training as a refresher to the policies and procedures. To promote the respect,comfort and safety of residents and staff the carpets in the corridors need replacement. And to ensure the house is maintained to a good standard and to enable residents to see out of the windows the owner needs to replace the misted double glazed windows within residents bedrooms. Provide all staff with one to one supervision with their line manager at a minimum of six times a year to assist staff in their development and identify any training needs. Key inspection report Care homes for older people Name: Address: Stansfield Hall Stansfield Hall Temple Lane Littleborough Lancashire OL15 9QH     The quality rating for this care home is:   two star good 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: Kath Oldham     Date: 2 1 0 9 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 35 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 35 Information about the care home Name of care home: Address: Stansfield Hall Stansfield Hall Temple Lane Littleborough Lancashire OL15 9QH 01706370096 F/P01706370096 rajan630@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rajanikanth Selvanandan care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief description of the care home Stansfield Hall is located approximately two miles from the centre of Littleborough. The home provides 14 single and 4 double bedrooms, all of which were let as singles at the time of the inspection. Access to the home is up two steps, although there is good ramped access to the side of the home via the conservatory. Grab rails are provided at each side of the steps. All accommodation is on ground floor level. For safety reasons there is limited access to gardens. A small patio area is provided and is used by residents in fine weather. Parking for approximately eight cars is provided, with further on-street parking available as needed. There are a number of shops nearby but they Care Homes for Older People Page 4 of 35 Over 65 22 0 Brief description of the care home are not easily reached by residents. A regular bus service to Rochdale and Todmorden stops close to the home. At the time of the inspection, weekly fees were between £384 and £450.00. Additional charges are made for hairdressing, chiropody, newspapers, dry cleaning, private telephone line rental/calls, and external activities in the form of a small donation for transport. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 21st September 2009 commencing at 7.15am. The inspection of Stansfield Hall included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was in June 2008. We should have just undertaken an Annual Service Review (ASR) this year instead of an inspection.This is when we do a review of good and excellent services that takes place between key inspections. Good services only have an inspection every two years and excellent services every three years. An inspection visit wasnt due as on our last visit the home was deemed a good service. We did an annual service review this year.However, information received for the annual service review told us we needed to have another look at this service.We had Care Homes for Older People Page 6 of 35 received information about the home in relation to a safeguarding investigation and we had received a complaint about different aspects of the home. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some months before our visit we sent the owner a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do.We considered the responses and information provided and have referred to this in the report. Whilst the AQAA gave us some information,for future it does need to contain additional information about the service provided. Stansfield Hall was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent as part of the annual service review and these comments were used to report on our findings when we did this. Some comment cards were returned after we had written that report and these comments have been used in this report. We also took with us on our visit some comment cards for distribution to staff and residents.The views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices and talking with residents and their visitors,the manager and staff.A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how the home was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents were looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people living at Stansfield Hall was residents. This term is, therefore, used throughout the report when referring to people living at the home. A brief explanation of the inspection process was provided to the manager on her arrival at the home and time was spent at the end of the visit with the manager to provide verbal feedback of our findings. We have received one complaint with regard to differing aspects of the home. This was passed to the owner to investigate using the homes complaints procedure. We had received information about safeguarding and this was passed through to the local authority to look into. At the time of writing this report the local authority has not let us know the outcome of their investigations.The manager had not notified us of this Care Homes for Older People Page 7 of 35 allegation in line with the regulations. