Care Home: Stratford Bentley Nursing Home

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What the care home does well Anyone wishing to move to the home has their needs assessed before they move in, to ensure that their needs can be met properly. Visitors are welcomed at the home and a flexible visiting policy is in place to make it easier for people to stay in touch with friends and relatives. The staff are friendly and respectful and there are enough on duty to meet the needs of the current people at the home in a manner that respects their dignity. Commenting in a questionnaire, on what the home does well, one person told us ‘The home do very well with everything, I am very happy at the home’. The people at the home are being provided with opportunities to get out and about more in the local community. This is particularly important for supporting people’s good mental health. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. People said, “the food I get, I like”, “I have enough to eat all of the time but you can ask for more”, “the food is good, there is too much of it”. The home has a good system in place with regard to the appointment of staff. Records seen show that references are always obtained and staff are not appointed prior to safety checks being undertaken. The home’s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. One person commented, ‘I have no complaints, staff would sort them out if needed I am sure’, ‘If I had any worries I would speak to staff’. Staff are well trained to provide them with the skills they need to carry out their roles in a safe manner. Accommodation is safe, clean, well maintained and comfortable. The manager is aware of maintenance issues, which are addressed promptly. One person said, “I like my room, it is always clean”. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said ‘staff treat you with respect’, ‘staff come quickly when they are called most of the time’, ‘staff are all kind and respectful, they are never rude, never rush you and I have no problems’. What has improved since the last inspection? The four requirements made at the last inspection have been met. This should mean people are better protected through improved medication management processes, people are better protected by good recruitment practices and good care practices in the use of bed rails. Improved arrangements are in place to help ensure meal times are a positive experience for all residents. Care plans and risk assessment have been reviewed to provide more up to date information on the needs of the people who live there. What the care home could do better: Two requirements have been made at this visit. The home must ensure that all staff are aware of the lines of accountability in relation to safeguarding. This will help ensure that areas of concerns are addressed appropriately in line with the home’s policies and procedures in safeguarding people. Regulation 26 visits must be carried out at least once a month by a registered provider or another appropriate person of the organisation who is not directly concerned with the conduct of the care home. This is to inspect the premises of the care home, speak with residents at the home and with permission their representatives, form an opinion of the standard of care provided in the care home; and prepare a written report on the conduct of the care home. Four recommendations have been made at this visit: People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective.Stratford Bentley Nursing HomeDS0000073290.V378656.R01.S.doc Version 5.2 Further improvements need to be made in the management of people’s medication to ensure storage in compliance with product license to maintain their stability and ensure sufficient supplies to ensure medication is administered as prescribed. Key inspection report CARE HOMES FOR OLDER PEOPLE Stratford Bentley Nursing Home New Street Saffron meadow Stratford on Avon Warwickshire CV37 6GD Lead Inspector Julie McGarry Key Unannounced Inspection 9th December 2009 09:00 DS0000073290.V378656.R01.S.do c Version 5.3 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 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. Stratford Bentley Nursing Home DS0000073290.V378656.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 Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratford Bentley Nursing Home Address New Street Saffron meadow Stratford on Avon Warwickshire CV37 6GD 01789414078 01789292270 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) Bentley House Ltd Lucy Carolyne Burr Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 30 The maximum number of service users to be accommodated is 30. 2. Date of last inspection 26th January 2009 Brief Description of the Service: The Stratford Bentley is a 30-bedded purpose-built, single storey care home registered to provide nursing care and accommodation for older people. There are 22 single rooms and 4 double rooms, all with wash hand basins and 10 with en-suite toilets. All rooms have French windows leading to landscaped gardens. The home is situated in a quiet cul-de-sac, yet close to the town centre of Stratford-on-Avon. There are regular buses into town. The home has three lounges and a dining room. It also benefits from a hairdressing salon and mobile library. Service users are encouraged to bring items of furniture in with them and can furnish and redecorate their private room to their own taste if they wish. Limited car parking space is available at the front of the home. Written information for prospective residents stated the fees range between £119 and £178.57 per day. Additional charges are made for hairdressing, telephone and newspapers. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Stratford Bentley Nursing Home DS0000073290.V378656.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 two star; this means that people using the service receive good outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out this unannounced key inspection on one day. As the inspection was unannounced the registered owner, manager and staff did not know we were going. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations; incidents; previous inspections and reports. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. This form was completed by the manager and returned to us within the required timescales. Eight people at the home completed questionnaires as part of the inspection process and seven relatives also returned a questionnaire giving their views of the home. Six staff completed and returned questionnaires. At this key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were 29 people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 Page 6 Throughout this report, the Care Quality Commission will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the manager of Stratford Bentley House Nursing Home. What the service does well: Anyone wishing to move to the home has their needs assessed before they move in, to ensure that their needs can be met properly. Visitors are welcomed at the home and a flexible visiting policy is in place to make it easier for people to stay in touch with friends and relatives. The staff are friendly and respectful and there are enough on duty to meet the needs of the current people at the home in a manner that respects their dignity. Commenting in a questionnaire, on what the home does well, one person told us ‘The home do very well with everything, I am very happy at the home’. The people at the home are being provided with opportunities to get out and about more in the local community. This is particularly important for supporting people’s good mental health. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. People living in the home benefit from having a balanced and nutritious diet. Assistance to eat meals is provided in a sensitive way. Staff were aware of individual likes and dislikes. People said, “the food I get, I like”, “I have enough to eat all of the time but you can ask for more”, “the food is good, there is too much of it”. The home has a good system in place with regard to the appointment of staff. Records seen show that references are always obtained and staff are not appointed prior to safety checks being undertaken. The home’s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. One person commented, ‘I have no complaints, staff would sort them out if needed I am sure’, ‘If I had any worries I would speak to staff’. Staff are well trained to provide them with the skills they need to carry out their roles in a safe manner. Accommodation is safe, clean, well maintained and comfortable. The manager is aware of maintenance issues, which are addressed promptly. One person said, “I like my room, it is always clean”. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 Page 7 There are sufficient numbers of staff on duty to meet the needs of people living in the home. People said ‘staff treat you with respect’, ‘staff come quickly when they are called most of the time’, ‘staff are all kind and respectful, they are never rude, never rush you and I have no problems’. What has improved since the last inspection? What they could do better: Two requirements have been made at this visit. The home must ensure that all staff are aware of the lines of accountability in relation to safeguarding. This will help ensure that areas of concerns are addressed appropriately in line with the home’s policies and procedures in safeguarding people. Regulation 26 visits must be carried out at least once a month by a registered provider or another appropriate person of the organisation who is not directly concerned with the conduct of the care home. This is to inspect the premises of the care home, speak with residents at the home and with permission their representatives, form an opinion of the standard of care provided in the care home; and prepare a written report on the conduct of the care home. Four recommendations have been made at this visit: People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. Person centred care ensures people who use the service are at the centre of their care treatment and support by staff should be carried out whilst ensuring that everything that is done is based on what is important to that person from their own perspective. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.2 Page 8 Further improvements need to be made in the management of people’s medication to ensure storage in compliance with product license to maintain their stability and ensure sufficient supplies to ensure medication is administered as prescribed. 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. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): 2, 3 and 6. People who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. People and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. 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. EVIDENCE: In the AQAA the manager states ‘we provide a statement of purpose and philosophy of care within the service user’s guide. Each resident has a contract in place. All residents have an assessment before admission to make sure we can meet their needs. On admission a care plan is agreed with the resident/relative. A brochure is provided for prospective residents/their Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 11 relatives so they have the information they need to make an informed choice about where they live’. To find out whether this was the case, three people were ‘case tracked’ during this inspection. This involved looking at their care files, talking to them and their family where possible, and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. The files of two residents admitted since the last inspection were examined to assess the pre-admission assessment process. Sufficient information is obtained about people before the home confirms that they are able to meet their needs. Assessments provide details of peoples health and personal care needs which include information on physical and mental health history, mobility, nutrition and communication. The availability of this information helps to ensure that the specific care needs of each person can be identified and used to help complete a plan of care. Relatives and people who may wish to use this service are encouraged to visit have a look around and stay for the day before they decide if they would like to move in. The homes statement of purpose and service user guide were looked at as part of the inspection. Both documents clearly identify the levels of service that could be offered to specific user groups. They are detailed, informative and reflective of the actual service being provided. This ensures that people have enough information to make an informed choice about whether they would like to live at Stratford Bentley. Although the AQAA states each person is provide with a contract, we found the home does not routinely provide people with contracts of their stay there. The manager agreed that this would become standard practice. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): 7, 8, 9 and 10. People living in the home can be confident their health and personal care needs will be met. Improved medicine management better protects the people who use the service. 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. EVIDENCE: The AQAA completed by the manager tells us ‘residents have access to health care services to meet their needs and their health and well being is promoted. Care plans involve and are agreed by the resident/relative. Residents are encouraged to make decisions and have choices. Staff have access to training and are competent to do their job. Medication audits are carried out and administration, safe keeping and disposal of medication is compliant’. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 13 To find out whether this was the case, three people were ‘case tracked’ during this inspection. This involved looking at their care files, talking to them and their family where possible, and talking to the staff that care for them. Three people’s medication records were looked. People at the home were seen to rise at their own pace and receive unhurried support eat their breakfast of choice. Everyone was well groomed and dressed in appropriate good quality clothing indicating they are supported to maintain a good self image. It is evident that since the last inspection the home has made improvements in peoples care plans. Three peoples care plans were looked at. The care files covered all the main areas of care including medical history, personal care, pressure care, nutrition, continence and mobility. Risk assessments are also available for areas that may cause a problem such as falls, nutrition, and the development of broken skin due to prolonged pressure. The care plans are evaluated on a monthly basis or more often if needed and changes are made to the care plans if there is a change in the need of the person. Care plans were individually dated and signed so there was a clear audit trail of when the care needs had been identified. This is helpful to know particularly when care needs change so that it is possible to see if a persons health has improved or deteriorated. There was documentary evidence to demonstrate that some people or their representatives have been involved in planning care. Examples of good risk assessments were seen for the prevention of pressure sores, moving and handling, and for the prevention of falls. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. For example, one person was identified as having an increased risk of developing pressure sores; a care plan was developed to minimise the risk and included the use of a pressure relieving mattress. We saw this in use for the person. The condition of the persons skin was recorded in care plan evaluation sheets. This should promote the health and well being of this person. Records show that assessments are being carried out to help the home determine the appropriate use of bed rails for people. Consent forms were also seen to show that people/ their representatives are in agreement to the use of the rails. When bed rails are not appropriate, alternative approaches to ensure people’s safety are being used when in their beds. This meets the requirement set out at the last inspection. Despite improvements to care planning and risk management, further development of care plans is needed to ensure care planning is person centred, and assessments are carried out in line with current legislation and good Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 14 practice. For example, on the three care files viewed we found a mental capacity assessment carried out by the home. For each individual the assessment recorded that each person ‘lacks capacity’, however there is no recorded information to support this conclusion. This is not in line with current legislation. The Mental Capacity Act requires decision- specific assessments of capacity and should be carried out by an appropriate professional. When this was discussed with the manager we were assured that this method of determining people’s capacity to make decisions will no longer be used. We saw that care plans are not written from the point of view of the person using the service. A more person centred approach to care planning would help remind staff about the way the person would wish to be treated and how they would like their care to be delivered. Examination of the care files found people had regular access to GPs, opticians, chiropodists, and dentists. Discussions with people who live at the home and with two relatives confirm that appointments to meet peoples health needs are arranged and people supported to attend the appointments. People who use the service told us that staff always promote and respect their privacy and dignity. Staff were seen referring to people by their preferred form of address and we saw staff knocking on peoples doors and waiting for a response before they entered the room. Relatives spoken with told us that the manager and her staff keep the family informed of any changes and are always available to discuss care and other needs as they arise. They also told us that the care is excellent, ‘very good’ and that when they leave they are confident that all their relatives needs will be met. In a survey one relative told us ‘X is bed ridden and their hygiene and nursing care is well taken care of. Should X’s condition change, I am always made instantly aware. What I particularly like is trained staff always ask me how I am when I visit, staff are always helpful and cheerful’. Another relative told us ‘X is always treated with the utmost dignity and respect, X is always dressed in co-ordinated outfits, is clean and tidy.. I can not praise the staff enough’. Staff spoken with had a very good understanding of residents individual needs. Information provided by staff reflected that detailed in the care and risk assessment plans. Staff were able to inform us of training they have received that guides them in the way care is to be provided. All the staff spoken with were enthusiastic and had a positive attitude on promoting peoples independence. The systems for the management of medicines in the home were examined. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 15 For most medicines, a monitored dosage blister packed system is used. Medication is safely stored in locked trolleys and a medicines fridge is available with daily recordings of the temperature which is within recommended limits. Temperatures of medication stored outside of the fridge needs to be maintained to ensure all medicines are being stored at appropriate temperatures that complies with their product license. Qualified nursing staff who have received training in medication were knowledgeable about the medicines they were administering and knew where to get further information if required. The facility for storing controlled drugs (CD) is satisfactory. The contents of the controlled drug cabinet were audited against the controlled drug register and were correct. The home does not store excess medication. Arrangements are in place for the safe disposal of medicines that are no longer required. The medication of people involved in case tracking were audited and demonstrated that medicines had been accurately administered as prescribed. The home should ensure that sufficient supplies of medication are stored on the premises to ensure medication is administered as required and not missed due to insufficient supplies. Residents spoken to during the visit commented: We have very caring staff We have a lovely atmosphere here. Comments in surveys received from people who live at the home include: ‘The home does well with most things’. ‘The home do very well with everything, I am very happy at the home’. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): 12, 13, 14, 15. People living at the home are enabled to take part in activities they enjoy and go out in the wider community if they wish. Their daily choices and individual rights are respected and contact with their families is supported. People benefit from a variety of healthy and suitable meals they like. 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. EVIDENCE: The AQAA states ‘Residents find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural religious and recreational interests and needs. The individual rights and choice are promoted but consideration is also taken in helping them to make an informed choice’. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 17 To find out if this was the case, a discussion was held with the manager, staff, people who use the service and visitors to the home regarding recreational activities on offer. Information displayed at the home tells us that a number of activities are planned for November and December, namely coach trip to Burton on the water, Christmas poems/ stories with an external activities provider, Christmas party, ‘Pets as Therapy’, Christmas piano tunes and evening carol singing by pupils from a local school. We talked to the activities co-ordinator about the way she plans the programme of activities. It was evident that she had collected information about the interests of residents living in the home and tried to plan activities to match their preferences. One person told us in a survey ‘I am very happy at the home, there are always things to do e.g. activities, lovely garden to enjoy and residents to talk to’. Relatives and friends were seen coming and going from the home and appeared comfortable and welcomed. We spoke to one relative who told us she was always made welcome when visiting. Relatives spoken to commented positively on the care being provided. There is evidence that residents are able to maintain links with their families and friends. Also visits from members of the clergy are arranged at the home to enable people to practice their faith. We observed the lunchtime meal. There was meal choice of minced pork or salmon, accompanied by potatoes and vegetables. An appetising pudding was offered. Residents spoken with knew what to expect for lunch, and we observed people being asked what their choice was whilst we were sitting with them. There were positive comments made about the food at Stratford Bentley, such as there is plenty to eat and the food is very good, and we have an excellent chef. All of the meal was well presented, looked appetising and nourishing, and appropriate plates and cutlery were used. There are choices offered for each meal each day, with the addition of a soft diet and diabetic diet alternative when necessary. Residents spoken with confirmed that they are asked each day which of the choices they would like. Good practice at meal times was observed for people who require liquidised diets. The cook ensures food portions are liquidised separately to maintain the colour and appearance of the foods where possible. Staff were available to offer discreet timely and sensitive assistance to residents who needed help eating their meal. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 18 The most recent Food Hygiene Inspection visit in November 2009 awarded a Silver Standard for food safety and compliance. Comments made in surveys returned by relatives of people who live at the home include: ‘Friendly staff to residents and family’ Compared with other homes… Stratford Bentley food is very good, the presentation of pureed food that X has is excellent and smells very appepitizing’. ‘My mother would appreciate someone to help her get some daily exercise other than group sessions’. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People living in the home can be confident that their concerns will be listened to and acted upon. Processes are in place to help protect the vulnerable people who use this service from harm. 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. EVIDENCE: The AQAA states ‘People living in the home can be confident that their concerns will be listened to and acted upon. The residents feel safe and well supported. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm’. To find out if this is the case, we requested the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has a complaints policy; this is displayed in the home for the benefit of the people who use the service or visitors. People who live here and Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 20 relatives spoken were clear about who they would speak to should they have any concerns. The home has policies and procedures regarding adult protection which according to information received on the AQAA, were updated in August 2009. There has been one referral to the local authority in relation to the safeguarding of vulnerable adults. We are informed by the local authority that the home did not take immediate action by informing relevant authorities at the time of the incident. The home needs to ensure all concerns are acted upon in a timely way and in line with the home’s policies and procedures on safeguarding and in line with the local authority procedures. Since this referral, the home has devised an action plan to help minimise the risk of such an incident reoccurring, and have been provided with support by the local authority to help ensure all staff are aware of their responsibilities in responding to concerns and allegations. Four staff spoken with demonstrated a satisfactory understanding of the types of abuse they might encounter and to whom they should report any concerns. The home does not manage finances on behalf of the people who live there. The home has a good system in place with regard to the appointment of staff. Records seen show that references are always obtained and staff are not appointed prior to safety checks being undertaken. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): 19 and 26. People living in the home are provided with clean, homely and comfortable surroundings to live in. 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. EVIDENCE: The AQAA states ‘All residents have their own room and are encouraged to personalise it with small items of furniture, pictures and photographs etc. Any equipment needed to maximise their independence is sourced. The communal Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 22 areas overlook a courtyard garden. There are two lounges, a large reception area and dining room for communal use. Vases of flowers make areas more pleasant to sit in and relax. The home has an infection control policy and action plan in place. All staff have received training this year and work to the policy to reduce the risk of infection.’ There have been no changes to the home’s environment to that stated at the last inspection ‘the home provides single storey accommodation built around a central landscaped seating area which is accessible to people living in the home. Each of the bedrooms has a patio door overlooking pleasantly landscaped gardens. Communal areas are in the centre of the building with three units off the central area each housing bedrooms and bathrooms. There are 22 single rooms and 4 double rooms, all with wash hand basins and 10 with en-suite toilets.’ We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. Equipment is available to assist residents and staff in the delivery of personal care which includes assisted baths profiling beds accessible showers and moving and handling equipment including hoists. A range of pressure relieving equipment including specialised air mattresses are available. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub were available and were used by staff when handling soiled linen and when supporting people with personal care. The home has a modern well organised laundry room with dedicated laundry staff. Residents clothing looked well laundered and ironed. The kitchen was clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): 27, 28, 29, and 30. There are competent staff on duty to meet the needs of people living in the home. Procedures for employment, induction of new staff and ongoing training ensure that people who use this service are protected and safe. 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. EVIDENCE: The AQAA tells us ‘Residents needs are met by the numbers and skill mix of staff on duty. There is a recruitment and employment policy and procedure in place which is followed when recruiting staff. Staff have access to training and update their knowledge and are competent to do their job. Staff have regular supervision and annual appraisals. Regular staff meetings are held’. To check that this is the case, we looked at three staff files, spoke with staff and the manager. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 24 The manager told the inspector that the usual staffing complement planned in order to meet the needs of the 29 people currently living in the home is 8am to 2pm - Two RGN’s Five Carers; One carer provides support to the Close Care bungalows at the home. 2pm to 9pm - Two RGN’s Three Carers; 9pm to 8am - One RGN Two Carers (all waking night staff). Additional support is also provided by the activities co-ordinator which can free up carer time. There is sufficient ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. Three weeks of duty rota records looked at confirmed that the staffing complement mentioned above is planned for and generally met with the support of agency care staff and the manager occasionally covering nursing duties. Staff from the home continue to provide domiciliary care to some of the people living in six privately owned bungalows known as the close care complex which are adjacent to the home. Staff continue to provide personal care to one person and are visiting others to provide meals. The staffing rota indicates a named member of staff on duty who is to respond to calls from the bungalows, and is allocated forty five minutes each morning to provide support in the bungalows. Staff training is provided on an ongoing basis and training schedules viewed showed that most staff had completed statutory training such as moving and handling and food hygiene. Records read show that staff are appropriately supervised by the manager and are given opportunities to meet with her on a regular basis both individually and as a team. An annual appraisal is also held and staff personal development needs are identified. Induction training records were seen on the new staff members file as evidence that new staff are trained and supported in their jobs. Staff spoken with said that they felt the training they attended was good especially with regard to the specific needs of those who spend time at the home. Staff were aware of the homes policies and procedures. The AQAA informs us that 53 of permanent care staff have achieved a minimum of level two in the National Vocational Qualification (NVQ) in care. This meets the National Minimum Standard for 50 of staff to be qualified.This Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 25 should mean that staff should have the necessary skills and knowledge to provide a good standard of support to the people who live there. The AQAA states that 100 of permanent staff have received training in safe food handling. The personnel files of three recently recruited staff were examined and each contained evidence that satisfactory checks such as Criminal Record Bureau (CRB) Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. From records and discussion with staff, we found evidence to show that staff starting work with a PoVA first are being supervised until CRB checks are received. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. The home has a handover system at the start of each shift. We observed one handover and found staff to communicate with each other in a concise yet comprehensive way. Comments made by residents during the visit include: The staff are lovely They can very busy I get on well with X, she is very nice. Comments made in surveys received by people who live at the home include: ‘Feel that the home is understaffed’; ‘If we hade more staff, help would be quicker than it normally is’; ‘Would prefer to have more regular staff than agency’; Have more staff, they always seem in a rush’. Comments made by relatives of people who live at the home include: ‘Most permanent staff are good. Temporary or agency staff at weekend not so good’. Staff comments from surveys include: ‘If staff levels will improve we can deliver better care to our residents’; ‘Employ more staff, especially carers at our buy home, especially in the mornings’ ‘Better administration by having a regular administrator’. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): 31, 33, 35, and 38. The service is run in the best interests of people living in the home. The safety and well being of the people who use this service, visitors and staff are promoted and protected. 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. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to an adequate standard. The AQAA states’ A suitably qualified person manages the home and monitors the service to ensure Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 27 improvements needed are recognised and acted upon and that the home meets is stated aims and objectives. The residents’ rights are safeguarded by the homes record keeping, policies and procedures. The health and well being of the residents and staff are promoted and protected’. The manager is well qualified to manage the service and discussions with her show an open, positive and inclusive approach to management. The service is well set up with the correct policies and procedures and staff training for when new people move in. From discussions with people living at the home staff the manager the examination of records, and observation of care practices show that a competent and skilled manager runs the service. One member of staff commented ‘Our matron / manager always makes sure that all aspects of nursing and care are given’. There are clear lines of accountability within the home with senior carers reporting to the manager who in turn is supported by the owner. Care staff are clearly aware of the lines of accountability in everyday care practices. There is a quality assurance system in place. The manager ensures that various areas of the service are checked on a yearly basis and changes are made where required. Staff and relatives are surveyed and discussion takes place to create incentives and to make changes to improve the service. Information provided by the manager in the pre-inspection questionnaire indicates that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. A gas landlord certificate was seen and was up to date. There was evidence from a random check of records that equipment is regularly serviced and maintained health and safety checks are carried out. A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. As discussed at the last inspection, the home needs to ensure ‘Regulation twenty six visits’ are carried out monthly by the registered provider and records of the visit report made available for inspection. At present the registered provider regularly visits the home however records of the visit are being maintained the manager and not the provider as required. The manager confirmed that they do not hold any monies for people living in the home. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 28 The home must report to the Local Authority any matters relating safeguarding in accordance with multi-agency policies and procedures. This will help ensure that areas of concerns are addressed appropriately in line with the home’s policies and procedures in safeguarding people. Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No 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. 1 Standard OP18 Regulation 38 Requirement The home must report to the Local authority any matters relating safeguarding in accordance with multi-agency policies and procedures. This is to ensure that people are supported by staff who respond in a way that promotes their safety and protection. Regulation 26 visits must be carried out at least once a month by a registered provider or an appropriate person who is not in daily contact with the home and records maintained for inspection. This is to check on the quality of service provided at the home and comply with the Care Homes Regulations Act 2001. Timescale for action 30/01/10 2. OP33 26 30/01/10 Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations People should be provided with contracts by the home detailing the terms and conditions of their stay at the home and what they can expect to receive for their money. This is necessary so that everyone is clear about what they have to pay for and so that their rights may be upheld. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. All medicines should be stored in compliance with their product licences to maintain their stability. Sufficient supplies of medication should be stored at the home to ensure each person received their medication as prescribed. 2. 3. 4. OP7 OP9 OP9 Stratford Bentley Nursing Home DS0000073290.V378656.R01.S.doc Version 5.3 Page 32 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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