Care Home: Stubby Leas Nursing Home

What the care home does well We have recognised the achievements made since the last key inspection, and the appointment of the Registered Care Manager. Requirements and recommendations made at that inspection have been re-assessed through a further Random Inspection and found to have been satisfactorily addressed. We have found that Stubby Leas offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys, and talking with people during the inspection include: "I feel like I am at home and it makes me happy and contented. It is a very nice place". "All staff are very attentive to resident`s needs, and are very caring. They keep `X` clean and fed, and look after his medical needs". From our examination of care records we established that there are effective pre admission assessments, and care planning of individual needs, which are meaningful in formulating a satisfactory standard of nursing and personal care. When we discussed the quality of care with those people using the service and visitors, it was clear that they appreciated this personable attitude and approach to care. Comments we received from relatives and staff during the inspection include: "We have seen a vast improvement in the way it treats people with respect, although a relaxed atmosphere, very easy to get along with". "There is a very good management team at the present, and I hope they continue to improve on this standard. Keep up the good work". Our inspection has clearly identified a much clearer `person centred` approach to care, especially for people with dementia. The arrangements for activities and socialisation are much improved, offering to people an inclusive quality of life, and a sound foundation to provide a good standard of care. There have been a much improved and positive address to the process of administering medication to provide a safe and secure service. We acknowledge the arrangements made to recruit and appoint the appropriate staff through a sound recruitment and induction programme, complemented with a developing training opportunity. We considered that the overall management style directed by the Registered Provider and Care Manager, demonstrated a satisfactory approach in maintaining a caring environment for care of the elderly. What has improved since the last inspection? Following on from the last key inspection we have acknowledged compliance to address those requirements, and a positive response to recommendations made. There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving people`s opinion has resulted in an awareness of expectation and concerns, including the improvements in providing meaningful activities and social interaction. There is clear evidence that the reviewed care planning system, established with a firm understanding of dementia care needs, is established, well maintained and accurate, reflecting the importance of socialisation and inclusion in the care process. We have acknowledged the significant improvements made in improving the general environment, and upgrading facilities to assist people, especially those with a higher dependency of care or dementia needs. We have recognised an improvement in the recruitment, appointment and induction of new staff, with a more robust process training and management approach. What the care home could do better: During the past year we recognised the efforts to and maintain the general level of decor and furnishings to meet an increasing wear and tear, and in addressing the needs of people with a higher dependency of care. We also advised that attention be drawn to the continual need for upgrading of fabric and furnishings. We require the Provider to maintain safe and hygienic environment with the provision of effective freezers in the kitchen, limited access and ensure that visitors are protected when entering the kitchen area. Attention is drawn to the poor standards in a few of the bedrooms, requiring immediate attention, and the flooding of the cellar requires action. Establishing a keyworker basis of working has identified the importance of person centred approach, relative to the needs of people using the service, although the Provider will need to ensure that an appropriate level of care staff are in receipt of National Vocational Qualifications, to maintain a suitably qualified workforce of care staff. We also consider that the formalisation of an interview record and follow up letter of appointment would enhance the system, and reinforce the agreements made on employment of staff. The achievements in establishing a good standard of care have been recognised, areas of detail, outlined through recommendations, will continue to play a part in the ongoing development and maintenance of an improving service. Key inspection report Care homes for older people Name: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Stubby Leas Nursing Home Fisherwick Road Whittington Lichfield Staffordshire WS13 8PT 01827383496 01827383086 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 1st Care Limited Name of registered manager (if applicable) Mr Amanullah Hossen Dilmahomed Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Age: Dementia (DE) age 55 and above. The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 48 Date of last inspection Brief description of the care home Stubby Leas Care home provides personal and nursing care for up to 48 people suffering with forms of dementia related illnesses. The home is situated in its own grounds on the edge of Fisherwick, a rural hamlet fairly close to the city of Tamworth, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. We found the grounds spacious, and there are pleasant country views Care Homes for Older People Page 4 of 34 Over 65 0 48 1 0 0 6 2 0 0 9 Brief description of the care home all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. Rooms are provided on all levels of the home with a mixture of single or double rooms, some with en suite facilities. Communal areas are on the ground floor and there is a separate smoking area. The home has a purpose built activity room where people have the opportunity to maintain their skills and hobbies or to enjoy new interests. The full