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 8 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must fully reflect residents needs in all aspects of their life and it is recommended that the support provided is based on a more person centred approach to how the resident themselves wants to be supported. Care Homes for Older People Page 9 of 35 Improvements to the way in which the dates weights were being recorded.eg. May 2009 needs to be amended.The actual day on which the weight is taken should be recorded,to accurately alert staff to the exact period of significant weight loss or gain.We also recommend that the directions in the care plan to weigh residents at the regularity indicated is followed so residents can be confident that staff will regularly monitor their wellbeing in relation to nutrition and weight. Residents general and specific health needs and interventions need to be fully recorded in the care file. Residents and/or their representative should be fully involved in the care planning process and that this is clearly evidenced by signatures in the care plan. To find out how residents and other relevant people feel about the quality of the service a system of quality assurance should be used to gather these views and other relevant information that will help to find out about the quality of service being provided and where the service may need to be improved. The manager needs to make sure when handwritten medication is indicated in the medication administration records that this is signed by the person making the entry and signed as verified by a second member of staff to confirm the accuracy of this record. When controlled drugs are prescribed to residents these must be double signed in the medication administration records as confirmation of administration in line with controlled drugs administration procedures. When medication has limited shelf life staff need to indicate on the box and bottle the date the medication was opened as an additional check that the medication is within date. The manager needs to liaise with residents and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available and who has taken part. Revise the menus so there is some variety to the meals each day and the meals are not repetitious. Maintain an individual record of all food served to residents in such detail that anyone looking at the record could see if the diet is sufficient in terms of nutrition. Provide residents with a menu,in the dining room for example,that they can see easily and can refer to which tells them what they are having for their meals on the day. The manager should ensure that the Commission is notified promptly of incidents affecting the welfare and safety of people living in the home. This will ensure that the wellbeing of residents can be monitored. The manager needs to arrange for all staff to attend protection of vulnerable adults Care Homes for Older People Page 10 of 35 training so they have the knowledge to recognise signs and symptoms of potential abuse. The manager needs to look at the whistle blowing procedures and re enforce through supervision and team meetings that if staff were to whistle blow they would not fear detriment as a result. It is strongly recommended that the manager attends the local authority safeguarding training as a refresher to the policies and procedures. To promote the respect,comfort and safety of residents and staff the carpets in the corridors need replacement. And to ensure the house is maintained to a good standard and to enable residents to see out of the windows the owner needs to replace the misted double glazed windows within residents bedrooms. Provide all staff with one to one supervision with their line manager at a minimum of six times a year to assist staff in their development and identify any training needs. 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 11 of 35 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 12 of 35 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 are given good information and have their needs assessed before deciding whether the home will be a good place for them to live. Evidence: The manager showed us a copy of the current Statement of Purpose and Service User Guide. Both documents contained all the information required by regulation.They had been updated since we last inspected the home . We were told in the AQAA completed by the manager in June 2009 that,Each service user referred to the home has a full assessment of their needs before coming into the home. This is done by a senior or the Manager, in Hospital or the service users home. We provide a statement of purpose and a service user guide on the assessment. Service users can visit the home and spend a day with us to get a better picture of the home if they wish. A full assessment is gained from social services when they refer someone to the home before the service user enters the home. Care Homes for Older People Page 13 of 35 Evidence: We looked at the care records of four people living in the home. Detailed assessments of their needs had been carried out prior to deciding that the service would be able to meet their needs. If people are to be funded through a local authority, a Care Management Assessment was obtained prior to residents being offered a place at the home.An example of a Care Management assessment was seen and it set out the residents primary health and care needs. The manager said she would undertake her own information gathering assessment through visiting the person/family and/or through visits to the see them at home.All information gathered and assessed prior to a residents admission is recorded and used in the decision making process when offering a resident a place at the home. A resident, who we asked, confirmed that they had been visited by someone from the home before the final decision to move to the home had been made. The assessments included identified risks and how these would be managed to keep residents safe from accidental harm. Risk assessments on the use of hoists identified the type of equipment and the size of sling that must be used. This ensures that the correct equipment is used to transfer people in a safe way. Assessments contained evidence of referrals to health care professionals,such as physiotherapists,dietitians and speech therapists. This home does not offer an intermediate care service. Care Homes for Older People Page 14 of 35 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. Residents have their personal and health care needs met and this is provided in a manner that protects their privacy and dignity. Evidence: The manager told us,we give a high standard of care at Stansfield Hall.All the staff are made fully aware of the residents needs.Care plans are