Care Home: Summerfields House Rest Home

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What the care home does well The management and staff make the people who use the service and their visitors welcome. There are frequent visitors to the home. Staff demonstrated great respect for the people who use the service, and people were addressed in an appropriate manner. Discussions with staff showed a clear determination that they belong to a committed team. People spoken with were very positive about the care that they were receiving. The home was clean, warm and comfortable. Staff recruitment and training records showed us that a good system of recruitment and training is in place, ensuring that peoples needs are met, and the safety of people using the service. What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the care manager told us about the following improvements made: "We have further improved the personal element of admission, particularly with the early introduction of the Key Worker. The manager who carrys out the pre-Admission Assessment will usually receive the new resident upon admission to the home. We have noticed that the personalising of bedrooms has had a positive effect, and we see service-users settling into their new environment more quickly as a result. The home is also able to provide the Statement of Purpose and Service User Guide in different formats when appropriate (e.g. audio/pictorial or in a different language). The individual Care Plans and Risk Assessments have been comprehensively reviewed to accommodate the guidelines contained within the Mental Capacity Act. The Gold Standard Framework for Palliative Care has been implemented where appropriate. All staff have received extensive occupational training (detailed under staff training). We ensure that we continue to work with other health professionals to enhance our knowledge and ability to deliver quality care. We also seek formal training from professionals in specific specialities, for example, in the areas of diabetes, and continence. We monitor temperatures in which medications are stored at on a daily basis. A record of these are signed and stored, ensuring the temp does not exceed 25 degrees. End of life care is discussed with individuals and family members are included if the individual wishes. This is all clearly documented in individual care plans. Introduction of a seasonal Newsletter avaliable to all service users and visitors. Installing of a whiteboard to display daily activities, the day and date, and duty staff etc. Greater variety of activities. Fully documenting residents meetings. Recognising that our service users are becoming more diverse and consequently tailoring outings for smaller groups, specifically to suit individuals wishes. The rear garden has now been made totally secure affording residents the freedom to wander without direct supervision. We now employ a member of staff three times a week, solely for the purpose of organising activities. Members of staff now work with residents, their family and friends, to complete their own `life histories` (including photos etc). Complaints procedure has been reviewed. All staff have received training on the Protection of Vulnerable Adults. All staff have received training stemming from the Mental Capacity Act. We have reviewed and improved the documentaiton relating to the Mental Capacity Act which is in every resident`s care file. All new staff routinely receive training and literature on the Mental Capacity Act which, having read and understood, they sign. All staff have received training on deprivation of liberty safeguard procedures and fully understand the implications of these upon residents, when in place. Finally, the home is aware that the Independent Safeguarding Authority has taken over from POVA, and we have the appropriate literature in place for this. Additional outside lighting has been installed, as well as additional fire fighting equipment, including additional smoke detectors and signal light boxes in roof spaces. Complete redecoration of outside of the home. Redecoration of bedrooms has continued as and when they have become vacant. Complete refurbishment of main kitchen and main ground floor bathroom (including a new Malibu Arjo bath), as well as the adjoining toilet. New flooring has been fitted to two ground floor toilets. All refurbishment has coincided with updated dementia signage, which has been supervised by Dr. Gail. A new outside staircase has been installed leading to the extension boilerhouse. Offered new training opportunities through distant learning packs. All Statutory and Occupational Training completed this year by our staff: Safe Handling of Medicines Diabetes Awareness Blood Glucose Monitoring Control of Infection (`Breaking the chain of infection` - Open Learning) Continence Awareness West Midlands Pandemic Influenza (learning modules) Food Hygeine Equality & Diversity Risk Assessment Promoting an activity based environment Dementia Awareness Sensory deprivation training Mental Capacity Act LETS talk about deprivation of liberty safeguards Essential Steps to Safe Clean Care Fire Safety Training First Aid Moving and Handling Our management structure allows us to undertake more direct observations of staff, to randomly monitor their level of competency in areas such as bathing, drug administration, personal care, and telephone manner. There is a continued emphasis on first impressions. The team have responded to this and their attitude and approach has become a key factor in the delivery of our service. Enhancement of the role of `On