Care Home: Summerhill Nursing & Residential Home

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What the care home does well Summerhill provides plenty of useful and accessible information for people thinking of coming to live there to help them make a decision. People are also well supported, through a planned admission process that is a process led by the individual and at their own pace. The senior staff and manager do individual needs assessment with people to provide a comprehensive assessment of individual needs and preferences so they know before people come to live there how a person likes to live their life. This also allows them to prepare people`s rooms with them and make sure any specialist support or equipment they may require is in place for them. The manager and activities staff try to make sure that there are plenty of opportunities for people to be involved in a wide range of activities in the home and there is a full activities programme within the home ranging from bingo to a poetry and film club. The home is well furnished and decorated to a high standard and the atmosphere is relaxed and homely. The home is well maintained, with a clear maintenance programme and safety testing to keep people safe. The gardens are tidy and accessible to people living there and some people, who enjoy gardening, are able to help with planting. The bedrooms in the home are well furnished and people bring in their own things to make it more personal and people have their own keys to their private rooms. The communal areas are warm and welcoming and furnished with suitable chairs for different needs and arranged in informal groups, we saw these areas are well used for group and individual activities. Our expert by experience also observed and commented upon the calm atmosphere within the home and that there appeared to be a happy atmosphere and a good rapport between the staff and people living there. The service has good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their needs. The management team have good systems for monitoring the home`s performance with regular and detailed quality audits and through consultation with the people living there and the staff working there. This helps to make sure they are meeting people`s expectations and helps show if they need to improve any aspects of the service to make it better or safer for people. There are effective complaints and safeguarding systems for the people living there and for staff to help sure that concerns and complaints will be taken seriously, investigated and action taken. The home has a competent management team that display a clear focus on maintaining high standards of care in the home and on supporting staff in professional development to improve the care they give. This now includes staff training in palliative care and dementia care best practice to try make to sure staff understand and know how to manage these areas of nursing practice and care better. The home also maintains good working relationships with local doctors and specialist and district nursing services. The manager keeps CQC informed of any changes or incidents in the home and responds positively to the inspection process and any advice given. There is a good standard of catering in the home and menus show choice and availability of nutritious food both day and night, prepared by the home`s two chefs. The home is clean and tidy and systems are in place to minimise any cleaning issues such as odours. What has improved since the last inspection? Since the last key inspection improvements have continued to be made to maintain the good environmental standards in the home. This includes improving the home`s walled gardens so people with dementia can enjoy and have more safe access to garden areas. Decoration has continued on a rolling programme to maintain high standards of decoration, the assisted bathrooms have been decorated and lighting has been upgraded on corridors. On Windermere suite, for people with dementia and nursing needs, new chairs and settees have been provided to upgrade communal areas. More nursing beds have been purchased so make sure people have appropriate beds for their physical and moving and handling needs and more pressure relieving mattresses to help make sure pressure area care needs are fully addressed. Fire risk assessments have also been upgraded to make sure they are up to date and people living there are kept safe and that the staff training is appropriate. To minimise clutter that might affect the suites where people live all suites now have their own designated storage and there is also improved bin storage. New carpet shampooing equipment has also been bought to improve general cleanliness. New telephone systems are being installed so all suites can have cordless telephones, easier telephone access from outside calls and people have individual numbers for their own telephones. These improvements are still ongoing. Since the last inspection changes have been made to the staff induction training to make it more comprehensive and NVQ training has been extended to catering and house keeping staff. The manager has undertaken additional training on `Customer care` and palliative and dementia care training for staff has been improved with accredited care pathways and `gold Standard` frameworks now routinely in use. The home now has registered nurses who have completed recognised professional training in these two important areas and act as a resource for training and supporting other staff. This should help staff be more aware of and understand the different specific conditions and their management and the care priorities at the end of life. Improvements have been made to the recognition of staff through the organisation`s `personal best` and `one life award` schemes. What the care home could do better: Summerhill has its own effective procedures in place for monitoring and improving practices. The manager acts on areas identified as needing improvement or change such as the continued development of palliative and dementia care. The manager has already identified the need for more opportunities for people to have more outside recreation, through their own consultations, and is taking steps to address this. We recommended that they did so. We have found that the management team welcome suggestions that will help them improve their service to benefit