kept up to date and regularly reviewed by senior staff.Each carer is a key worker and writes a weekly report to add to the care plan this is monitored by senior staff.This ensures that individuals needs are being met and if their wishes change they are noted and acted upon. Staff respect residents dignity and their right to privacy. A member of staff when asked what the home did well told us,It makes residents feel at home in a relaxed environmentA member of staff also told us,I think our service users are well cared for their needs are met. Another member of staff told us,general standard of care provided at the home is good, majority of staff are experienced and are very caring.And added, all residents needs are met daily.Additional members of staff said, the service users are very well cared for and Care Homes for Older People Page 15 of 35 Evidence: receive good personal care. In my opinion the service users are well cared for, all needs are met. A further staff member said, I feel the home does well for all our service users. Further staff said,the home supports every residents individual needs and take into consideration all the residents disabilities. The care the residents have is 100 .The service users are well cared for and their needs are met.We were told, many things have changed. Manual handling is now in place. Baths are done on a daily basis. Life at the home is more organised We observed interactions between staff and residents and it was evident that their relationships were based on respect and that staff recognised their rights to receiving care and support in a private and dignified way.Two residents said they usually receive the care and support they need and staff are usuallyavailable when they need them and one resident responded,always to the same questions. Residents should be confident that staff will regularly monitor their wellbeing in relation to nutrition and weight. We recommend an improvement to the way in which the dates weights were being recorded.eg. May 2009.The actual day on which the weight is taken should be recorded,to accurately alert staff to the exact period of significant weight loss or gain.We also recommend that the directions in the care plan to weigh residents at the regularity indicated is followed so residents can be confident that staff will regularly monitor their wellbeing in relation to nutrition and weight. Staff spoken were able to describe in detail how the person was supported but not all of this person centred information had been recorded or reflected in the care plan.Care plans must fully reflect residents needs in all aspects of their life and it is recommended that the support provided is based on a more person centred approach to how the resident themselves wants to be supported. It is also recommended that residents and/or their representative,be fully involved in the care planning process and that this was clearly evidenced. We recommend that care plans are developed to be more person centred to reflect more individualised care needs which identifies and recognises the aspirations and goals of the resident including what support will be provided to enable people to take part in their local community.A resident said that a member of their family used to take them out but they were ill so it didnt happen anymore.They said,they do not have the staff spare to go out. Information about residents health needs was recorded in the care plans but was not Care Homes for Older People Page 16 of 35 Evidence: very detailed or comprehensive.For example,there was little reference to residents dental care or nutritional needs.The manager acknowledged that staff knew this information but it was not fully recorded.It is recommended that residents general and specific health needs, such as dental, nutritional and emotional,and interventions were fully recorded.All residents who we spoke to were confident that medical support was appropriately obtained in a timely manner. Support from specific health providers such as District Nurses and other health professionals were recorded.Residents with specific health needs, such as diabetes,had been referred and received input from health providers such as chiropodists and opticians. Staff were observed talking with and supporting residents.They were seen to be supportive and respectful in the way that they spoke to, encouraged and helped residents. The medication administration system was checked and found that all deliveries of medication were recorded on the Medication Administration Record (MAR).Returned medication was signed for correctly.Staff who had responsibility for administering medication had received training from the supplying pharmacy and a number had completed more in depth medication training. We examined the medication system in place for the four residents whose care plans we had seen.Medication administration records appeared to be accurate and up to date and all medicines were stored securely in the medication room.We observed appropriate medication administration procedures being followed by staff. We looked at the medication administration records being used on our visit.We noted that handwritten medication was not signed as verified by a second staff member to make sure the entry was correct. This is best practice and provides a degree of protection for residents that they are getting the correct medication at the right time as prescribed by their doctor. Some residents are prescribed controlled drugs by their doctor. These should be double signed in the medication administration records in line with controlled drug procedures. This needs to be arranged by the manager. When a resident is prescribed a cream or lotion by their doctor this needs to be recorded when it is administered. Some services do this on the medication administration records other complete a cream chart. When we looked at a selection Care Homes for Older People Page 17 of 35 Evidence: of residents medication records we could not see that certain creams had been administered as