Call` manager (i.e. to be a ready point of referral for any issues that may be raised by visiting families, rather than deferring to the followi What the care home could do better: Consideration should be given to the purchase of an appropriate Medication cabinet, which meets the Misuse of Drugs (Safe Custody) Regulations 1973, and which would ensure the safe administration of medication. Consideration should be given to the way in which the furnishings are arranged in the main lounge area, to enable people to comfortably watch the television. Regular audits of falls should be undertaken. With a view to ensuring that appropriate and effective contingency measures are in place for those individuals. These should also link in with any personal risk assessment already in place. Key inspection report Care homes for older people Name: Address: Summerfields House Rest Home 12 Burton Road Branston Burton On Trent Staffordshire DE14 3DN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pam Grace     Date: 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 35 Information about the care home Name of care home: Address: Summerfields House Rest Home 12 Burton Road Branston Burton On Trent Staffordshire DE14 3DN 01283540766 F/P01283540766 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Annette Gilliland,Mr Mark Gilliland care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 21, Old age, not falling within any other category (OP) 21 Date of last inspection Brief description of the care home Summerfields House care home is a privately owned large Victorian detached house that has been extended to provide accommodation for 21 older people with needs associated with old age, seven of which may have dementia care needs and three of whom may have physical disability. The home delivers a very good standard of residential care, for older people and Care Homes for Older People Page 4 of 35 Over 65 0 21 21 0 Brief description of the care home people with dementia related conditions, in a safe, clean and homely atmosphere. The home is not registered for people with nursing needs. Care staff are trained to meet the needs of the people using the service, and the inspection process has confirmed the home is well equipped to meet individual requirements. Health service professionals are accessed when required including the local General Practitioner and the Pharmacist. The home is situated on a main road in a residential area of Burton on Trent, within a short distance of the town centre with all its amenities, a bus route passes the door and parking is available. Accommodation is provided on two floors, the first floor being accessible by shaft lift, as well as a staircase that is fitted with a stair chair lift. On the ground floor there are ten single bedrooms and one double bedroom, and on the first floor there are seven single and one double bedroom. Three of the single bedrooms on the ground floor have ensuite facilities. There are two assisted bathrooms, one on each floor, plus a domestic style bathroom and seven separate toilets located throughout the premises. Communal facilities consist of two lounge areas and a dining room. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission CQC database, the Annual Quality Assurance Assessment AQAA document that had been completed by the Registered care manager, comments and surveys received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. A tour of the environment was also undertaken. At the end of our inspection feedback was given to the Registered care manager and the Care Standards manager, outlining the overall findings of the inspection, and giving Care Homes for Older People Page 6 of 35 information about the recommendations that we would make. People spoken with were very positive about the care they were receiving. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been one complaint made to the home, and two Adult Protection Safeguarding referrals made to Social Services, since the previous inspection. The complaint had been dealt with in a timely way under the homes complaints procedure. We had a poor response to the seven Have Your Say surveys given to individuals at the service. Only one survey was received at the time of this report. There were no requirements, and 3 recommendations made as a result of this unannounced inspection. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the care manager told us about the following improvements made: We have further improved the personal element of admission, particularly with the early introduction of the Key Worker. The manager who carrys out the pre-Admission Assessment will usually receive the new resident upon admission to the home. We have noticed that the personalising of bedrooms has had a positive effect, and we see service-users settling into their new environment more quickly as a result. The home is also able to provide the Statement of Purpose and Service User Guide in different formats when appropriate (e.g. audio/pictorial or in a different language). The individual Care Plans and Risk Assessments have been comprehensively reviewed to accommodate the guidelines contained within the Mental Capacity Act. The Gold Standard Framework for Palliative Care has been implemented where appropriate. All staff have received extensive occupational training (detailed under staff training). We ensure that we continue to work with other health professionals to enhance our knowledge and ability to deliver quality care. We also seek formal training from professionals in specific specialities, for example, in the areas of diabetes, and