Care Home: Summerhayes

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What the care home does well A relative of someone who lived at the home commented `In my opinion it is the best care home in the area.` A visiting health professional surveyed said `A really excellent care home.` People`s needs are assessed so that the home knows what support they require, and people can access good information about the home, before a decision is made that an individual will move in. This promotes the success of any admissions to the home. People benefit from contact with their friends, family and the community around the home, which the home fully supports. They enjoy a varied and wholesome diet, eaten in surroundings that suit them as individuals. They are enabled to lead their chosen lifestyle, and are supported to enjoy activities of interest to them as an individual. People feel they are treated with respect, as the staff uphold their privacy and dignity. People can have confidence in the home because it is led and managed appropriately. The home`s policies and practises ensure complaints, concerns and opinions are heard and acted upon. The accommodation is clean and there is a relaxed, family atmosphere, with ongoing improvements being made in line with people`s needs. People`s personal, health and social needs are currently met. They are supported by sufficient numbers of staff who are caring and who are able to meet their needs safely. What has improved since the last inspection? Contracts are given to people when they are admitted to the home, to help ensure they are aware of their rights and responsibilities. Pre-admission assessments of people`s individual needs are recorded. Individuals are then involved in the initial drawing up of their care plans and in reviews, being consulted about any changes made. Care planning includes assessments of identified risks and how these may be minimised. Recreational opportunities have been improved to meet people`s individual social and psychological needs. There is a record of all complaints made to the home, including details of the home`s investigation and any action taken. The laundry floor and walls have been made easy to keep clean. Mrs Mason has consulted the local fire authority about fire precautions at the home, to ensure that people living there are protected from the risk of fire. Mrs Mason is undertaking the management qualification recommended for her new role. What the care home could do better: Whilst we can see improvements in care planning systems, making individuals` plans of care clearer and person-centred throughout would help to ensure that people`s needs will be met as individuals wish, and consistently, in the longer term. Aspects of medication management have been improved but further action must be taken to ensure the safekeeping and safe administration of people`s medicines. There has been much renewal of the fabric of the home, but evidence of regular inhouse maintenance and safety checks, including for Legionella, would further help to assure people that their accommodation remains safe and well maintained. Seeking advice from relevant professionals before using equipment without fittings provided by the manufacturers would ensure people are always moved safely and comfortably. People would benefit over time, as their needs change, if staff had more training related to the needs of people living at the home or the needs of those for who the service is intended. Also, increasing staff knowledge of local safeguarding procedures would give people living at the home greater protection from harm. Other action is also needed to ensure the home is run entirely in the best interests of people living at the home and with full regard for the health and safety of everyone there. More information is needed when recruiting staff, for example, to better protect people from unsuitable staff. And relevant records must be kept for money or other valuables handed to the home for safekeeping. Key inspection report Care homes for older people Name: Address: Summerhayes The Square Sandford Crediton Devon EX17 4LN     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: Rachel Fleet     Date: 2 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Summerhayes The Square Sandford Crediton Devon EX17 4LN 01363777070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Info.summerhayes@btconnect.com Mr Andrew Charles Fraser Mason,Charlotte Ann Mason care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 14. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability aged 65 years or over on admission (Code PD(E)) - maximum of 3 places Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Summerhayes is a care home providing personal care and accommodation for up to 14 older people. The home does not currently admit anyone who needs assistance from two staff regularly overnight, as usual staffing levels mean such needs could not be met. It cannot provide nursing care other than through the local community nursing services. Care Homes for Older People Page 4 of 36 Over 65 14 3 0 0 3 1 1 0 2 0 0 8 Brief description of the care home The home is a large detached, older style property with well maintained gardens and a parking area. It is in the village of Sandford just outside the town of Crediton. There are bedrooms on both the ground and first floor, with stair-lift access between floors. All bedrooms have a handwash basin except for one, which the owners are currently addressing. A bath with adaptations for people with mobility problems is on the ground floor, with a shower room upstairs. Also on the ground floor, there is a large lounge and separate dining room, with level access to the garden, which has a covered terraced area at the front of the house. The owners are progressing a planned programme to upgrade the accommodation and facilities, having acquired the home within the last 2 years. At the time of this inspection, the homes weekly fees were £391 - £566.50 per week. Fees varied according to the room being offered, but the level of care required by individuals did not affect the fee. A fee is also charged to cover escort and mileage costs to health appointments (based on the hourly wage of the staff on duty at that time of day), if a resident or their family wish the home to provide this service rather than making their own arrangements. However, the home provides free transport in the Crediton locality, with a staff escort if necessary, to meet peoples social needs and wishes. Our inspection reports are available in the entrance to the home. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place as part of our usual inspection programme. Our unannounced visit to the home took place over 10 hours, on a weekday. Before our visit, we had sent the home a questionnaire (the Annual Quality Assurance Assessment, or AQAA), which was returned by Mrs Charlie Mason, the homes registered manager and owner. The AQAA included the homes assessment of what they do well, any plans for improvement, information about people living at the home, staffing, policies, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 7 staff. We sent surveys to 7 health and social care professionals who support people living at the home. We received 7 surveys back from residents, 5 from staff, and 3 from the professionals. All were positive about the home. Care Homes for Older People Page 6 of 36 We spoke in some depth with 5 of the 11 people who were living at the home on the day we visited, and met others more briefly. We talked with a visitor and 4 staff (care and ancillary staff), as well as looking around the home. We case-tracked 3 people who lived at the home, which means we looked in more depth at their care. They included people new to the home since our last visit, someone with more complex or changing needs than other people at the home, and someone who did not have relatives to support them. We read their care records and related information (medication records, etc.). We met them, and observed some of the care and attention given to them, as well as speaking to staff and looking at the accommodation in relation to their needs. We checked staff recruitment files, information on staff training, quality assurance information, and records relating to health and safety (such as accident and maintenance records). We ended our visit by discussing our findings with Mrs Mason, who assisted us fully during the inspection. Information included in this report is from all these sources, and from communication with or about the service since our last inspection. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Whilst we can see improvements in care planning systems, making individuals plans of care clearer and person-centred throughout would help to ensure that peoples needs will be met as individuals wish, and consistently, in the longer term. Care Homes for Older People Page 8 of 36 Aspects of medication management have been improved but further action must be taken to ensure the safekeeping and safe administration of peoples medicines. There has been much renewal of the fabric of the home, but evidence of regular inhouse maintenance and safety checks, including for Legionella, would further help to assure people that their accommodation remains safe and well maintained. Seeking advice from relevant professionals before using equipment without fittings provided by the manufacturers would ensure people are always moved safely and comfortably. People would benefit over time, as their needs change, if staff had more training related to the needs of people living at the home or the needs of those for who the service is intended. Also, increasing staff knowledge of local safeguarding procedures would give people living at the home greater protection from harm. Other action is also needed to ensure the home is run entirely in the best interests of people living at the home and with full regard for the health and safety of everyone there. More information is needed when recruiting staff, for example, to better protect people from unsuitable staff. And relevant records must be kept for money or other valuables handed to the home for safekeeping. 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 36 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 36 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. Peoples needs are assessed so that the home knows what support they require and people can access good information about the home, before a decision is made that an individual will move in. This promotes the success of any admissions to the home. Evidence: We saw a pre-admission assessment for one person admitted to the home since our last visit, which was generally comprehensive and detailed. It included the persons current interests and social activities that they enjoyed, and their needs and preferences. There was less about any needs arising from the persons mental health condition, although some relevant information had also been obtained from health and social care professionals supporting the person in relation to their previous care setting. Our conversations with Mrs Mason showed that she had considered some of the implications of these needs for the person, should they go to live at the care home. We discussed consideration of other, longer term, implications also. Care Homes for Older People Page 11 of 36 Evidence: Mrs Mason told us that if someone was offered a place at the home after such an assessment and it was accepted, the home then sought more information on the persons life history, to help staff know them as an individual. We saw this had also been obtained. Three community health or social care professionals thought the homes assessment arrangements usually or always ensured that accurate information was gathered, with the right service then planned for the individual. Mrs Mason told us that if a resident is admitted to hospital, she re-assesses their needs again before they are discharged, to ensure that the home can still care for them appropriately. All surveys for people living at the home said they had received enough information to help them decide if the home was the right place for them, before they moved in. Six said they had been given written information about the homes terms and conditions, with one saying Dont know. We noted the homes Service User Guide, available in the homes entrance hall, was