prescribed by the residents doctor. A cream chart was also not available. This needs to be rectified as confirmation that this prescribed medication is being applied as prescribed by the doctor. This will also help the staff to double check whether the cream is working and to be able to report back to health professionals with records to verify this information. Some medication has a limited shelf life and the date when this type of medication is opened should be indicated on the box and bottle to confirm this. This enables a proper check to be made that the medication is still in date. The manager did say that all this medication is discarded after the 28days. However this does need to be recorded as we have indicated. Care Homes for Older People Page 18 of 35 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. Some activities are available to residents, and visitors are welcome in the home, which enhances residents fulfillment and social stimulation. Evidence: In relation to meals we were told by the manager that, Comments from service users about the meals are listened to and acted upon immediately. The chef provides a well balanced diet with choices for all tastes. She is aware of their individual likes and dislikes and is always asking them for their ideas and giving other options to the set meals.A member of staff told us, I think our service users are well cared for their needs are met and have a very well balanced diet. A further staff member said, They also enjoy their food and always have an option. A member of staff in response to the question what does the home do well responded, organise the kitchen.A relative told us,meals could be on a longer rotation seem to be repeated often. We had a meal with residents. Time was spent by staff trying to encourage a resident to have something to eat and gave them lots of choices and meals. This was done in a sensitive and patient way encouraging the residents abilities and needs.The work that staff do to improve a residents situation was commented on with one relative stating that,The staff look after her very well and she is eating now.Whilst another relative Care Homes for Older People Page 19 of 35 Evidence: highlighted that,Encouragement with eating is done well and calmly and consistently. We looked at the menu for the weeks of and before our visit. The meals recorded as having been served to residents were very repetitious or similar types of meal. The meal prepared to residents for a period of eight days were, meat and potato pie, cottage pie, lamb hot pot, corned beef hash pie, meat and onion pie, potato pie, roast chicken and cottage pie. We were told that residents liked these types of meals. This may be the case but some variety does need to be made to the menus. There wasnt a menu on display that residents could see or refer to. This would be good so the residents could remind themselves of the meals they are having for the day. We were told that the staff used to keep an individual record of food served to residents so that you could check what residents were eating and make sure they were having the correct diet and nutrition. This record is no longer kept and does need to be started again. This record can be used by staff if someone is loosing or gaining weight.If a dietitian is involved in a residents care then this record would provide valuable information so they could check whether an individuals diet is correct in relation to nutrition. We were told that fresh produce was used in the preparation of meals and the home has a really good butcher who supplies meat to the home.Other produce is supermarkets own brands in relation to cereals and such like. Two residents said theyalways liked the meals at the home and one responded, usually. With regard to activities the manager told us in the AQAA she completed before the visit, Service users with dementia are taken out for walks and involved with daily chores like the folding of napkins, watering of plants.Activity coordinator visits twice a week and also takes service users out either as a group or individually depending on their needs.One carer has been on specific training and provides a weekly keep fit class which is thoroughly enjoyed by all. A member of staff told us that the home could do better by,more activities to keep the service users occupied and entertained.Other members of staff said the home needed toprovide more activities for the residents.If anything I would like to see more activities for the service users.I think they could do with more activities to keep them entertained.Spend more time with residents instead of making an effort when people are there. Time is very limited when with the residents. More activities Care Homes for Older People Page 20 of 35 Evidence: should be done and more outings.Examples of artwork completed by residents was on show in the corridor. We looked at the activities record which did detail some activities as having taken place. We could not see from the record which or how many residents had taken part in the activity. On our visit two residents were seen playing dominoes with a staff member and music was playing in the lounge which some residents were singing along to. Many of the residents choose to spend time in their bedroom and occupy themselves by watching television, receiving visitors or reading. Some residents we were told do not routinely come out of their rooms during the day and others come to the dining room to have their meals. In one of these residents care files we looked at who stays in their room all day didnt indicate the support staff give the resident in the form of stimulation or occupation. The care records looked as if this resident didnt get any stimulation or conversation from staff.We describe earlier in this report the need to have more person centred care plans for residents. All residents and staff who we asked, confirmed that there were no unreasonable restrictions on visiting and that people are made to feel welcome by the staff team when they did visit. Care