continence. We monitor temperatures in which medications are stored at on a daily basis. A record of these are signed and stored, ensuring the temp does not exceed 25 degrees. End of life care is discussed with individuals and family members are included if the individual wishes. This is all clearly documented in individual care plans. Introduction of a seasonal Newsletter avaliable to all service users and visitors. Installing of a whiteboard to display daily activities, the day and date, and duty staff etc. Greater variety of activities. Fully documenting residents meetings. Recognising that our service users are becoming more diverse and consequently tailoring outings for smaller groups, specifically to suit individuals wishes. The rear garden has now been made totally secure affording residents the freedom to wander without direct supervision. We now employ a member of staff three times a week, solely for the Care Homes for Older People Page 8 of 35 purpose of organising activities. Members of staff now work with residents, their family and friends, to complete their own life histories (including photos etc). Complaints procedure has been reviewed. All staff have received training on the Protection of Vulnerable Adults. All staff have received training stemming from the Mental Capacity Act. We have reviewed and improved the documentaiton relating to the Mental Capacity Act which is in every residents care file. All new staff routinely receive training and literature on the Mental Capacity Act which, having read and understood, they sign. All staff have received training on deprivation of liberty safeguard procedures and fully understand the implications of these upon residents, when in place. Finally, the home is aware that the Independent Safeguarding Authority has taken over from POVA, and we have the appropriate literature in place for this. Additional outside lighting has been installed, as well as additional fire fighting equipment, including additional smoke detectors and signal light boxes in roof spaces. Complete redecoration of outside of the home. Redecoration of bedrooms has continued as and when they have become vacant. Complete refurbishment of main kitchen and main ground floor bathroom (including a new Malibu Arjo bath), as well as the adjoining toilet. New flooring has been fitted to two ground floor toilets. All refurbishment has coincided with updated dementia signage, which has been supervised by Dr. Gail. A new outside staircase has been installed leading to the extension boilerhouse. Offered new training opportunities through distant learning packs. All Statutory and Occupational Training completed this year by our staff: Safe Handling of Medicines Diabetes Awareness Blood Glucose Monitoring Control of Infection (Breaking the chain of infection - Open Learning) Continence Awareness West Midlands Pandemic Influenza (learning modules) Food Hygeine Equality & Diversity Risk Assessment Promoting an activity based environment Dementia Awareness Sensory deprivation training Mental Capacity Act LETS talk about deprivation of liberty safeguards Essential Steps to Safe Clean Care Fire Safety Training First Aid Moving and Handling Our management structure allows us to undertake more direct observations of staff, to randomly monitor their level of competency in areas such as bathing, drug administration, personal care, and telephone manner. There is a continued emphasis on first impressions. The team have responded to this and their attitude and approach has become a key factor in the delivery of our service. Enhancement of the role of On Call manager (i.e. to be a ready point of referral for any issues that may be raised by visiting families, rather than deferring to the following day). Broadband internet has been installed. Impemented deprivation of liberty safeguards within care planning. Improvded documentation on Mental Capacity Act. Fire Risk assesment has been reviewed, and evacuation plans in all zones include details on the level of mobility, whether night sedation has been taken, and the dementia status of all residents in the particular zone. Improved administration and filing systems. What they could do better: Consideration should be given to the purchase of an appropriate Medication cabinet, which meets the Misuse of Drugs (Safe Custody) Regulations 1973, and which would ensure the safe administration of medication. Care Homes for Older People Page 9 of 35 Consideration should be given to the way in which the furnishings are arranged in the main lounge area, to enable people to comfortably watch the television. Regular audits of falls should be undertaken. With a view to ensuring that appropriate and effective contingency measures are in place for those individuals. These should also link in with any personal risk assessment already in place. 