comprehensive and in large print. Staff we spoke with felt that they got relevant and sufficient information about people newly admitted to the home, to help them look after them properly from the day that they moved in. Care Homes for Older People Page 12 of 36 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 feel they are treated with respect, as the staff uphold their privacy and dignity. Their needs are currently being met, but because individuals plans of care are not always clear and person-centred, there is a risk that their needs may not be met as individuals wish or consistently, in the longer term. Practises are not sufficiently robust to ensure peoples medication is managed safely. Evidence: All surveys from people living at the home said they always or usually received the care and support they needed, and that staff were always or usually available when needed. When asked, in surveys for people living at the home, what the home does well, two comments received were General care and attention is good. Staff all helpful and Care. A health professional commented Very caring; excellent quality of care in terms of health and social wellbeing. Care staff we spoke with clearly knew people, their needs, routines and preferences well. Ancillary staff also spoke about people living at the home as individuals, showing that they knew enough about them to work alongside them or with them in fulfilling Care Homes for Older People Page 13 of 36 Evidence: their particular roles. Of 5 staff surveys we received, 4 had said the individual was always given up to date information about the needs of the people they support or care for, with 1 saying usually. Most people we spoke with knew there was a written care plan about them, telling us that it was discussed with them and that staff added to it regularly. We saw that the wishes of, or suggestions from, next-of-kin or other advocates were also taken into account. Three community health or social care professionals thought peoples needs were usually or always properly monitored, reviewed and met by the service. We found a care plan in each bedroom we visited, including for those people who did not seem to know about their care plan. The care plans were comprehensive, had been regularly reviewed and updated. They included peoples current needs and wishes, as well as their wishes regarding end of life care should their health deteriorate or in the event of sudden collapse. In one case, the information in the bedroom was not up to date but we saw recently updated computerised records which Mrs Mason said would be printed out. We discussed with Mrs Mason that although, when we looked at care records for the 3 people we case-tracked, there was a person-centred approach evident in care planning, this needed further work. We saw very useful information on the daily routine of someone who for health reasons might not be able to tell staff what they usually did or preferred to do. However, we also read a care plan indicating staff should adjust someones diet with regard to their weight, but without indicating here if there were problems relating to the persons weight, if it was increasing or reducing, etc. People were noted to be Christian but without indicating if they were practising Christians. Information had been obtained about their specific interests, hobbies, etc., but there was nothing in their care plans about these or how they were to be enabled to enjoy them. The computerised care plan package used by the home included information that should be removed where it did not apply to a particular individual. In places, this had not been done, so it was not always clear there what actual care and support the person wished to have or should have. For example, it was noted that someone did not wish to have baths (which the person confirmed), but the text continued as though they were to be assisted to have baths. In 2 care plans, it was stated the individuals had no capacity to make informed decisions, when this clearly was not true. We also noted that sometimes peoples health problems were not reflected in care plans - for example, regarding care planning on mobility when someone had a Care Homes for Older People Page 14 of 36 Evidence: diagnosis of Parkinsonism, which can affect mobility in various ways. We noted that pre-admission information about one person who had mental health problems indicated they liked to be sociable, as we observed during our visit when in the persons company, and as the person themself told us. Yet their care plan said they liked their own company, and we saw that they were sat on their own sometimes. We saw staff spent little social time with them during our visit. Staff told us the person often had visitors to occupy their time. Three community health and social care professionals thought the service always sought advice and acted on it to meet peoples needs and improve their wellbeing. One went on to say they were particularly impressed about the home, on this point, saying the home had advocated strongly for one person to get them specialist assessment and services, as well as getting prompt advice on the Deprivation of Liberty Safeguards and any obligations under the Mental Capacity Act 2005. All surveys for people living at the home said the home always made sure they got the medical care they needed. We noted that someone who had dementia was given high calorie snacks or cut-up fruit regularly through the day, as well as finger food at lunchtime. Although we did not note this was part of their written care plan, it is very good practise, as people with dementia can be at risk of not eating enough and may need food that can be eaten easily. Also, when this person said they were hungry as preparations began for lunch, staff told them they would bring them their lunch, did so straight away and explained what the meal was. This again helped to ensure the person ate well since people who have dementia may not recognise food, and by ensuring they did not get agitated or distressed through being kept waiting. Mrs Mason told us that none of the current residents required regular visits from the community nursing service. People told us that staff were