Homes for Older People Page 21 of 35 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. Residents and their relatives are able to complain and action is taken to respond to their concerns. Evidence: Residents are given written information on the procedure for expressing concerns and complaints. The people that we spoke to said they knew who to speak to if they had any concerns and they were confident that these would be dealt with and resolved to their satisfaction. Staff completing comment cards told us that they knew what action they must take if someone had concerns about the home.Staff were not so confident in the whistle blowing procedures and felt unsure that there wouldnt be any repercussions.The term whistle blowing is used in national minimum standards to describe the actions of employees who draw attention to bad practice where they work.Employees may whistle blow within their organisation or,if they do not have confidence in their employer or fear detriment as a result,may disclose their concerns to others. Good care service providers create an atmosphere where their staff feel able to report bad practice.Such reports are thoroughly investigated and addressed within the service.A good whistle blowing policy can be an important tool in creating this atmosphere.Robust procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) ensure the safety and protection of residents. With Care Homes for Older People Page 22 of 35 Evidence: this in mind the manager needs to look at the whistle blowing procedures and re enforce through supervision and team meetings that if staff were to whistle blow they would not fear detriment as a result. The AQAA completed by the manager in June 2009 told us that they had a whistle blowing procedure in place and this was along with all the policies and procedures for the home were reviewed on 3rd May 2009. We were made aware of two safeguarding issues and the steps taken by the manager to safeguard a resident. The local authority should be contacted to report any allegations of potential harm or abuse and this wasnt completed by the manager at the time the abuse was alleged.The manager has been reminded of the correct procedures to follow and was clear on the action to be taken in future.The manager had failed to notify us about this matter in a timely manner as required by The Care Homes Regulations.We contacted the local authority and they were looking into these matters. At the time of writing this report we had not heard the outcome of these investigations by the local authority. The manager has policies and procedures for responding to allegations or suspicions of abuse concerning the people living in the home. Some staff had received training in how to recognise the signs and symptoms of abuse and what action they must take if a person was suspected of being at risk of harm. This needs to be extended so that all staff have this training. We also advise that the manager attends the local authority safeguarding training as a refresher to the policies and procedures. The manager told us, All service users have a copy of the complaints procedure within the service user guide in their room.The manager responds immediately to any concerns raised by service users and is available at any time of the day. If she is not in the building senior staff can contact her on her mobile at any time.The Manager speaks to service users and relatives regularly so is aware of any problems arising. All residents who completed a comment card said there was someone they can speak to informally if they are not happy and they know how to make a formal complaint. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and homely environment that meets their needs. Evidence: The manager told us in the AQAA, The small maintenance work around the home is not being completed quickly enough. The manager has agreed with the owner that the maintenance man from the other home should attend one day each week on a set day . Anything that is an emergency will be dealt with as before on the same day. Two residents in their comment cards indicated that the home wasalways fresh and clean.A member of staff told us,the home is always clean and tidy. A relative told us,Very comfortable. The premises were clean throughout and in the main well maintained. There are two combined lounge dining rooms where people could choose to spend their time. A number of residents choose to spend the day in there bedroom and said they had all the comforts of home. The lounges had been redecorated since we last visited and new carpets and lounge chairs purchased.These rooms looked bright and fresh. The communal areas were comfortable with a homely feel to them. Care Homes for Older People Page 24 of 35 Evidence: The manager told us that residents like to sit in the conservatory and in warmer weather have the doors open which leads onto the car park. The roof in the conservatory has in the past been painted on the outside;in an effort to protect residents from the heat of the sun. The manager told us that attempts have been made to remove the paint as it is chipping and peeling away. However, this couldnt be achieved. The appearance of the roof detracts from the comfort the manager is trying to promote within the house. It really does needs some attention. The carpets in the corridors are showing the signs of wear and tear and age and are faded and in are places buckled through deep cleansing. The appearance of the carpets detract from the comfort and facilities available elsewhere in the home.They need replacement to promote the safety and comfort of residents and staff. Some bathrooms/toilets need to be redecorated also to further promote the appearance of these rooms.In one of the toilets we looked in there was a hole in the ceiling and the walls really needed redecoration.A ceiling tile in the linen cupboard was missing and needs to be replaced. Several bedrooms were seen and these were clean and well maintained.All the ones we looked at had been personalized with residents belongings.Some of the bedrooms are quite big and the residents have made a separate section for sitting and sleeping.One resident told us it was like living in a flat. As we described earlier in this report a number of residents choose to spend the majority of their day in their bedrooms. The house has some lovely views of the surrounding countryside.A number of the windows within residents bedrooms were misted so residents would not be able to see out. To ensure the house is maintained to a good standard the misted double glazed windows within residents bedrooms need to be replaced. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of appropriately recruited staff, promotes the independence and well being of residents. Evidence: At the time of our visit the staff rota showed that between 8:00am and 5:00pm there were three care staff supporting residents needs. After 5.00pm the staffing ratio is reduced to two. In addition, the manager was available during the day.Between 10:00pm and 8:00am, two night staff were on duty. Staff were observed spending time talking with residents and the support they gave was unhurried.Comments from residents and relatives were positive about the staff team in terms of their work, attitude and values in supporting residents. A member of staff told us, All training needs are met.A further staff member said, everyone goes out of their way for each other and also especially the residents. We were also told, I have started my role as a care assistant. I have had my induction and then as I have got into my role I have been on courses and have found that my manager and all the seniors, care assistants have been absolutely fantastic. I feel so at ease that you can approach anybody with any concerns, issues and can talk to them and even if you have anything to say it is always confidential and wont be Care Homes for Older People Page 26 of 35 Evidence: taken further. I have been treated as part of a team and cannot praise everybody for there help, support and patience that they have given me. A relative told us,Staff are pleasant.Visitors are made to feel welcome. A further relative told us, the home is always short staffed and care seems to be rushed sometimes. Staff talked about residents in a respectful manner and they had a good understanding of their needs and how these should be met. The NVQ in care is a nationally recognised qualification which is intended to increase the knowledge and skills of carers so that they may undertake their caring duties more competently.We were told that six staff have obtained NVQ 2, four have NVQ 3 and the manager has NVQ 4 and the registered managers award. We looked at a sample of staff files relating to recently recruited staff, in connection with the process for vetting potential staff members. These demonstrated that appropriate references and criminal records bureau disclosures had been obtained before staff commenced employment. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and practices of the home provided a safe environment for people to live but there was no system in place to monitor the quality of the service people received. Evidence: Manager holds NVQ 3 and 4 in care, has obtained the registered managers award(RMA) and has 20 years experience in elderly care.She has been in post for over 18 months and we were told that she had made necessary changes to improve the standard of care and the health, safety and welfare of the service users. A member of staff told us,the manager, owner, senior staff and care assistants all work as part of a team.And added,It is a very caring nursing home and we can approach any of the staff and managers whenever we have issues, problems concerns or for general advice. The manager told us that the owner completes Regulation 26 visits each month, which Care Homes for Older People Page 28 of 35 Evidence: means the owner consults with people who use the service and staff about service provision and standards, look at records and discuss the running of the home with the manager. A relative told us managers are approachable and easily contacted if needed. Residents have the opportunity to come together in a formal residents meeting every three months or so. We were told that family members or friends are also invited to these meetings.These meetings looked at things such as leisure and social activities, meals and any other issue that residents wanted to raise about the home. To find out how residents feel about the quality of the service they receive and to ensure that the staff and management working practices are in line with current guidance, regulation and legislation,a quality assurance system by means of sending out periodic comment cards needs to be developed. Information provided by the manager confirmed the range of policies and procedures they have and that these had all been reviewed on 3rd May 2009.The manager was aware of new legislation relating to the Deprivation Of Liberty safeguarding procedures and told us she had not needed to make any applications. Residents were helped and supported with managing their personal monies through either relatives or the local authority being the appointee and looking after residents financial affairs. The Local Authority Environmental Health and Health and Safety department had made a visit to the home since the previous inspection. They had highlighted improvements that needed to be made.We were told that these had been addressed. Information provided by the manager stated that all servicing of gas and electrical items and other equipment, such as hoists had been carried out.Checks to fire equipment were being carried out on a weekly basis.Cleaning schedules for the kitchen were in place. Temperatures for refrigeration and hot water were being recorded. We were told in the AQAA that equipment in the home was serviced and tested as recommended by the manufacturer. We were also told that there was a comprehensive health and safety policy and that staff had received training in the prevention and control