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 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Summerfield House delivers a professional, flexible, reliable and focussed service. Information offered ensures that residents and prospective residents can make an informed choice about the home. Particular emphasis is placed on ensuring admission to the home is personal and well managed. Service users are given the opportunity to visit the home prior to admission before a placement is accepted. If this is not practicable then either of the senior managers will visit the prospective service user in their current place of abode. We encourage families to personalise bedrooms prior to admission, and our handyman Care Homes for Older People Page 12 of 35 Evidence: will always assist in this effort if required. For those who do not have immediate family, an External Advocate is always avaliable. Individualised pre admission Assessments are completed to ascertain whether the prospective residents needs can be met. If necessary, this will include other professionals such as the CPN and District Nursing team. If we discover that the home is unable to meet their needs, then a full explanation, along with helpful advice and guidance on where they may find the appropriate care is provided. We ensure that residents who are referred by Social Services have a Care Management Assesssment and Care Plan in place prior to admission. We undertake our own robust assessment and liaise with other professionals, if appropriate, prior to admission. A Service User Guide and Statement of Purpose is provided pre admission to enable prospective residents to make an informed choice about the home. The first six weeks of any admission is regarded as a settling in period, after which, a full review of their pre admission assessment is undertaken with all parties to ensure that all their needs are being met, and that any concerns (either with the service user, their family, or Summerfields) are discussed. Subsequently, a formal contract is entered into between the home and the resident and or their family, when part or all of the care fee is met by the resident family. On admission the service user is allocated a key worker. She or he will assist the service user in building relations, familiarising themselves with their new surroundings, and will be their point of contact for any minor concerns. Advance written notice will always be provided before any revision to the Fee Structure is implemented. We saw the up to date Statement of Purpose and Service User Guide for the service, these were clear and informative, and were available in large print, audio or pictorial format. We spoke with the relative of a person who had recently moved into the service. He confirmed that they had been able to visit the home, and had received appropriate information, which had enabled them to make an informed choice. Care plans seen evidenced a robust and detailed assessment process. Pre admission assessments had been undertaken prior to a person moving into the home. These were a combination of Local Authority Social Work assessments, and the homes own assessment, which was completed by the Registered care manager. The pre admission assessment then informed the full care plan. Care Homes for Older People Page 13 of 35 Evidence: This service does not provide intermediate care. Care Homes for Older People Page 14 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Care Plans are formulated using a person centred approach, where by the resident is supported in making their own decisions. Service users are deemed to have full capacity unless assessed otherwise. This plan is signed by the resident, or family member, indicating their agreement. This is routinely reviewed on a monthly basis but may be at any time if circumstances dictate, and with the residents approval. We will always work in partnership with the resident and their family (if requested by the resident) and other health professionals to provide the best support and care for the individual. The residents personal choices are paramount in their daily living. For example, what to wear, and how their personal dignity and welfare is maintained. Staff training Care Homes for Older People Page 15 of 35 Evidence: supports the policy of residents being allowed to make their own decisions in this regard. We fully respect an individuals privacy and dignity. For instance, knocking before entering a room, and ensuring private personal needs or requirements remain confidential. Residents are encouraged to keep their existing GP on admission and are not encouraged to change. If this is not practical then advice is provided to the resident family so that they can make a decision on where to source their GP. We provide acess to any health care services appropriate to the individual. For example, tissue viability, diabetic nursing, hearing services, opthalmology, chiropody, as well as any nutrional or continence support. For all medication we have a robust policy for receipt, storage, handling, security, administration, and disposal. Staff receive training on all aspects of drug handling, and the application of this training is monitored. Residents are encouraged to maintain their own independence where possible, and to make decisions on their own health care requirements. However, for those who are not able to, we closely monitor their well being, and we will call for a GPs services if required. Fluid and dietary intake of all residents is carefully monitored, and their weights are recorded to assist with this important assessment. Fluids charts are put in place where there is any area of concern, and the individuals GP would be notified at this time. Evidence of any skin changes relating to any pressure areas are carefully monitored. If there are any areas of concern then District Nurse support will be requested, and consequently the supply of pressure relieving equipment. It is a continual area of frustation that some of our residents return from hospital in patient visits with pressure sores when their skin was free of any concern at the time of admittance. Further to this monitoring, individual risk assessments are put in place for each resident. These identify any areas of increased risk, for example, in areas of malnutrition, pressure relief, and falls. When a resident experiences a deterioration