range of fees were not detailed in the service Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Registered Care Manager, Registered Provider, Operations Director, senior nurses and care staff on duty, whose input contributed to this report. Our inspection of the Home allowed us free access to all areas, and open discussion with people who use the service, relatives and staff. There were 45 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with mental health and physical care needs. To do this we looked at (case tracked) four peoples files from admission referral to the present time, and four staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their Care Homes for Older People Page 6 of 34 input contributed to the subsequent report. We acknowledged receipt of a well presented and comprehensive Annual Quality Assurance Assessment (AQAA), and eleven survey forms returned from those we sent out to people who use the service, some weeks before the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for the people using the service. It also gave us some numerical information about the service. Relatives who were present were complimentary of the family approach to care, the freedom they enjoyed, and the involvement that the Care Manager and his staff encouraged. It was evident that they were inclusive in the process of care. Everyone appeared comfortable and at ease with their surroundings. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Registered Provider, Care Manager, Operations Director and senior nurses, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Following on from the last key inspection we have acknowledged compliance to address those requirements, and a positive response to recommendations made. There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving peoples opinion has resulted in an Care Homes for Older People Page 8 of 34 awareness of expectation and concerns, including the improvements in providing meaningful activities and social interaction. There is clear evidence that the reviewed care planning system, established with a firm understanding of dementia care needs, is established, well maintained and accurate, reflecting the importance of socialisation and inclusion in the care process. We have acknowledged the significant improvements made in improving the general environment, and upgrading facilities to assist people, especially those with a higher dependency of care or dementia needs. We have recognised an improvement in the recruitment, appointment and induction of new staff, with a more robust process training and management approach. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may choose this service will be given enough information upon which to make a decision about its suitability for them. People can feel confident that their needs would be assessed in full before they move in. Evidence: The Home provides detailed information about the service it provides in the well presented Statement of Purpose and Service User Guide, which provides an informative description of the Homes aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, and that we considered that the Service User Guide be presented in a large print and audio version to help people to make an informed choice. It was also suggested that the Service User Guide could contain more pictoral content. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the Home operates upon, offering those people who may use the service, and their relatives, the Care Homes for Older People Page 11 of 34 Evidence: opportunity to make an informed choice about where to live. Through our case tracking of four peoples care records we clearly identified that the Care Manager, or his Deputy, conducted the pre admission assessment. We looked at the care records as part of our case tracking process, and saw that people had been involved the assessment of their needs prior to admission. We looked at the case file of a person who recently moved into the home to see if information had been sought regarding this persons needs prior to moving in. Information had been obtained from the previous health care setting, and that the Care Manager had visited this person prior to offering accommodation at the Home. We looked at other case files and they included pre admission assessments by the Home in addition to social worker reviews, community care services, and other social care settings. We found that the now-established documentation identified a clear dependency assessment, designed to form a foundation for care planning to meet needs, which included a copy of the care plan from social services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. Existing files examined showed this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual are discussed and documented, ensuring that their personal needs would be met. We saw evidence during the day to confirm that a number of people who have dementia, or confusion are receiving the appropriate level of care to ensure that their needs, health and well being are being met. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that much care had been taken in involving people, and their families in the admission process. Two of the Surveys completed by relatives told us that they both had to make the decision for their relative to move into the home, they stated that they were very satisfied with the accommodation and care provided. We asked for, and received plenty of comments and descriptions from friends, and the information we received was very informative and helpful. I feel like I am at home and it makes me happy and contented. It is a very nice place. When the male nurse visited me, the information I received was very informative and Care Homes for Older People Page 12 of 34 Evidence: helpful. From our discussions it was evident that people are able to visit and assess the facilities and suitability of the Home at any reasonable time to meet with staff and management. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated when talking to people, and examining records on case tracking. This home does not provide intermediate care facilities. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that their health care needs will be met and they will receive prompt medical attention. People who use this service will be treated with respect and dignity. Evidence: Care records and case tracking we examined provided clear evidence to show that the pre-admission assessment represented the foundation for a well considered, and detailed care planning process, including risk assessments of moving and handling, nutritional screening and potential for falling. We recognise that peoples profiles offered an individual plan of care, based upon dependency assessment and activities of daily living. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon dependency assessment and activities of daily living, frequently reviewed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with a substantial and very informative daily progress report. Established monitoring systems following a process of goals, care and evaluation of high quality care plans, appreciated by those people and relatives alike. Other records Care Homes for Older People Page 14 of 34 Evidence: detailed Doctors visits and any actions taken as a result of those visits. Staff told us: Since the last inspection we have worked hard to improve the record keeping to make sure everything is recorded to create a comprehensive, person centred care package. People using this service said: They are good at promoting a caring, loving, homely atmosphere. We asked if they got the help they needed, they said All staff are very attentive to residents needs, and are very caring, another person told us The Home is always welcoming to residents and family. They all work hard under constant pressure, the managers and all the staff do a good job. We saw evidence that showed us people are seen by doctors and other health care professionals such as district nurses, diabetes specialist nurses, physiotherapists and chiropody services. We have received some comments members of staff who told us: Good at caring for the needs of the resident and very good dementia care. I feel that when it comes to the needs of our residents, the nurses are always on form to the best they can be. There is always a pleasant atmosphere. We have considered that the strength of improved planned care lies within the continual review process in monitoring and adapting care profiles, and we confirmed, that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. As is appropriate and observed, a checking chart ensures that constant monitoring of people with high dependency needs is carried out. A daily report is maintained to control monitoring, and offer a comprehensive account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of goals, care and evaluation models of monthly assessment. We confirmed that the administration of medicines is of a good standard to maximise Care Homes for Older People Page 15 of 34 Evidence: protection for people who use the service. We found that the Care Manager is responsible for overseeing all matters relating to medicines, with senior nurses taking operational responsibility for day to day actions. We found a well developed, and smooth process of ordering, receiving, storing, and administering medicines. The process of tracking the disposal arrangements requires a review to complete the secure audit trail. Nevertheless working records were seen to be complete and easy to follow through, with no observed breaches in the administration system. All four people being cases tracked were found to have appropriate medication. Our case tracking of four peoples care confirmed to us that specialist support and advice are sought as needed. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their life style, complimentary regarding the quality of their lives, and the care they were receiving at Stubby Leas. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. Individual spiritual persuasions were seen to be documented and respected. Throughout the inspection we have observed staff speaking politely to people living at the home, assisting them when needed with sensitivity and understanding of their needs, and we noticed that staff knocked before entering peoples rooms. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are supported to lead active lives. The home provides nutritionally balanced meals for people. Evidence: We found in the course of inspection that daily life to be accommodating peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which peoples needs were respected, with the security that there are familiar events to the day they could relate to. There are two activity co-ordinators, who hold a high profile in contributing to the care planning process, and is clearly well accepted by people who use the service and staff alike. There is a large activity room and adjacent sensory room, both under re-furbishment at the time of inspection. We recognise the initiative taken in the promotion of peoples dignity and representation within the unit, through the recognition of a dignity champion, applying to principles underlying a dignity in care campaign for the elderly. Work is underway to secure individual life histories, to be used as a basis for personalised social care, offering choice and support. Staff were seen to supervise people in the Care Homes for Older People Page 17 of 34 Evidence: lounge areas throughout the inspection. Some comments we received from surveys sent out before the inspection: It has a good set of staff who are committed to the residents and smooth running of the Home. We all work as a team and help each other which makes for a happy home for the residents. It is a nice environment for the residents. We know that there are always activities arranged each week, but now dad is not able, or interested in taking part in them. They do well in the provision of activities with many genuine caring staff. The current management implementing good structure and listens to staff needs, with training provisions for all staff. Gets to know its residents and strives to give person centred care. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments received from relatives on the day confirm their appreciation and involvement with the progress of their loved ones health and social status: I am very pleased with the progress dad has made over the past couple of months, and the loving care given. Much appreciated. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed an improved and positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality, to accommodate the needs of people with dementia. We noted the introduction of orientation reminders and the use of clearly identifiable corridors as a focus point for people with access to familiar items, such as colour schemes, murals and points of recognition. The Home operates a secure system of handling peoples monies, with only small amounts of petty cash, which was efficiently handled through the administrators office, and subject to internal inspections and audits. The Care Manager emphasised that the strength of protecting personal rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Advocacy procedures and services are available to those who Care Homes for Older People Page 18 of 34 Evidence: require them. Quarterly relatives and residents meetings are valuable forums for open communications, and are recorded. The Home offers a satisfactory catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. We confirmed that the cook knew most of the people using the service, and some of the relatives, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant lunch was served during inspection, served in pleasantly furnished and clean dining rooms. Staff were seen to offer discreet assistance to those who required it. People interviewed confirmed that that the quantity and quality food provided was satisfactory. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can feel confident their views will be listened to and acted upon. Staff have received safeguarding adults training and have a good understanding of how to protect the people living here from harm. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy was seen and records examined. All people who use the service had received information on the procedure to complain, including reference to the Care Quality Commission (CQC). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. Two complaints had been forwarded to CQC and handled by the Registered Provider satisfactorily. and were seen to have been handled in a responsible manner. No safeguarding issue had been received by us since our last inspection Comment we had received in the course of inspection stated: Ive been coming here regularly over the past six months, sometimes it is necessary to mention things that are not quite right, but the manager and staff are always ready to listen when we point things out, and importantly sort it out. Care Homes for Older People Page 20 of 34 Evidence: We looked at the systems in place for safeguarding vulnerable adults. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining four staff files. Booklets from the General Social Care Councils Code of Conduct are given to all staff to help reinforce the induction and training programmes. We spoke to staff about the training they have had, who demonstrated a very good understanding of what abuse is, who they would report it to, and how they would keep people safe. Staff were aware of the Homes whistleblowing policy, they said: We are very confident of the manager knowing that you can report bad practice anonymously if need be. Staff induction and in house training programmes clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse, of all natures. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Stubby Leas provides a clean and comfortable environment for the people who use the service. There is a need to maintain the fabric and furnishings of the home to a satisfactory standard to meet all peoples needs. Evidence: The location of Stubby Leas is conducive for a care home, to meet the needs of an elderly population of people with mental illness and dementia. Stubby Leas Care home is situated in its own, extensive grounds, with accommodation provided on three levels, which are accessed, by stairs or a passenger lift. There are two distinctive blocks to the house, connected by the ground floor accommodation. We found the grounds spacious, and there are pleasant country views all round, although with a limited car park. The attractive garden and patio areas are well maintained and secure, and we were informed, used extensively during the summer months. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. The general state of exterior repair and maintenance was found to be satisfactory. A tour of the Home verified that the premises were generally fit for purpose, presenting a somewhat rambling building that can present difficulties in staffing and supervision. The standard of cleanliness is satisfactory, although some areas were found to have been adversely affected due to untoward incidents. It was warm and Care Homes for Older People Page 22 of 34 Evidence: relatively tidy, and continuing to receive a much improved maintenance and refurbishment, although much remains to be achieved. Communal areas present much improved, pleasantly furnished areas, to accommodate social or reflective needs, in a homely setting. There are four main lounges, each providing a comfortable seating area, with a good standard of furnishings. On the day of inspection staff were seen to be deployed in lounges with people, and actively engaged in interactions. There are two pleasant dining rooms, clean and fresh smelling, overall offering an increasingly comfortable, homely yet secure environment. We observed that staff supervision is available throughout the day. A large activity room is recognised as an activity centre, with an adjacent sensory area, both being upgraded at the time of inspection. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the Home. On admission the Care Manager assesses each individual persons needs for equipment and necessary adaptations. We acknowledge the efforts made to provide a homely atmosphere and the decor throughout continue to be of a much improved standard. The quality of most bedrooms have improved and are subject to a continual programme of upgrading, new carpets and upgrades to bathrooms were satisfactory, some seen to have been personalised with peoples possessions, and some personal furniture brought in with them, although there remain significant amounts of sub-standard furnishings that need urgent replacement. Bedrooms were individually and naturally ventilated, and windows were provided with restrainers for safety and security reasons. Radiators and hot water temperatures were regulated to reduce the risks of accidents from scalds, and all personal electrical equipment were seen to be tested. On inspection we found there are an appropriate number of variable height and profiling beds, with integral protection rails. The nurse call alarm system was satisfactorily tested, and personal electrical equipment (PAT), that is televisions, radios, etc, where seen to be tested. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. We saw that one room was of a very poor standard to force a closure of use until fully refurbished, and we also found several bedrooms poorly presented, lacking warmth and comfort, but generally a much improved situation, with people we spoke to during the course of the inspection expressing their general approval of their accommodation standards. Some comments we received from people who use the service: I feel like I am at home, and it makes me happy and contented. It is a very nice place. Care Homes for Older People Page 23 of 34 Evidence: Could do to buy new furniture for the Home, as a lot is falling to pieces, needs constant repairs to it; and the gardens being more accessible to the residents. To me personally my job as housekeeper I absolutely love it. I have never felt this way about a job before, I love the Home and I love the residents to bits, they give so much back and are all individuals. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the Home. The refurnished areas presented collages and memorabilia to assist people in recognising their personal space, including the use of colour schemes, and recognisable items placed throughout the unit. The housekeeping services in the home were seen by us to be of a good standard. The people spoken to generally remarked that they find the environment always clean and fresh, although there was a malodour at the reception area of main corridor at the time of inspection. We noted that the cellar area was extensively flooded, although secure from casual access. People have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a much improved quality, clean, and generally uncluttered. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Sluice facilities are suitable to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate (COSHH) posters and information charts. The laundry area presented a somewhat confusing picture, requiring a reorganization to receive and separate clean from used laundry. It was suggested that a clothing name label machine would reduce confusion. There was some evidence of communal use of tights, to be discontinued immediately. COSHH signs were evident, although in need of renewal with laminate posters. The kitchen was inspected with the cook, and found to present a well equipped and organised area. All fridges and freezers were seen and two old freezers require replacement, heavily damaged due to wear and tear, although checked daily by the kitchen staff. A cleaning schedule was in place, that required daily records to be accurate, up to date and comprehensive. The kitchen floor was found to be very slippery, due to the type of cleaning agent used. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and little ways. She was aware of the issues of culture, Care Homes for Older People Page 24 of 34 Evidence: ethnicity and age diversity, having had experience in dealing with a diverse population. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home have confidence in the staff who care for them. Staff are recruited safely and this prevents unsuitable workers from working with vulnerable adults. Evidence: We confirmed that there were 45 people using the service on the day of inspection, of which 34 people were receiving nursing care. We examined three weeks of duty rotas were examined, from the 11.01.10 through to 02.02.10. On the day of inspection the staffing levels were: Morning shift 2 Trained Nurse 6 Carers 2 activity coordinators Afternoon shift 2 Trained Nurse 6 Carers Night duty 1 Trained Nurse 4 Carers We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and absence. The Manager is supported by a team of Registered Nurses and experienced senior Care Homes for Older People Page 26 of 34 Evidence: carers. It is recognised that there has been a positive commitment to decrease the reliance on agency nurses. The administrative, catering, domestic and laundry staff were found to be appropriate for the size of the home and the needs of the people who use the service, however the continuing upgrading in fabric and maintenance will require an extra effort and resource. We were informed through the AQAA that 8 (15 ) care staff have National Vocation Qualification (NVQ) II or III, with a further 11 care staff committed to programmes, and with new staff committed to undertaking training. This was confirmed on examination of training records and speaking with staff. We have noted through our examination of staff records, and discussions with staff that a training programme is drawn up. It is recognised that staff received a meaningful induction programme to meet their level of experience, and that mandatory training is given. We confirmed that fire training is arranged, Safeguarding and Manual Handling is presently underway. There has been discussion that all senior nursing and care staff underwent a Dementia training course. A training matrix has been drawn up for implementing. All staff advised us that they received a good induction programme on starting work at Stubby Leas. Staff supervision has been established with an agreement to cascade the effort throughout the organisation. The Provider and Care Manager have established, and continue to pursue satisfactory procedures for interview, selection and appointment of staff, although on examining records there remain some inconsistencies, requiring a review of process. Improvements requested at the last inspection had been met, two written references were available for all workers, Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (PoVA) list checks had been completed. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live here. The home benefits from an experienced manager who has a clear understanding of the service and its plans for improvement. Evidence: The Registered Care Manager, Mr Amanullah Dilmahomed, has demonstrated a professional commitment and competence in running Stubby Leas, in establishing a solid professional policy portfolio that has been implemented, to achieve a good standard of set aims and objectives. A Registered Mental Nurse, with extensive clinical and managerial experience, he is supported by a team of experienced Registered Nurses, who are trained in general and mental nursing. We recognise the efforts made to substantially change the ethic of care at Stubby Leas over the past 12 months, addressing the not inconsiderable problems of delivering care for people with mental and physical health needs. There has been an establishment of the Keyworker and Named Nurse team concept, with a strong principle of teamwork and transparency. We also recognise the efforts to recognise a dignity champion to further the Care Homes for Older People Page 28 of 34 Evidence: independence and individuality of living in Stubby Leas. We were impressed by the openness and confidence in the observed interactions of staff, relatives and people using the service. The relationships were seen to be of mutual trust and respect. The Registered Providers have responded well to the robust efforts of clinical management in maintaining a high profile and involvement in the much improved running of the Home, and are prepared to delegate a wide range of management responsibility to good effect. Comments we received from staff interviewed on the day: It has a good set of staff who are committed to the residents and smooth running of the Home. We all work as a team and help each other which makes for a happy home for the residents. It is a nice environment for the residents. We all take pride in any aspect of care and knowledge about all our clients, and try at all times to keep a high standard of care, enjoyable to all clients and staff and family members. We work well as a team and make everyone welcome. There is a very good management team at the present, and I hope they continue to improve an this standard. Keep up the good work. Appropriate risk assessments are in place for people, through care planning and recording, staff selection and the maintenance of the general environment; these are up to date and accurate. Health and safety notices can be seen throughout the home. Records inspected included surveys asking people who use the service their opinion, these are expected to be conducted annually, in conjunction Audit from the Providers. The Manager offered evidence of procedures and safe working practices including: medicines, Confidentiality and Movement and Handling procedure. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded at least once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. Social Workers review meetings are often a vehicle for assessing quality. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. This we found to be true from talking with relatives and staff. Small amounts of cash were efficiently handled by the administrative officer, although essentially the home operates a cashless society. Care Homes for Older People Page 29 of 34 Evidence: As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. Cascading supervision programmes are established as part of the normal management/training process, with all care staff expected to receive six sessions of individual formal supervision annually. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. An examination of administrative, monitoring, planning and care records showed an organised and much improved, professional attitude to effective record keeping. Random samples of records they were found to be well maintained, accurate and up to date, ensuring that the peoples rights and best interests are safeguarded. Records inspected included, hoist checks, fire prevention tests on equipment, six monthly fire training and procedures, Health and Safety checks on equipment servicing and planned preventative maintenance and risk assessments. Relevant legislation was discussed and is fully understood by the management, i.e. introduction to CQC, updates The Mental Capacity Act and Deprivation of Liberties paper. The health and safety of people using the service and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical appliances and regulation of the water system. The accident book was seen and found to be in order for staff, people using the service, and reporting arrangements to Riddor. A regular analysis is recorded on trends and frequency. Health and safety notices can be seen throughout the home. The administration and management of the home is effective, uncomplicated and sensitive to the needs of people. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 23 Room1 is unfit for purpose and is to be totally refurbished before returning for general use. Due to very poor state of cleanliness, decor and furnishings. 01/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 That the Service User Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. There remain significant amounts of sub standard furnishings that need urgent replacement. That the kitchen area be segregated from general access to unauthorised staff to maintain control over food hyggiene environment. That the laundry area receives address to reorganise to seperate used from clean linen. That communal use of Page 32 of 34 2 3 4 16 24 26 5 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations certain clothing be discontinued forthwith. 6 7 26 29 That two old freezers be decommissioned and replaced, and that cleaning schedules are recorded. That the Registered Care Manager ensures that there is a consistency in the organisation of staff records, including a record of staff interviews and issuing of letters of appointment. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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