observant, noting if they were under the weather or unwell, providing extra help at such times and contacting the GP. Care records showed that people were also enabled to attend hospital appointments, regarding both physical and mental health needs. The home had the services of a visiting optician and a chiropodist. We were told that no-one self-medicated currently. The homes medication policy was readily available to staff. During our visit, we noted they administered peoples medication individually, signing after each person had taken their medication, as indicated in the policy. But they took medication around in the blister packs from the supplying pharmacy, without having any means of quickly storing it securely in an Care Homes for Older People Page 15 of 36 Evidence: emergency. Mrs Mason agreed to obtain a suitable, lockable, storage facility. We found a handwritten direction that had not been signed by 2 people to verify its accuracy, where others had been, which Mrs Mason said she would address. Where a variable dose of medication had been prescribed, staff had not recorded what dose they had given the individual. Two people were prescribed a pain-killer for use when needed, and had been having it regularly. Staff told us that their GPs had been made aware, and one was coming to review one person as a result. Dates of opening had been recorded on skin creams so that staff could monitor shelf-life thereafter. It was usually but not always clearly indicated where the creams were to be applied - efforts should be made to have consistently good information for staff. One medication was being stored in the controlled drug cupboard. Non-medication items were being stored there, which is not good practise. The fridge used for 2 items requiring cool storage was also used for milk containers. Mrs Mason told us these were only ever unopened containers, but agreed that medication would be kept in a container to reduce cross-infection risks. We spoke with someone who wished to remain in their bedroom rather than use the communal rooms, and they said staff respected this. People confirmed that staff knocked before entering their room. One person added that if they rang their call bell, staff did not knock before entering because they knew the person would only ring if there was an emergency; the person was glad that staff knew them well enough for this response to happen. People confirmed that their post was brought to them in a timely manner, for them to open themselves. Bathrooms and toilets had working privacy locks. Health and social care professionals thought the service respected peoples privacy and dignity. One commented in their survey Affords my client dignity, respect and a safe, supportive care environment, where they have thrived and settled despite their reluctance to accept their need for assistance. Care Homes for Older People Page 16 of 36 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 benefit from contact with their friends, family and the community around the home, which the home fully supports. They enjoy a varied and wholesome diet, eaten in surroundings that suit them as individuals. They are enabled to lead their chosen lifestyle, and are supported to enjoy activities of interest to them as an individual. Evidence: Of surveys for people living at the home, most said the home always or usually arranged activities they could take part in if they wished; 1 person said this happened sometimes. People we spoke with said they had enough to do with their time. Someone we met who had a sensory impairment told us that they couldnt join in with organised group activities because of it but they enjoyed going out into the garden. Other people also said they enjoyed using the garden. Some confirmed that the number of outings had increased since our last visit, as stated in the homes AQAA. Care staff told us that the number of organised activities had increased also. More recently these had included a trip to a chicken farm, which staff explained had a coffee shop that people enjoyed visiting. Records showed people had, in the last week, participated in a range of recreational activities - quizzes, listening to a storyteller (a number attending this during our visit), Care Homes for Older People Page 17 of 36 Evidence: exercise sessions, doing puzzles (also as seen during our visit), playing dominoes and Famous faces, with chatting, watching TV, listening to music, reading the newspaper and the hairdressers visit also recorded as recreational occupation of time. Other arranged activities included discussing the royal family, card making, cooking and aromatherapy. We observed that people joined in if they wanted to, during our visit. A church service was held at the home for anyone wishing to attend. Of surveys for people living at the home, most said staff always or usually listened and acted on what the individual said; 1 person said this happened sometimes. Three community health or social care professionals thought the home usually or always supported people to live the life they chose wherever possible. They also thought the homes manager and staff usually or always had the right skills and experience to support peoples needs, including responses to their more diverse needs. When we asked staff how they knew peoples personal preferences, they said they found this out from peoples care plans, from asking people, or by offering them choices. We saw care plans had information on peoples preferred bedtime and rising time, etc. One person confirmed that they liked having a cup of tea at 6am and assistance with a full wash, as indicated in their care plan and daily care notes. Another person said they had a shower rather than a bath, which was also indicated in their care plan. Several people living at the home were from the local area so had known each other for years, as well as knowing the staff from the local area. Some told us they went out to the local village, where they had lived and worked. During our visit, one person went out to a local community centre. The AQAA stated that the home provided free transport to take people to church, clubs, groups, shops or visiting, etc. People told us that visitors were made welcome. When