in their health they, as individuals, are encouraged to discuss their wishes and thoughts on their end of life care. Family involvement is encouraged but only with the agreement of the resident (when possible). Staff spoken with could tell us exactly how to care for individuals in the home. Care Homes for Older People Page 16 of 35 Evidence: People using the service had access to a wide range of health care services according to their individual need, and assessments were in place that looked at tissue viability, pressure areas, nutritional needs, continence needs, hearing and sight. Care plans seen evidenced that health and social care needs are being met. Care plans and risk assessments were comprehensive and up to date, they had also been reviewed to include the guidelines for Mental Capacity, in line with Deprivation of Liberty and the Mental Capacity Act. The Gold Standard Framework for Palliative Care had also been implemented where appropriate. Staff and people spoken with told us that staff spend time talking to individuals, to ensure that they understand the choices, decisions and actions that need to be taken. We observed staff knocking on bedroom doors, talking to individuals during our visit, and addressing them appropriately. We spoke with staff, relatives and people using the service. They told us, staff are always helpful here, we can do what we want, and get help from staff if we want. We can see the doctor if we need to, and they help us with our medicines.We have never had any problems with the staff here, they are always very helpful and kind. We looked at the way in which the service administers their medication. Medication is stored in a locked cabinet in the office. We recommended the purchase of a medication cabinet, which would ensure that medication is administered safely. Each person has a medication file, which contains details about any known allergies, and all medication being administered. Staff told us that they receive regular and update training, and that audits and competency checks are undertaken by the manager on a regular basis. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this servce are able to make choices about their life style, are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We have a planned and considered approach to supporting residents with social, community based, and recreational activities. Residents are able to receive visitors whenever they choose as the home operates an Open Visiting policy. Residents can choose to see their visitors in their private rooms, if they wish. We strive to accommodate any requests for larger personal possesions to be brought into the home, which is consistent with our encouragement to personlise individual bedrooms. These could include chairs, cupboards and similar items. These requests will be subject to a Risk Assessment. If any resident has no regular visits from friends or family, then we actively encourage the use of advocates. Care Homes for Older People Page 18 of 35 Evidence: The home operates an Open Door policy so that all visitors are able to discuss with staff, Key Workers, and managers, any concerns they may have, as well as to offer praise. Our staff work very hard in maintaining communication with all families and friends which allows ample opportunity to discuss any issues which might arise. Due to our person centred approach to care, daily living routines are flexible and varied according to individual needs and wishes. For example, some residents assist with setting and clearing tables, whilst others want to help with dusting. Meetings are held with small groups of residents to discuss ideas on areas of improvement. The items discussed will usually include menus, decor, newspaper provision, and activities. One recent product of this has been the introduction of fish and chip meals, in the paper, from the local chip shop. The menus are evolving, and three main meals are offered every day. An alternative is offered if the main meal is not suitable for any resident. Special diets are also catered for (if a resident is diabetic, for example). Snacks and drinks are also avaliable throughout the day and night. Our Key Worker system also helps to identify the type of activities that would be most apropriate for our service users. Many of these activities will be arranged in the home, and include bingo, cake making, musicians, Scout,Girl Guide entertainment and sing songs, and reminiscence sessions which involve discussions, picture sharing, and videos etc. We have strong links with the local community which enables us to offer our residents opportunities to engage in activites outside of the home. For instance, these include lunch clubs, Mecca Bingo, Rotary Club outings, garden centres, school OAP parties, and supermarket visits. Transport for these events is provided. We also receive invitations to larger social functions at a nearby Care Home. People told us that they can take part in whatever activities are on offer that day, we saw that some people were in the main lounge area watching television, enjoying drinks and snacks. They told us that they were happy at the home, some preferred to sit and do nothing much, and others were sitting with staff at the dining tables, talking, completing puzzles and drawing and painting. One person was sitting in the smaller lounge area which is quieter, he said he preferred the quieter area. We heard staff talking to people appropriately, and taking an interest in what they were doing. We were told that the service has a visiting minister, some people attend a lunch club, and some people