the people living there and work well with other agencies to try to do this. We did not make any requirements at this inspection. Key inspection report Care homes for older people Name: Address: Summerhill Nursing & Residential Home East View Kendal Cumbria LA9 4JY     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: Marian Whittam     Date: 1 1 1 2 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 31 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 31 Information about the care home Name of care home: Address: Summerhill Nursing & Residential Home East View Kendal Cumbria LA9 4JY 01539726000 01539727254 askinsh@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 71 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE, Physical disability Code PD. The maximum number of service users who can be accommodated: 71. Date of last inspection Brief description of the care home Summerhill is a care home with nursing registered to provide nursing and residential care for up to 71 older people. The home is divided into 4 suites as follows: Buttermere for general nursing care, Windermere for nursing care of people with dementia, Grasmere for high dependency personal care with mental health needs and Thirlmere for those people with personal care needs only. Care Homes for Older People Page 4 of 31 Over 65 0 71 0 71 0 71 Brief description of the care home The home is in a residential area of the South Lakeland market town of Kendal and close to the shopping areas, banks, libraries and general amenities. The home has mature and well-tended gardens, including a secure walled garden for Windermere suite. It has patio and seating areas that overlook the town. There is a large car park to the front of the building. The home is on two floors these can be reached by a passenger lift or by stairs. There are attractive dining and communal areas for people living there on each suite and all residents have single bedrooms with en suite facilities. The home has its own kitchen and laundry facilities on site. Fees payable at the home are 700.00 pounds per week to 833.00 pounds a week, depending on individual needs, as at the date of the inspection. There are additional charges for personal newspapers and magazines, hairdressing and private chiropody. The home makes information about its services available through its Service User Guide and Statement of Purpose. There is an information file containing useful information on the home and all the services provided in every persons bedroom. Care Homes for Older People Page 5 of 31 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: The quality rating for Summerhill Nursing and Residential Home is 3 Star/Excellent. This means that the people who live there and use this service experience Excellent quality outcomes. This site visit to Summerhill forms part of a key inspection. Two inspectors carried out the inspection visit and both were in the home for seven hours. The site visit took place on 11.12.2009. We gathered information about the service in different ways in order to help us make a judgement: We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed by the registered manager,Kath Dean, and returned by the date requested. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers of services about their service and how they believe they are meeting Care Homes for Older People Page 6 of 31 outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. We sent out surveys to people living at Summerhill and to the staff who work there to get their views and experiences of the service. We looked at all the information we have about the service, any changes they have made and how the manager has dealt with any complaints or safeguarding vulnerable adults. We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. We spent time during the visit talking to people who live there and to visiting relatives and spent time with them during the day to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with staff to get their experiences of working there. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. We asked an Expert by Experience to visit Summerhill with us. This is a person who because of their shared experience of using services and /or ways of communicating visits the service with us to help us get a picture of what it is like to live in or use the service. We use the information from experts by experience to help us to gather and verify information we have about the service. During the visit we looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people live in and what facilities are available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. We also examined the handling of medication by looking at relevant documents, storage and talking with staff handling medications. Feedback was given to the manager at the end of the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: Summerhill provides plenty of useful and accessible information for people thinking of coming to live there to help them make a decision. People are also well supported, through a planned admission process that is a process led by the individual and at their own pace. The senior staff and manager do individual needs assessment with people to provide a comprehensive assessment of individual needs and preferences so they know before people come to live there how a person likes to live their life. This also allows them to prepare peoples rooms with them and make sure any specialist support or equipment they may require is in place for them. The manager and activities staff try to make sure that there are plenty of opportunities for people to be involved in a wide range of activities in the home and there is a full activities programme within the home ranging from bingo to a poetry and film club. The home is well furnished and decorated to a high standard and the atmosphere is relaxed and homely. The home is well maintained, with a clear maintenance programme and safety testing to keep people safe. The gardens are tidy and accessible to people living there and some people, who enjoy gardening, are able to help with planting. The bedrooms in the home are well furnished and people bring in their own things to make it more personal and people have their own keys to their private rooms. The communal areas are warm and welcoming and furnished with suitable chairs for different needs and arranged in