asked what the home did well, a relative commented Make me as a visitor very welcome. I do come very regularly. A visiting professional, commenting on what the home did well, said An extremely warm welcome. Activity and social events, recorded by staff in relation to each person, showed that some were enabled to ring family or friends. All surveys for people living at the home said they always or usually liked the meals at the home, which was reflected by the people we spoke with. Asked what the home did well, someone living at the home commented Food. People said they could have breakfast in bed, or have their meals in their room, if they wished. One person who chose to eat in their room confirmed that food was still sufficiently hot when brought to them. The menu for the week of our visit showed a variety of dishes. Care Homes for Older People Page 18 of 36 Evidence: Lunch was the main meal of the day. During our visit, the choices offered were chicken and vegetable pie (made with fresh vegetables) or sausage, egg and chips, followed by fruit and custard, icecream and fresh fruit. The teatime menu was quiche, sandwiches, home-made cake, yogurt and fruit. Dishes of freshly cooked vegetables were taken round at lunchtime, so that people could help themselves or indicate to staff how much they would like. There was a relaxed atmosphere. One person called out to the cook in the near-by kitchen to ask for more chips, sharing in the subsequent laughter and banter from their dining companions. We discussed with Mrs Mason that people eating in the dining room had salt and pepper available, and were offered a drink with their meal, yet someone eating in the lounge was not offered these or the extra vegetables. Care Homes for Older People Page 19 of 36 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. The homes policies and practises ensure complaints, concerns and opinions are heard and acted upon. Staff lack some knowledge about local safeguarding procedures, with a subsequent risk that people at the home may not be as fully protected from harm as possible. Evidence: All surveys for people living at the home said there was someone they could speak to informally if they were not happy, and they all knew how to make a formal complaint. Three community health or social care professionals thought the home usually or always responded appropriately if they or someone else raised any concerns. All staff surveyed knew what to do if someone had concerns about the service. The complaints policy is clear and appropriately worded with current contact details for external organisations. We have not received any complaints about the home since our last visit. People we spoke with said they felt able to raise any queries or say if anything were wrong. We looked at the homes record of any complaints it had received, which showed there had been 2 since our last visit. We noted that the manager had offered to meet a complainant after a period of time to check if the issue had been resolved, which is very good practise. Care Homes for Older People Page 20 of 36 Evidence: People we asked confirmed that they felt safe with the staff, both in terms of their skills and as individuals. Staff we spoke with appropriately described what might be considered poor or abusive practise, and knew about their responsibility to report it, being clear about their roles within the home and who they would tell. However, they were less clear about the range of external services they could also contact, if necessary, or where this information might be found. The homes safeguarding policies that we read did not include information for staff on reporting concerns to relevant local organisations (i.e. the police or Care Direct of Devon County Council) if necessary. Care Homes for Older People Page 21 of 36 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. People benefit from a clean home that has a relaxed, family atmosphere, and where ongoing improvements are being made in line with their needs. There has also been much renewal of the fabric of the home, but evidence of in-house maintenance and safety checks would further help to assure people that their accommodation remains well maintained. Evidence: The AQAA stated that since our last visit, the main hallway had been redecorated and carpeted through, 5 bedrooms had been re-carpeted and 4 redecorated, with everyone to be offered redecoration of their room. The gardens had been improved, with new garden furniture and garden games also purchased. Some people voiced particular appreciation of the homely feel of the accommodation. People we asked were happy with their bedroom and its facilities, as well as with the rest of the home. Some bedrooms had access to the veranda, with the garden beyond. One person had no wardrobe in their room. We were told it had been removed to create more space when the person needed hoisting, but we noted the hoist was no longer used. Mrs Mason said the storage arrangements for their clothing was working well but agreed to keep the situation under review. One person we case-tracked had impaired sight, and another liked to do embroidery Care Homes for Older People Page 22 of 36 Evidence: both said the lighting was sufficient for them. Communal rooms had sunny aspects. The home felt warm throughout; one person pointed out that they could control the heat of their bedroom radiator as they wished. People we asked, who lived at the home, felt there were enough aids and adaptations provided. Some thought the new stair-lift was particularly helpful. Mrs Mason said the home also had a stair-walker - obtained when the lift broke down (which is unviable to repair or replace at present). Written signage was provided on shared facilities such as toilets. A bath downstairs had adaptations for people with mobility problems; there was an ordinary domestic shower cubicle upstairs. We noted a toilet had a handrail on one side only, which could be unhelpful to certain individuals. A health professional, when asked what the home could do better, said Better decor. I think this is being planned already. Mrs Mason said such matters would be fully addressed in the ongoing refurbishment of the home, with