Care Home: Stonebridge Nursing Home

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• The Lodge Nursing Home
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• Sunnycroft
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What the care home does well Stonebridge have an excellent management team the owners and manager are committed and enthusiastic in promoting the standards of care for all the people living in the home. The health and safety of the people who use the service are protected by the policies and procedures in the home. The environment has been changed and refurbished to provide a living area specifically designed and equipped for the individuals assessed health care needs. The home have developed person centred care so each person is treated as an individual with dignity and respect. Each person has their own care plan so that all staff know how to Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 support them and deliver the care to meet their assessed needs and in a way which the person is content with. Each person has their own bedroom, which have been decorated in different styles and colours, to ensure that no two are the same, and residents have the choice of colour if they wish. They encourage and assist in the personalisation of each room. This gives people using the home their personal and private space. People who live there do the activities they enjoy doing and that help them to develop skills and meet their needs this is all part of person centred care. The staff told us that the home is committed to them receiving training, and that they have the skills and knowledge to meet the care needs of the people. The home has a thorough recruitment procedure in place so that only people suitable to work with vulnerable people are employed. People living at the home receive a well-balanced and varied diet that meets their nutritional and dietary needs. What has improved since the last inspection? Since the last key inspection in 2007 the home has undergone major environmental changes and refurbishment to provide a more suited environment that effectively meets the specific needs of the people who live there. There has been significant investment in the gardens, resulting in the development of some unique sensory areas that stimulate the interest of people who have memory loss problems. The quality of design is highly commended. The home has invested in upgrading bathing facilities with assisted technology that enables staff to meet the high dependency needs of people with complex disabilities. There is a quality assurance system that asks what the people living there think about the home so that their views make a difference to the service provided. The outcomes from the questionnaires used are analysed and used to further enhance and develop the quality of service provision. What the care home could do better: The quality of service has improved from good to excellent and it is therefore difficult to identify any areas that require further development. With their pro active approach, they have met and exceeded the national minimum standards as a result no requirements or recommendations have been made following this inspection. The Annual Quality Assurance Assessment from the service told us of the plans for further improvement in the next 12 months.Stonebridge Nursing HomeDS0000068267.V376417.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Stonebridge Nursing Home 180 Birchfield Road Headless Cross Redditch Worcs B97 4NA Lead Inspector Chris Potter Key Unannounced Inspection 8th July 2009 09:00 Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 2 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 Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonebridge Nursing Home Address 180 Birchfield Road Headless Cross Redditch Worcs B97 4NA 01527 542128 01527 547069 Julia@stonebridgenursinghome.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alexandra House Care Services Ltd Julia Marie Foley Care Home 52 Category(ies) of Dementia (52), Mental disorder, excluding registration, with number learning disability or dementia (52) of places Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide personal care (including nursing care) to service users of both sexes whose primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 52 Dementia (DE) 52 The maximum number of service users to be accommodated is 52. 2. Date of last inspection 19th January 2007 Brief Description of the Service: Stonebridge Nursing Home is registered to accommodate a maximum of 52 people suffering with a dementia type illness and enduring mental health problems. Peoples health care needs are assessed as requiring 24 hour nursing care. Stonebridge Nursing Home has undergone huge reconfiguration and refurbishment since January 2008 by the current owners. Building work is completed and the home can provide accommodation for people in five shared bedrooms and 42 single bedrooms some with en suite facilities. The Home is located in a residential area of Redditch, which is convenient for visitors using public transport. The home provides parking facilities for visitors. Other areas of the home for people include three separate living areas, and each area has been designed to meet the specific needs of the people using that space. The owners have refurbished bathing facilities providing specialist baths and showers with fixed ceiling hoists so that the home can accommodate peoples physical disabilities. The home has a passenger lift to enable people with physical disabilities to access all areas of the home. The home has landscaped gardens for each area of the home so people can access to the outdoors. The gardens have raised flower beds colour themes, garden furniture and memorabilia including an old red telephone box. The home is owned by Alexandra House Care Services Limited, and the providers Mr and Mrs Edmunds are at the home daily providing guidance and support for the home. The registered manager is Julia Foley, who is a first level registered mental nurse with additional qualifications and many years experience. Current fee rates for living at the home are available on request from the home direct. In the reception area there are leaflets of interest for anyone who wishes to read them and a copy of the Care Quality Commission inspection report is available on request for people to read if they wish to. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We visited the service during the day on the 8th July 2009. The last key inspection was the 7th July 2009. We spent time observing daily life, and we met with people who use the service. We spoke to the owners, manager and staff who were present throughout the inspection. We looked at care files and records completed by the service which must be kept by the home to show that it is being run properly. Before we visited the service we looked at the information we had received since the last key inspection. This included an annual service review, notifications of incidents sent to us by the service, surveys sent to us by people using the service, other professionals and staff working at the home. The Annual Quality Assurance Assessment (AQAA) is completed by the manager and should tell us how well the home think they are performing and should give us some information about the home, staff and people who live there, improvements and plans for improvement which we would take into consideration. Some people who live at the home, the owners, manager and various grades of staff were spoken to during the inspection. Some people living there were unable to verbally communicate their views about the home due to their health care needs. Time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: Stonebridge have an excellent management team the owners and manager are committed and enthusiastic in promoting the standards of care for all the people living in the home. The health and safety of the people who use the service are protected by the policies and procedures in the home. The environment has been changed and refurbished to provide a living area specifically designed and equipped for the individuals assessed health care needs. The home have developed person centred care so each person is treated as an individual with dignity and respect. Each person has their own care plan so that all staff know how to Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 6 support them and deliver the care to meet their assessed needs and in a way which the person is content with. Each person has their own bedroom, which have been decorated in different styles and colours, to ensure that no two are the same, and residents have the choice of colour if they wish. They encourage and assist in the personalisation of each room. This gives people using the home their personal and private space. People who live there do the activities they enjoy doing and that help them to develop skills and meet their needs this is all part of person centred care. The staff told us that the home is committed to them receiving training, and that they have the skills and knowledge to meet the care needs of the people. The home has a thorough recruitment procedure in place so that only people suitable to work with vulnerable people are employed. People living at the home receive a well-balanced and varied diet that meets their nutritional and dietary needs. What has improved since the last inspection? What they could do better: The quality of service has improved from good to excellent and it is therefore difficult to identify any areas that require further development. With their pro active approach, they have met and exceeded the national minimum standards as a result no requirements or recommendations have been made following this inspection. The Annual Quality Assurance Assessment from the service told us of the plans for further improvement in the next 12 months. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 7 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. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 and 4 People using the 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 provided with sufficient information about the home to assist them with their choice of home. EVIDENCE: Stonebridge provide potential people with an information pack when they enquire about a suitable place and the homes facilities. This pack includes the service user guide with photographs of the home and garden. It provides details about advocacy services, and a copy of the homes terms and conditions. This information assists people to decide whether they wish to live at Stonebridge Nursing Home. Given the health needs of the people living in the home this is usually done on their behalf by relatives and friends. People are invited to visit the home prior to making their choice and where possible a trial visit is arranged for the person. Since the last key inspection the home has updated their pre admission assessment. This is a comprehensive assessment which provides the home with sufficient information about the individuals mental and physical health care needs. This assists them in making appropriate arrangements prior to the person being admitted to the home to ensure that Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 10 there assessed needs are met. We looked at the pre admission assessments for three people who had recently moved into the home. The assessments were very detailed and provided a good insight into the persons mental and health care needs prioritising the information using a level of risk calculation. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. The Annual Quality Assurance Assessment received from the home in June 2009 told us clearly how they were meeting these standards, and how they plan to improve by improving the written information in line with the web site which they have set up recently. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 People using the 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 people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: We looked at three peoples care records in detail and these showed that each person had an individual plan of care developed from the comprehensive pre admission assessment. They showed that personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons records. The record provided clear information about the individuals health care needs and the reason for admission into Stonebridge. Where possible the family have provided a life history for the individual which advises staff of dietary likes and dislikes, favourite past times, what time they prefer to go to bed etc. This assists the staff in getting to know the individual. For example a person’s care plan stated to monitor their dietary intake, and the home had completed Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 12 nutritional assessments, weights monitoring and were maintaining a record of all diet and fluids. We spoke to the resident who confirmed that they were receiving nutritional supplements. The manager told us that people are encouraged to be involved with the planning and reviewing of their care, and we saw in the records that either the person or their relatives had signed to say that they agreed with the care plan. We are very happy with the care Staff always give the support or care that we expected or agreed. The staff told us that they have the right skills and experience to look after people living in the home. The care records showed that the home was reviewing and updating them at least monthly and maintaining detailed daily records. The home has introduced the named nurse for the individuals and a photograph of the named nurse is displayed in the persons bedrooms to assist visitors to the home in accessing information. Records included individual risk assessments. These detailed how staff are to support the individual to be as independent as possible whilst minimising any risks to their health, safety and welfare. Risk assessments had been regularly reviewed and updated. Staff told us that they were provided with sufficient information about the people and were kept updated with any changes in their care. Staff demonstrated good knowledge and understanding of the individuals care needs. They also confirmed that they were given time to look after the residents and the carers confirmed that they were able to read the care records for additional information. Peoples privacy was seen to be maintained by the staff, they were knocking on doors before entering and speaking to people courteously The Annual Quality Assurance Assessment received from the home prior to the inspection told us that they have improved in the last 12 months: Care planning and documentation generally has improved; audit practices have proved very effective and will continue. We have improved dramatically the standard of our induction training and consequently staff recruitment and retention has improved, ensuring continuity of care. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards 12,13,14,15,16 and 17 People using the 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 have the opportunities to be involved and stimulated by a wide range of interesting activities and access the gardens. The dietary needs of the residents are well catered for with a balanced diet and a varied selection of foods. EVIDENCE: Through the person centred care approach helps the staff to support people living in the home to live the life they chose. This involves providing engagement for the individual. Staff do not wear uniforms and the manager told us that this has reduced the barrier between the residents, however some visitors find this confusing. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 14 The home welcomes visitors, and refreshments are available for them. Information about the individuals family and friends is included in the persons care record. Throughout the day people were observed walking around the home and gardens in a contented manner. The people with more complex needs were being assisted with intense supervision from the staff, reading, playing games, listening to music. The home has specifically designed the areas so as where people are there are a variety of things for them to do and look at to stimulate their minds. For example there are various items around the home for people to examine. The current theme for the home is a Cruise, so various areas of the home show the destinations, parts of the boat, and countries being visited. In the reception area of the home, they have a large digital photo frame with pictures of people participating in various activities. The gardens have been landscaped and provide sensory areas for people to use. People were seen using the garden and some residents chose to have their lunch sitting outside. We were told by the staff that when a new person moves into the home they establish their preferences about what time they get up and go to bed, if they prefer male or female carers and all this information is respected. The home respects individual choices for religion and accesses external sources to ensure that their religious needs are met. People were appropriately dressed for the temperature of the home, age and gender. Information is recorded in the care records regarding the persons preferences with clothes and appearance. The home provides varied well balanced meals for the residents and caters for cultural and dietary needs. We were told by the residents that the food was very good. The menu is displayed in the lounge areas and people are provided with a choice of meals the day before. The breakfasts vary from full cooked breakfast to cereals and toast, lunch on the day was roast pork, but we saw people with salads, sandwiches who requested different to the menu. People were being assisted with their meals in a sensitive manner. We saw the lunch being served in the pleasant dining areas, in a relaxed manner. The food appeared appetising, and the people told us that they were enjoying their meal. Some people were enjoying wine with their meal. We were told that they are hoping to introduce a system for people with short term memory loss to chose their on the day by looking and deciding at the choices on the plate available. The home enjoys food themed events to go with the cruise. In addition to the meals we saw snacks available in the home for the people to eat, and drinks were within reach. The Annual Quality Assurance Assessment received from the home told us that they are looking to improve in the next 12 months by: Develop from the choices given at mealtimes to the presentation of the choices at the table; we know that people, even if they can not name or recognise food, will know which they would prefer to eat if they can see it and smell it before they choose. We also need to work more on the hour or so before meals, using objects or activities to prompt discussion about food to stimulate appetite and interest. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the personal care and health needs of individuals are met so ensuring their health and well being. The people living there get their prescribed medication at the right time so their health needs are met. EVIDENCE: Staff told us that the home is committed to training to ensure that they have understanding about the individuals healthcare needs. This includes Diabetes, and other chronic healthcare conditions. The manager and care director are currently completing a diploma in dementia and pass on the good care practises to all staff. If the home admit a person with a rare health condition they research information to assist them in ensuring the persons needs are met and staff understand the condition. Infection control practises were good, hand gel is located in the entrance to the home and all staff carry a hand gel cleanser with them. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 16 As part of the refurbishment the home has invested in more suitable equipment to help staff meet the assessed needs of the people living there. In the bathrooms ceiling hoists have been fitted which assist staff in manoeuvring people into the bath and shower. Comments received from the other healthcare professionals relatives, staff compliment the home in meeting the physical and emotional needs of the individuals. Records sampled showed that each person is registered with a local doctor, who they are supported to visit if they are unwell. Where appropriate health professionals are involved in the care of individuals. The outcome of any health appointments are recorded and records showed that staff follow the advice given to ensure individual’s health and well being. The home has good procedures in place for the management of medication. Medication is stored safely, and accurate record keeping enables the home to know which medications have been given and at what times. We looked at three peoples medication records and they had been completed by the nurse who administered the medication. The manager completes a monthly audit of the medication system and these records were looked at and support that the nurses are adhering to the homes medication policy. The home has good links with the local pharmacy and recently were audited by the Primary Care Trust. Medication requiring refrigeration was stored in the fridge and the nurses monitor and record the fridge temperatures daily. Some people are prescribed medication for as and when required (PRN). Staff told us clearly when they would administer the PRN for named people. It was recommended that a care plan is developed for the PRN medication to ensure that if agency staff were covering the home are aware at what point to administer the PRN medication. The home is in the process of providing a medication storage cabinet in each persons bedroom. To further promote person centred care for people living in the home. Copies of all prescriptions are kept so that it can be tracked what each person has been prescribed and staff ensure this cross-references with the medication supplied for the individual. Nursing staff attend medication training to ensure they keep up to date with legislation and new medicines so that people get their prescribed medication to meet their health needs. The Annual Quality Assurance Assessment received from the home told us The Home has a full range of appropriate and well-maintained aids and adaptations. Residents are supported in accessing dentistry, chiropody and optical services, as well as the medical and pharmaceutical services of the NHS. The Home employs a clinical support nurse to support care practice in the care team, and a tissue viability specialist to assist in the audit of care and documentation, as well as to provide specialist training. Plans for improvement in the next 12 months include: To improve and consolidate wound audit documentation and to maintain a very low rate of pressure area damage. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 17 To ensure all newly recruited staff complete training on palliative care by the end of the year. To make progress in developing a support group / network for families. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the people living there feel their views are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: People using the service and relatives told us they were aware of the complaints procedure, including how to complain to the Care Quality Commission by way of information provided by the home, e.g. the service users guide and notices displayed in the homes reception area. Records demonstrated complaints are investigated by the Director of Nursing and manager, and responded to within given timescales. The records showed that the home have received two complaints in the last 12 months and details of the complaint and the investigation carried out and the outcome was recorded. The home are aware of the need to refer people to the adult protection process, and work closely with the authorities. The Annual Quality Assurance Assessment received from the home told us We have maintained our excellent record of complaints management. We have improved the training for new staff on complaints management, disciplinary procedures and the protection of vulnerable adults. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 19 From sampling records and talking to staff it was evident that some people can be challenging. All staff were clear about how to manage a situation if a person became aggressive. The management work to the principal of spending time looking at the causes of individual’s behaviour to see if anything can be done to improve their well being. For example by changing the layout of the home in smaller dedicated areas have assisted in reducing peoples anxieties. At the inspection everyone appeared contented, and their was a feeling of calm generally throughout the home. The management and staff have completed training in the Mental Capacity Act and how this affects the people living there. They have also completed the Deprivation of Liberties Safeguards training and provided guidance for people in the service users guide. Information is provided for people about advocacy services available for them to contact for assistance external to the home. All staff have completed training in adult protection and the prevention of abuse so they know how to protect the people living there from abuse, neglect and self-harm. Review of the current accident book showed no occurrences, or trends, in the nature and type of reported accidents, which may cause concern. The homes thorough approach to the prevention and management of incidents, such as falls, was evident through crosschecking with the individual documentation. These showed people recorded as having had falls, had all been risk assessed with regard to their mobility and potential for falling. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. EVIDENCE: The environment has been changed and refurbished to provide a living area specifically designed and equipped for the individuals assessed health care needs. Since the last key inspection in 2007 the home has undergone major environmental changes and refurbishment to provide a more suited environment that effectively meets the specific needs of the people who live there. There has been significant investment in the gardens, resulting in the development of some unique sensory areas that stimulate the interest of people who have memory loss problems. For equality purposes, the gardens are equipped with raised flower beds that Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 21 enable people who may have physical difficulties to engage in horticultural activities, while there are many items of garden furniture available that allow people to rest and appreciate the grounds. The focal points within the gardens capture and stimulate peoples interest. The gardens also provide a place where people using the service can relax and enjoy the tranquillity of, for example, a water fountain. The quality of design is highly commended. Internally, the home provides plenty of space within which people can walk around without feeling claustrophobic, while maximising independence. Family sized lounge/diners have been developed and equipped with large, flat-screen televisions which people can easily view. Although Stonebridge can accommodate up to 52 people, the design and layout of the home means that three, smaller living areas have been developed which are used individually to accommodate people with low, medium and high dependency care needs. By subdividing the home into separate areas, the home stops itself from becoming depersonalised through size. Indeed, the ethos within the home is to focus on being peoples home. During our visit, we noticed relaxing music being played, and residents seemed to be enjoying this, and were observed being in a state of wellbeing. Stonebridge clearly demonstrates that, although the environment is not the be all and end all in relation to person-centred care, it can, when planned right, help people to feel relaxed, comfortable and content - just as they may do in their own homes. There has been significant focus, effort and investment in developing Stonebridges environment to achieve excellent status. This achievement is more so commendable given the initial, stark environmental constraints the current owners were confronted with. The home has invested in upgrading bathing facilities with assisted technology that enables staff to meet the high dependency needs of people with complex disabilities. This area of investment results in peoples choices and lifestyle preferences being honoured and maintained. Each person has their own bedroom, which has been decorated in different styles and colours, to ensure that no two are the same, and residents have the choice of their own colour scheme, if they so wish, to promote choice and maximise individuality. They encourage and assist in the personalisation of each room. This gives people using the home their personal and private space. The Annual Quality Assurance Assessment received from the home told us how they have improved in the last 12 months; We have made huge changes to both structure and style; most importantly of all we have created four garden areas to which residents have free access, and which have already made a real contribution to the quality of life here. While everyone using a garden can be observed discreetly from the main building, residents can experience a real sense of freedom and choice – in a garden specifically designed to meet the needs of that group. We have continued to learn more about making the environment, as well as the care, person-centred. We have focused our energies and finances on the areas that our residents and visitors have told us were most important to them – e.g. locks were not a priority for anyone who took part in the surveys and have therefore not been put in place. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,34,35 and 36 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident staff numbers on duty, and skill-mix, are sufficient to meet their assessed care needs, and that recruitment and employment practices are consistent with safeguarding them from abuse. EVIDENCE: Throughout the day good interaction was observed between members of the staff team, and between staff and the people living there. This helped to give the home a good, relaxed atmosphere within which to live. Staff said that they are working as a team and they now get the training they need so they know how to support the people living there. Management have invested considerably in staff development - providing each new employee with five supernumerary days within which they receive the training, development and support they require to help them support people with their life activities. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 23 More than 50 of the care staff employed within the home hold (at least) an NVQ (National Vocational Qualification) level 2 in Care, and all staff have received training in person-centred, dementia and mental health care. This level of investment is commendable, and has resulted in the delivery of true person-centred care to people using the service. In their Annual Quality Assurance Assessment, the home said; we continue to prioritise, and invest heavily in, training. We have a dedicated training room which is well-equipped and accessible to all staff. The period of induction exceeds the required standard and, though costly, has contributed to the retention of quality staff and to a massive reduction in the use of agency staff. All staff are given copies of personal care policies and procedures, and have the support of a clinical support nurse, whose primary role is to monitor and develop care practice standards. In addition to the investment placed in staff training, the numbers of staff employed is of worthy note. During the morning period, the home was staffed by two registered nurses and eleven carers. In addition, the homes manager was on-site and ancillary staff (catering and domestic staff) also provided service support. The manager did inform us that the weekend periods posed the biggest staffing problem, but the home resolves possible staffing shortfalls through the use of agency staff. The homes recruitment process is robust and appropriate measures are taken to ensure that only people who are suitable to work with vulnerable people are employed to work at the home. Written references are taken up and an enhanced criminal records bureau check (CRB) is undertaken before people are allowed to work in the home. The opinions of people living at the home are included within the staff selection process. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,39,40,42 and 43 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home and their views are considered. The health, safety and welfare of the people living there is promoted and protected so ensuring their safety and well being. EVIDENCE: The Nurse Manager is an experienced and proactive RMN (Registered Mental Nurse), who has successfully managed the home through numerous changes and challenges. She is aware of clinical, managerial and financial responsibilities and shares a clear vision for the future of the service with the Directors. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 25 The manager completes monthly audits in medication, wound care, infection control and accidents to assist in monitoring the homes performance, which also ensures staff are following correct procedures. Feedback is encouraged from the people using the service, relatives and professionals using the service. The comments from the doctors covering the home have been complimentary. Expressions of appreciation by relatives regarding the care of their relatives were seen. These included comments such as; We would like to say thank you to you all for taking care of our (relative), you made her very comfortable and she was happy to be with you. The home does not take responsibility for residents monies. Instead, invoices are sent to the nominated person for payment. The home employs a maintenance operative who has a well organised system for ensuring that the safety checks are completed. The fire records requested were available and up to date. All staff have supervision six times a year, followed by an annual appraisal. The Annual Quality Assurance Assessment received from the home tells us; The manager has excellent “people skills” and has excellent working relationships with all professional agencies. She maintains her on-going personal development and education and is currently taking part, along with the Directors, in a year-long diploma level course in person-centred care. Both the Nurse Manager and Director of Nursing carry out spot checks on all areas of the Home, including unannounced night inspections. The outcomes of these are always reported back to the CQC, along with full details of any disciplinary action that has been prompted. The manager’s role is supported by the Director of Nursing, who leads on service development and training, and also by the Deputy Manager. The management team works hard to ensure that the Home operates in an honest and transparent manner at all times, valuing and acting on the opinions and feelings of both residents and staff. Provision has been made for possible emergencies within the Business Continuity Plan. Efficient system for managing residents’ finances; no staff act as appointee or carry any responsibility for any element of individual finance except the safe storage and recording of pocket money. The Home acknowledges where there are changes still to be made and proactively manages any issues; its management have a style and commitment which exceeds requirements and which we believe demonstrates an “excellent” outcome for residents. Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 4 26 X 27 4 28 X 29 3 30 4 STAFFING Standard No Score 31 4 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 4 3 4 x 3 4 Version 5.2 Page 27 Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stonebridge Nursing Home DS0000068267.V376417.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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