attend the local church. Care Homes for Older People Page 19 of 35 Evidence: We were told that people are asked on a daily basis what they would like to do, and staff said they try to get people interested in the various activities on offer. A newsletter is produced by the service every few months. Peoples views and opinions are taken into account when planning and arranging activities at the home. Regular meetings are held for the people using the service. The key worker system is now in place, and people spoken with were aware of who their key worker was. Relatives spoken with confirmed that they can visit at any reasonable time, routines are flexible, and people can make their own mind up if they want to join in with activities or not. We observed that the staff can manage individuals with difficult behaviours, and try to engage them in regard to the activities on offer. We were told that people can see their visitors in private if they so wish. Menus are four weekly, and during our visit we saw that meals served were nutritious, varied, and individuals can choose their option each day. The kitchen was inspected and found to be well equipped, clean and tidy. Fresh food supplies were in need of replenishing, we were told that this is done twice weekly, and that usually, fresh fruit and vegetables were available. Records of fridge and freezer temperatures and hot food temperatures were kept. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: The home has a robust complaints procedure designed to ensure that all residents are protected from abuse in accordance with written policies. All residents and a family member sign upon receipt of a copy of the Complaints Procedure, and the contents are fully explained by the Care Manager. This procedure is also on public display in the entrance hall. Also in the entrance hall is a comments book. It should be noted that our Open Door policy and our frequent review processes will identify any areas of concern. We would consider ourselves to be failing our service users if any residents or families concerns proceed to a formal complaint. If any concerns are raised with members of staff they are all documented, as a matter of policy. These will then be fully investigated by a manager, who will liaise with the relevant parties and take action if it is deemed necessary. A Restraint Policy is in place, although the use of restraint is only possible when Care Homes for Older People Page 21 of 35 Evidence: approved by the Registered Care Manager, who has the support of the family (and appropriate health professionals), and only in exceptional circumstances. All staff as part of their induction programme are made aware of the signs and symptoms of adult abuse. They are also trained to accept that some residents will have varying degrees of mental and physical ability, and this will change from day to day. A whistleblower procedure and policy is in place which allows all staff the freedom to raise any concerns in confidence, with senior management. As part of the induction procedure all abuse policies and procedures are fully explained to new staff. These are refered to and emphasised during the staff reviews, once every three months. The care manager told us that the service promotes the recording of complaints in a transparent manner, and that the home will continue with this approach. The complaints procedure is readily available in the Service User Guide, and is clearly visible on the homes notice board. Minor concerns are recorded in a comments book, and there is a suggestions box sited in the hall. Staff spoken with told us that they are trained to recognise the signs and symptoms of adult abuse during their induction, and also when undertaking the National Vocational Qualification level 2 in care. The required policies and procedures relating to this area were available for us to view, staff sign during their induction to say that they have read and understood them. There had been two Safeguarding referrals made to Social Services, and one complaint received by the service, since the previous inspection. We were kept notified under Regulation 37 of any incident or issue concerning the people using the service. We highighted and discussed the number of falls that had been reported to us, and recommended that the service should undertake to audit these, with a view to ensuring that appropriate and effective contingency measures were in place for those individuals. These should also link in with any personal risk assessment already in place. Staff recruitment records sampled, evidenced that the service has a safe and robust recruitment procedure which included appropriate security checks, identification, application form and two references for new staff. This ensures the welfare and safety Care Homes for Older People Page 22 of 35 Evidence: of the people using the service. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We pride ourselves on our ability to keep the home well maintained and to a good standard of hygiene. This not only visually demonstrates the emphasis we place on maintaining high standards but also ensures all residents comfort and safety. We employ a handyman five days a week, and is responsible for all routine maintenance and testing, as well as redecorating residents rooms upon a change of occupancy. Arrangements are made to decorate long term residents rooms as required. The interior and exterior of the home are fully maintained to a high standard. Furniture is regularly maintained and replaced as required to maintain the comfortable appearance of the home. Care Homes for Older People Page 24 of 35 Evidence: The handyman immediately resolves any defects raised by the Pest Control Contract, or through Environmental Health Inspections. Control of infection is a major concern and the maintenance of the internal building fabric so that it can be easily cleaned is a major factor, and is a main element in the handymans responsibilities. Residents are encouraged to maximise their independence and they are assisted with this where appropriate. To maximise the indepenced of our residents, the home also guarantees the supply of small equipment, such as frames, walking sticks, and rails. The home provides all equipment that is required for the moving and handling of residents who require assistance. These are maintained and tested by the manufacturer to their recommended specification. The home maintains a comfortable level of sheltered outdoor space, as well as gardens which are accessible to all residents including those with mobility problems. Bedrooms are personalised as much as is practicable, with residents personal possesions. We observed the environment, and the improvements that the service had made since the previous inspection. The home is safe and well maintained, with adaptations to suit peoples individual needs. It is decorated and furnished to a good standard that creates a comfortable and homely environment. The home was fresh and clean throughout on the day of the inspection. We observed people in the main lounge, and talked to individuals about the way the lounge furniture was set out. The chairs in the main lounge area were situated too close together, and some people had difficulty in viewing the television. The bathrooms provided sufficient moving and handling equipment for those people who required assistance and support. The laundry area is well equipped for the prevention of cross infection, and has the required sluicing facilities. We saw that individual bedrooms were kept to a good standard of cleanliness and were personalised. The service employs a maintenance person who carries out any required maintenance on an ongoing basis. The home meets infection control standards, we were advised that the home has an effective infection control policy and procedure. We saw that soap dispensers, paper Care Homes for Older People Page 25 of 35 Evidence: towels and protective clothing are utilised, and the service has a weekly clinical waste collection. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Staff at the home are well trained, competent, and are in sufficient numbers to meet all of the residents needs. The low turnover of staff at the home we believe is indicative of the high standards that are set by the senior staff, and opportunities that are in place to enable individuals to develop within a service focused, team environment. Recruitment procedures are robust with CRB checks, written references, and a required complete employment history on the prospective employees application form. We recruit in a fair, open, and non discriminative way, ensuring that we employ individuals with the appropriate skills and experience. All staff will receive a Contract of Employment and their Job Description (which is attached to the contract). All new staff willl undergo a comprehensive induction programme that includes a separate Health and Safety booklet. Care Homes for Older People Page 27 of 35 Evidence: The home is committed to training and all staff receive constructive, positive and meaningful in house training. The Care Manager prioritises training and encourages staff to undertake external courses, qualifications beyond those dictated by the basic requirements. This helps us to ensure that the service we provide is of the highest possible standard, from a training and qualifications perspective. Statutory Training (in manual handling, control of infection, and fire safety) is usually provided by external services, but within the home. This ensures that it is structured around the infrastructure of Summerfields itself and engages with the equipment that is available. National Vocational Training is also encouraged and individual staff members willingness to participate is discussed as part of the recruitment process. The senior management along with the rest of the staff are totally committed to NVQ training schemes. Staff are aware of their own limitations and are encouraged to take ownership of their development, further to meetings with the Care Manager. Staff meetings are held regularly and it is compulsory for all staff to attend. These are essential for team building, engaging with the opinions of all staff, managing change, and reinforcing the expectation of high standards. The number of staff on duty during the inspection was satisfactory to meet the needs of the people using the service. Three staff files were examined and all evidenced that a safe and thorough recruitment practice was in place. This included two written references, criminal records bureau checks, application forms that covered gaps in employment and the required identification certificates and photograph. Male staff are also recruited to the home, this promotes equality and choice. All staff within the home had received mandatory and update training, according to their roles and responsibilities. The registered manager told us that she prioritises training, and enables staff members to undertake external qualifications beyond the basic requirements. This ensures a consistent and needs led service for the people using the service. Care Homes for Older People Page 28 of 35 Evidence: National Vocational Qualification