upgrading of bathroom facilities a high priority as these areas looked in need of attention. One person told us there had already been enormous changes, adding that standards of care had still been maintained. One person told us people could always ask for help, there being a call bell in every room. The home had a new call bell system, which was portable. Asked what the home could do better, a staff member commented Provide better staff facilities. At present, there is no private office space within the home, but plans have been submitted to create this. Since our last visit, a new kitchen has been fitted in line with environmental health requirements, and the laundry room has been redecorated and re-floored to meet hygiene standards. Fire safety measures have been improved, in consultation with the fire service. Electrical circuits and plumbing has also been replaced or upgraded, to meet relevant regulations There were written risk assessments for both the internal and external environment. We found that some stated that regular checks should be made, but we found no record was being kept of these checks to show that the need for any routine maintenance was being monitored and addressed. All surveys from people who lived at the home indicated the home was always fresh and clean. The home looked clean generally during our visit, although some high dusting was needed in one or two places. Staff felt minor repairs were addressed sufficiently quickly (with Mr Mason acting as the homes handyman), and told us that they had contact numbers that they could use for external professionals such as plumbers and electricians. Care Homes for Older People Page 23 of 36 Evidence: We saw stocks of disposable gloves, paper towels and disposal bags in bathroom and toilet areas. People living at the home told us that staff wore disposable gloves when assisting them with personal care. Staff described appropriate practises for minimising cross-infection, including use of disposable aprons and hand-washing as well as wearing gloves. We saw staff wearing fresh disposable aprons when serving food. The laundry had washable surfaces - an improvement since our last visit - and handwashing facilities for staff. Our conversations with care staff confirmed that the washing machine had suitable programmes for thorough cleaning of laundry, and they knew which to use. They also had access to soluble bags for containing any particularly soiled items, reducing cross-infection risks from handling of such items as these bags are put into the machine. Mrs Mason agreed to review movement of laundry bags, as we saw one being dragged, which had possible implications for staff and the environment. Some moving equipment was kept in individuals rooms if it was required for their care. Staff confirmed that a handling sling we saw in someones room would be used by that person only, which is good practise as it reduces cross-infection risks. Care Homes for Older People Page 24 of 36 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 the home are supported by sufficient numbers of staff who are caring and who are able to meet individuals needs safely, although people would benefit if staff had more training related to the needs of the people they support. Recruitment practises are not as robust as possible for protecting people from unsuitable staff. Evidence: When we first arrived, there were 2 care assistants on duty with Mrs Mason, the cook and a housekeeper. We were told that 2 care staff were on duty every day until 10pm. Overnight, there was an awake care staff member, with a sleep-in staff member (usually Mrs Mason) on call. A cook was employed to work every day until midafternoon, whilst care staff undertook some housekeeping duties at week-ends when there was reduced domestic staff cover. Of staff surveyed, 3 thought there were always enough staff to meet peoples individual needs, 1 thought there usually were, and 1 did not respond to this question. The rota reflected these staffing arrangements except that Mrs Mason herself was not on the rota, to show when she was the on-call staff member at night or the hours she worked in general, being the homes manager, etc. She agreed to remedy this. Mrs Mason told us that because of the night staffing arrangements, the home did not admit anyone who regularly required assistance from two people at night. But if the Care Homes for Older People Page 25 of 36 Evidence: needs of existing residents increased due to a temporary illness or other situation, she altered the staffing arrangements to ensure their needs would be met at such a time. Peoples comments about the staff included that they were very good and very nice and helpful, with confirmation that people felt there were enough of them around. A visiting professional commented Very well led. Excellent staff. A relative commented on the Extensive nursing experience of manager and her motivated staff. Another said Every staff member gives over 100 to all residents at all times. One person living at the home added that although staff were busy, they were available to people; another person indicated they felt they couldnt ask for an extra bath because of the demands already on staff. Staff told us that they had enough time to read care-related information about the people they looked after, as well as to chat to them and lead some of the planned activities. A visitor commented I find the staff here very sociable and kind to my relative. There seems to be someone around at all times within shouting distance. Care staff we spoke with had worked at the home for a minimum of 3 years. We looked at the recruitment records for the 4 care staff employed since our last inspection - 3 being employed for bank or occasional work, and 1 who was employed part-time (who had worked at the home previously). Two satisfactory references (including 1 from the persons most recent employer), proof of identification, health declarations and police checks were available for each, having been obtained before they began their employment. Copies of certificates for relevant qualifications (such as nationally recognised care qualifications) were available for one but not another. Two people had provided