informal groups, we saw these areas are well used for group and individual activities. Our expert by experience also observed and commented upon the calm atmosphere within the home and that there appeared to be a happy atmosphere and a good rapport between the staff and people living there. The service has good systems in place for recruitment and training and this helps make sure that people are supported by the right staff who understand their needs. The management team have good systems for monitoring the homes performance with regular and detailed quality audits and through consultation with the people living there and the staff working there. This helps to make sure they are meeting peoples expectations and helps show if they need to improve any aspects of the service to make it better or safer for people. There are effective complaints and safeguarding systems for the people living there and for staff to help sure that concerns and complaints will be taken seriously, investigated and action taken. The home has a competent management team that display a clear focus on maintaining high standards of care in the home and on supporting staff in professional development to improve the care they give. This now includes staff training in palliative care and dementia care best practice to try make to sure staff understand and know how to manage these areas of nursing practice and care better. The home also maintains good working relationships with local doctors and specialist and district nursing services. The manager keeps CQC informed of any changes or incidents in the home and responds positively to the inspection process and any advice given. There is a good standard of catering in the home and menus show choice and availability of nutritious food both day and night, prepared by the homes two chefs. The home is clean and tidy and systems are in place to minimise any cleaning issues Care Homes for Older People Page 8 of 31 such as odours. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 31 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at Summerhill are given information about the home and have their needs assessed to make sure that the service they receive is based on their personal needs and preferences. Evidence: Clear and comprehensive information about the home and the services provided is available in the Statement of Purpose and service user guide that is given to all people living in the home and people asking about using the service. The documents have been subject to regular review to make sure the information is up to date. A useful information pack is provided for everyone in their bedrooms and this has information on the service, the staff, facilities and about helping people settle into their new home. This level of information helps to make sure that people thinking of coming to live there and their families know what the home can provide to meet their needs and helps them make an informed decision. People living there have contracts and terms and conditions of their residence so they are aware of their rights and responsibilities Care Homes for Older People Page 12 of 31 Evidence: whilst living there The registered manager makes sure an assessment of peoples needs and expectations is done before and when they come to live there so they can be sure they can give them the care and support they need. This includes gathering information from other agencies and health care professionals involved in their care and any treatment. We could see this in peoples care plans where social workers, occupational therapists, mental health teams and medical consultants had been involved in assessing people before and after admission. There is a trial period when people first come into the home to make sure it suits them and that their needs are being fully met. There is also a review as part of this process with the person and those involved in their care and support. We spoke to a relative of a person who had been admitted recently and they were pleased with the admission process and felt they had been given all the information needed to decide about using the home. They told us, Staff were extremely good during the admission and the care given was excellent. Admissions to the home are managed sensitively with the emphasis on supporting people and providing a homely atmosphere. The registered manager has recently completed Customer First training and over the next year it is planned that all staff will have this to help them improve the service for people. People may visit the home to look around and speak with staff, ask questions and spend some time on the units. People thinking of coming to live there are encouraged to have a look around, not by appointment, but when they chose. Surveys we received from people living there indicated they had information before they moved in and a written contract about the homes terms and conditions. A relative of a person living there told us that although their relative had been in only a few months they were Very impressed by every aspect of their care. The home does not provide intermediate care. Care Homes for Older People Page 13 of 31 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. People living at Summerhill receive the care and support they want in a way that protects their privacy and dignity and meets their individual needs and expectations. Evidence: All the people living in the home have a clear and easy to follow individual plan of care, based on their individual initial assessments and stated preferences. Each persons care plan we looked at set out clearly their health, personal and social care needs and, if appropriate, end of life wishes. A lot of background information had been collected with people about themselves, with help from relatives if appropriate. Information about their occupations, interests, family, friends, pets and the things that they valued and wanted in their lives. This information is very useful in giving a fuller picture of the person so staff can know about the individual before they came to live there. We looked at five peoples care plans in greater detail and these had relevant and clear risk assessments in place. These included nutrition assessments, mental health and cognitive assessments, mobility and dexterity, moving and handling, personal Care Homes for Older People Page 14 of 31 Evidence: care, social and cultural