training is a high priority for the management and staff working at Summerfields House. The staff we spoke with confirmed that they were either in the process of undertaking this award, or that they had applied for it. Regulation states that 50 per cent of the workforce must be trained, Summerfields House exceeds this level. Staff told us of their commitment to caring for the people using the service. They could tell us exactly how individuals were cared for. They told us that they were happy in their work, and that current staffing levels were enough to meet peoples needs. The cook reportedly helps out as part of the care staff for an hour or two in the mornings, and then returns to her duties as cook. This reportedly works out well. Staff said that they enjoy running activities for people, and have time to talk to people. There is reportedly a low staff turnover at the service. Care Homes for Older People Page 29 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: The Registered Care Manager has 30 years experience in a caring environment. The Care Standards Manager has been at Summerfields for 9 years and has the Registered Care Managers Award. The home has a clear, structured, and accountable management structure appropriate for its size. It offers leadership and enthusiasm which is cascaded down to all team members. There is an ethos of openess and teamwork in the home allowing staff to deliver a good standard of care in a well organised, and supportive system. All records are kept for a minimum of 3 years and the home has registered with the Data Protection authorities. All policies and procedures are regularily updated and reviewed. An annual Quality Assurance Audit is Care Homes for Older People Page 30 of 35 Evidence: undertaken. The results of this, and the views expressed in Resident Meetings, are used to illustrate where we are doing well and where there is room for improvement. There is also a comment and suggestion book in the entrance hall which is monitored by the Care Manager who will personally follow up on all entries. All residents are aware that they have access to their own files. Residents are encouraged (when possible) to take responsibility for managing their own money and possessions, and are provided with facilities to keep these safe. If this is inappropriate we have a rigorous system, which is secure and documented, which enables us to securely manage this for them. We do encourage these residents to appoint a lasting Power of Attorney and they will be given assistance in doing this if required. The Annual Quality Assurance Assessment document was well completed, and contained good information in relation to the service and how it plans to improve. The document was returned to us on time. There had been two Safeguarding referrals received by Social Services, and one complaint made to the service since the previous inspection. The complaint had been amicably resolved. Staff spoken with, and records seen confirmed that staffing levels had been maintained, appropriate update and mandatory training had been undertaken. Staff meetings are held regularly, and staff supervision is undertaken. Recruitment files seen evidenced that the service has a safe and robust system of recruitment in place. Relatives and people spoken with during our visit told us that they were happy with the staff, and the services provided. We were told that staff spend time talking to people, and that they enjoy their work, this was also directly observed during our visit. Daily organised activities are on offer for those people who want them, people have a choice in what they do each day. Regular meetings are held for the people using the service, and one to one discussion takes place each day in regard to choices of meals. The home has a well developed quality assurance process which covers all aspects of living within residential care. The results are available on the notice board. The care manager confirmed that the results were evaluated and any areas which demonstrated that individuals or their relatives were dissatisfied was discussed with the individual or their representative. This demonstrates that the home strives to ensure that people using the service are aware of the services and activities available to them. Care Homes for Older People Page 31 of 35 Evidence: Individuals are helped to take responsibility for managing their own money wherever possible, and are provided with facilities to keep their valuables and money safe. Where the home is responsible for a persons money, there is a rigorous system in place whereby clear records are maintained and receipts kept for all purchases made on behalf of individuals. The service is well maintained, and has an ongoing rolling programme of redecoration and maintenance. Care Homes for Older People Page 32 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Consideration should be given to the purchase of an appropriate Medication cabinet, which meets the Misuse of Drugs (Safe Custody) Regulations 1973, and which would ensure the safe administration of medication. Regular audits of falls should be undertaken. With a view to ensuring that appropriate and effective contingency measures are in place for those individuals. These should also link in with any personal risk assessment already in place. Consideration should be given to the layout of the main lounge chairs, which were too close together and resulted in people not being able to comfortably view the television. 2 18 3 19 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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