a list of their employment to date, on their application forms, but without including any dates; no-one had given written reasons why they had left jobs where they were working in similar settings. We discussed with Mrs Mason that the homes application form did not prompt individuals to give this information, which employers need. And no interview notes were available, to confirm that any gaps in employment or reasons for leaving previous jobs had otherwise been explored and explained satisfactorily. The home gave an initial, brief induction/orientation programme to new staff on their first day, and they then undertook a full induction programme. This was to nationally recognised standards. we saw some of the staff workbooks, which were marked externally by the company supplying the induction materials. The AQAA stated that 10 of the 14 care staff had a recognised care qualification. One Care Homes for Older People Page 26 of 36 Evidence: care staff we spoke with had a care qualification but was now undertaking a higher one, whilst a second was undertaking their first care qualification. All staff surveyed said they were given training that helped them understand and meet peoples needs, and that kept them up to date with good practise. When asked what the home did well, two commented Train and support staff to do a good job and Keeps me up to date so that I can do my job well. They also felt they always or usually had enough support, experience and knowledge to meet peoples diverse needs. Mrs Mason kept an overview of staff training, to show which staff were due refresher training. The annual training programme included various safe working topics, person-centred care, dementia care, and communication. Four staff had also undertaken a course on dementia through a college of further education. One staff member told us that someone living at the home had been visited by the Speech and Language team, who had then helped staff to learn more about the persons needs and how to meet them. We noted the staff training overview record did not include many conditions or disorders of old age. People we case-tracked had sight problems, for example, and staff we spoke with confirmed they had not had recent updates on this topic. Care Homes for Older People Page 27 of 36 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. People can have confidence in the home because it is led and managed appropriately. Some further action is needed to ensure it is run entirely in their best interests and with full regard for the health and safety of everyone at the home. Evidence: Mr & Mrs Mason were registered as providers of Summerhayes in June 2008, and are continuing their planned development and improvement of the service. A staff member commented The present owners in a short time have brought in changes, all for the better. Mrs Mason always gives her full attention to the smooth running of the home. Mrs Mason is a Registered General nurse, who achieved a BSc (Hons) in Nursing Studies since qualifying, and who has worked as a senior nurse managing care. Her last job related to the introduction of certain national standards for the health care of older people. She has recently begun the management qualification now recommended for managers of care services, hoping to complete it by October 2010. Care Homes for Older People Page 28 of 36 Evidence: The homes AQAA was thorough and detailed. It included how the home had addressed the requirements and recommendations made at our last inspection. Complaints and peoples views or survey results were used in assessing how well the home was doing and where it could improve. Equality, diversity and human rights matters had been given much thought. Staff we spoke with confirmed they had one-to-one supervision with senior staff. They said their manager met with them regularly to discuss their work, and gave them enough support. Staff recruitment, however, was not sufficiently robust to protect people living at the home from unsuitable staff. Staff surveyed thought information-sharing within the team usually or always worked well. A communication book was used also for raising queries, noting repairs that were required, etc. Staff meetings were said to be useful. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. The manager said they had spoken with relevant professionals about use of a lap-belt on someones chair, but had been told they did not need an authorisation in the specific circumstances. The lap-belt was no longer used, as the persons risk of falling had reduced. People told us that there were no residents meetings, but said they received a newsletter - which we saw in peoples bedrooms. They also felt able to talk with Mrs Mason, with some saying they could ask to see her if they wished or that she was readily available around the home. Asked what the home did well, a staff member commented Encourages both staff and residents to have their say and involvement. One person also recalled that they had been given a survey to complete. These are sent out annually by the home. The homes quality assurance policies indicated that surveys were sent to professionals and staff as well as to residents. We saw some of the returned surveys, although results are still to be collated and compiled into an action plan, for development of the home based on the views of those who use the service. The home did not hold money for minor expenses on behalf of people living there. Instead, people were sent a monthly account, thus paying in arrears for hairdressing, chiropody, etc. Staff we spoke with said they did not handle peoples money other than occasionally doing shopping for someone, taking payment from the individual Care Homes for Older People Page 29 of 36 Evidence: after giving them the items with the receipt. We found the home was holding cash for some people, without keeping a proper record of this, etc. The homes Statement of Purpose says that lockable facilities can be fitted in peoples rooms, if they wish, for safe storage of valued items. Staff we asked felt that they had sufficient and appropriate equipment and facilities to do the work required of them safely and properly. The AQAA indicated servicing was up