of infection. We were told since our last visit to comply with requirements the manager has taken Care Homes for Older People Page 29 of 35 Evidence: advice from the local environmental health officer with regard to the smoke free legislation and how this affects the home. We were also told by the manager that as required on the last inspection the owner has taken advice from the local fire officer regard to fitting an automatic door closure on the doors of residents who wish their doors to be left open and have also now included in the fire risk assessment and individual risk assessments the risk to residents in designated smoking rooms. We received mixed responses about staff meeting with their manager regularly to discuss there work and development and to arrange any training needs. One staff member in response to our question does your manager give you enough support and meet you to discuss how you are working , said, she used to but for some reason now doesnt.Other staff said there manager met with them often or regularly. We looked at the records in some of the staff files which recorded supervision sessions. One member of staff had a recorded meeting with the manager in February 2009 and nothing further. A second staff member had a record of a meeting in 2008. A new member of staff who started work in August 2008 had two sessions in February and June 2009. For another new member of staff there was no record of any supervision meetings. They had worked at Stansfield Hall since July 2009. Staff should meet individually with their line manager on a regular formal basis to discuss their career development, the philosophy of the home and their training needs. This would assist staff in their development and identify any training needs. Care Homes for Older People Page 30 of 35 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 31 of 35 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 7 Care plans must fully reflect residents needs in all aspects of their life and it is recommended that the support provided is based on a more person centred approach to how the resident themselves wants to be supported. Improvements to the way in which the dates weights were being recorded.eg. May 2009 needs to be amended.The actual day on which the weight is taken should be recorded,to accurately alert staff to the exact period of significant weight loss or gain.We also recommend that the directions in the care plan to weigh residents at the regularity indicated is followed so residents can be confident that staff will regularly monitor their wellbeing in relation to nutrition and weight. Residents general and specific health needs and interventions need to be fully recorded in the care file. Residents and/or their representative should be fully involved in the care planning process and that this is clearly evidenced by signatures in the care plan. 2 9 The manager needs to make sure when handwritten Page 32 of 35 Care Homes for Older People 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 medication is indicated in the medication administration records that this is signed by the person making the entry and signed as verified by a second member of staff to confirm the accuracy of this record. When controlled drugs are prescribed to residents these must be double signed in the medication administration records as confirmation of administration in line with controlled drugs administration procedures. When medication has limited shelf life indicate on the box and bottle the date the medication was opened as an additional check that the medication is within date. 3 12 Liaise with residents and their relatives or friends to find out what activities they would like to take part in and provide these routinely.Ensure that activities undertaken are recorded to demonstrate what is available and who has taken part. Revise the menus so there is some variety to the meals each day and the meals are not repetitious. Maintain an individual record of all food served to residents in such detail that anyone looking at the record could see if the diet is sufficient in terms of nutrition. Provide residents with a menu,in the dining room for example,that they can see easily and can refer to which tells them what they are having for their meals on the day. 5 18 The manager should ensure that the Commission is notified promptly of incidents affecting the welfare and safety of people living in the home. This will ensure that the wellbeing of residents can be monitored. The manager needs to arrange for all staff to attend protection of vulnerable adults training so they have the knowledge to recognise signs and symptoms of potential abuse. The manager needs to look at the whistle blowing procedures and re enforce through supervision and team meetings that if staff were to whistle blow they would not fear detriment as a result. 4 15 Care Homes for Older People Page 33 of 35 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 It is strongly recommended that the manager attends the local authority safeguarding training as a refresher to the policies and procedures. 6 19 Replace the carpets in the corridor to promote the respect,comfort and safety of residents and staff. Ensure the house is maintained to a good standard replace the misted double glazed windows within residents bedrooms. To promote the respect of residents remedy the problems with the roof in the conservatory to improve the appearance of the room. 7 33 To find out how residents feel about the quality of the service they receive and to ensure that the staff and management working practices are in line with current guidance,regulation and legislation,a quality assurance system by means of sending out periodic comment cards needs to be developed. Provide all staff with one to one supervision with their line manager at a minimum of six times a year to assist staff in their development and identify any training needs. 8 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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