to date. We saw evidence that portable electrical appliances and lifting/moving equipment had had safety checks within the last year. Mrs Mason said the stair-walker was due to be serviced soon. Where we checked upper windows, all but one window was restricted, which Mrs Mason said she would attend to urgently. As noted under the section on Environment, no routine safety checks were recorded as might help the home themselves to identify such an issue. We noted an open ground floor window could be opened wide, and we discussed whether this was a security risk. Mrs Mason said that staff always locked such windows in the evening. Mrs Mason told us that the water board had visited the home recently. She confirmed that some measures were in place that would control risks from Legionella, but this still needed a written risk assessment, etc. A new thermostatic valve was to be fitted for the bath by 30/11/09. We saw records showing that staff checked bath water temperatures before bathing someone. We saw someone was moved in a wheelchair without footrests. We noted that their feet were in a position that could lead to them falling forward from the chair. We were told that the person wouldnt keep their feet on the usual footrests, and that staff usually pulled the chair backwards to reduce such a risk. Mrs Mason agreed she would ask for advice from relevant professionals, to ensure the person was transported appropriately. The kitchen had dedicated hand-washing facilities. Food stores, fridges and freezers looked clean and orderly, with cleaning schedules drawn up and up to date. Food portions in fridges were covered and dated. The cook confirmed they had undertaken the Environmental Health Department training on food safety. The homes resuscitation policies stated that there would always be a first aider on duty, which Mrs Mason was able to provide evidence of when we looked at the rotas. Staff we asked about first aid matters were able to describe signs of a fractured bone, which they would look for if someone fell, for example. They also confirmed that they took part in fire drills, which we saw were also discussed in the residents newsletter. The staff training matrix indicated all staff had been updated on fire safety matters. Care Homes for Older People Page 30 of 36 Evidence: Mrs Mason confirmed she had sought advice from the local fire and rescue service on fire safety matters, since our last visit. Care and ancillary staff confirmed they had had training on safe handling of loads. Care staff told us that their training had not involved observation of their practical techniques, but one added that they worked with visiting physiotherapists thus developing appropriate techniques. They also said no-one currently required the use of a lifting hoist, and only 1 person needed 2 staff to assist them, as appeared to be the case during our visit. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 19 The registered person shall 24/02/2009 not employ a person to work at the care home unless the information and records specified in paragraph 1-9 of schedule 2 have been obtained. To ensure that people living at the home are protected by the recruitment procedure. IMPROVEMENT BUT NOT FULLY MET. Care Homes for Older People Page 32 of 36 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 9 13 The registered person shall make arrangements for the safekeeping and safe administration of medicines in the home through Provision of safe, securable delivery/transport systems for medication administered to people living at the home Recording the administration of variable dosage medication, including the reason for giving the medication and the dose given So that peoples medicines are managed safely, and their health needs are met. 16/12/2009 2 35 17 You must keep a record of 16/12/2009 all money or other valuables you receive for safekeeping on behalf of anyone living at the home, providing a receipt, & with reference to Page 33 of 36 Care Homes for Older People 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 Standard 35 and as detailed in Schedule 4.9 (a) & (b) To protect the financial interests of people living at the home. 3 38 19 You should not employ anyone to work at the home until you have obtained the information required under Schedule 2, particularly Written reasons as to why they ceased to work in previous employment where they were working with children or vulnerable adults And A satisfactory written explanation of any gaps in their employment history To ensure that people are looked after by suitable individuals. 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 16/12/2009 1 7 It is recommended that you ensure everyone has a personcentred care plan that, throughout, clearly indicates their current needs and how staff are to meet them, to ensure individuals needs will be met consistently and appropriately over time. Page 34 of 36 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 2 9 Only medication should be stored in medicine storage facilities, with other arrangements made for storage of nonmedication items. It is recommended that, by training or other means, staff know local multi-agency safeguarding reporting procedures, to ensure the home has robust procedures for responding to suspicion of or evidence of abuse. There should be a programme of routine maintenance, with records kept to show it is being implemented, helping to evidence that the home is well maintained. It is recommended that the staff training programme be revised regularly to ensure it includes conditions affecting people currently living at the home, or for whom the home is intended, such as visual and hearing impairment. It is recommended you always seek advice from relevant professionals before using moving or handling equipment without the fittings provided by the manufacturers, to ensure people are moved safely and comfortably. It is recommended you evidence informed assessment of any risks at the home due to Legionella, and take any necessary action subsequently identified, to protect the health of everyone at the home. 3 18 4 19 5 30 6 38 7 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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