needs and preferences and skin and pressure area care. These assessments and associated care plans had been reviewed and changed as needed to make sure they correctly reflected peoples needs and expectations and were clearly working documents. We observed that as part of the homes audit framework for quality monitoring regular checks are done on care plans and on medication records to help identify any omissions or errors early and address them. Relatives we spoke with and people living there all confirmed that the care given was focused on the individual and what they wanted from their care and life in the home. The depth of information and detail in the care plans and on individual expectations and needs helps to ensure that care staff are aware of needs on a very individual basis. We saw that for some people their plans included how they like to structure their day and attention was given to important details. One relative told us, Staff go the extra mile. We could see that care plans are frequently reviewed so information is up to date and any discussions that take place with GPs, relatives and advocates were well recorded and any action taken. There was evidence of prompt referral to general medical practitioners,local health services and also support agencies, dental, chiropody and district nursing services, mental health professionals and physiotherapy. Some members of staff have completed courses on care of the dying and on The Liverpool Palliative Care Pathway and the service is working towards Gold Standard Framework for Care Homes (GSFCH) for end of life care. Systems are in place to provide care and comfort for people whose condition is deteriorating with support from appropriate health care professionals. The management have recognised the need to continue to develop good palliative care and the home now has its own Liverpool Care Pathway champion to act as a training resource for other staff and to promote good palliative care. These pathways and frameworks help to promote cross boundary, seamless care for people if their health deteriorates through working with palliative care specialists and the Primary Care Trust (PCT). It also monitors quality and can reduce the need for people to go into a hospital at the end of their lives for care so they stay in their home environment with people they know and who know them. One of the registered nurses working with people with dementia is the Dementia Care Champion. We spoke with them and they told us about the 13 week training course they had attended to develop their professional and practical skills to support people with dementia in a person centered way. They were using clinically accepted good practice tools to observe and identify areas they could improve and things they could do to improve peoples quality of life and interactions. They put forward their recommendations to the manager and had found the manager and organisation Care Homes for Older People Page 15 of 31 Evidence: supportive to make any necessary changes. They also provided additional training to staff on dementia care to maintain staff awareness of peoples often complex interpersonal needs. We did a spot check of the medicines on both nursing and residential suites, we looked at storage, handling and records and how these were being monitored and managed. A mobile lockable drugs trolley was used on medication rounds and all medicines were stored securely. We found these to be of a good standard and subject to audit to make sure the homes procedures and best practice were being followed by staff. There was evidence of good practice with regards to obtaining acute prescriptions, checking prescriptions with doctors and hospitals on admission, double checking any changes to medication being prescribed and recorded on charts and clear instructions on giving as required medicines. Any variations in medication doses were recorded and the reasons why any medicine had not been given was clearly stated and what was done. The records for receipt and disposal of medicines were clear and checked by 2 staff members. Such good practices help make sure that people get the medicines they have been prescribed correctly, they do not run out and people receive as required medicines, which may have sedating effects, only when they need them. We looked at the policies and procedures in use and the medication records we checked were being completed correctly. We spoke with people living there and their relatives and spent time in communal areas of the home observing what went on during the day. Our expert by experience also spent time with people in different areas of the home. They told us that they observed that there was good interaction between the people living there and staff at all levels. They noted that staff and people living there were singing carols on the units and there generally seemed to be a happy atmosphere. This supported our own observations. We saw that communication between staff and people living there was appropriate and any communication problems were outlined in the individual care plans. Staff were able to spend some time chatting with people or reading to them, whichever was suitable. On the day of our visit people living on the residential unit were helping to decorate their Christmas tree. Comments made to us on care included, The personal touches are good and for such a vulnerable person my relative is treated with dignity by the staff at all times. I am impressed, and so are my family, by every aspect of care. The nursing unit is excellent. Care Homes for Older People Page 16 of 31 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 living at Summerhill have support to make choices about their lifestyles and following their cultural, religious and social preferences. The quality and choice of meals provided meet the expectations and nutritional needs of people living there. Evidence: Summerhill has two activities coordinators working with people living there to provide a range of group and one to one activities. This includes outside entertainers, in house poetry and film clubs, quizzes, bingo, art sessions, gardening and gentle exercise classes. The home maintains its links with the University of the Third Age. The staff and manager at Summerhill work to promote peoples right to live a life that is meaningful within the home. Peoples interests and hobbies are recorded and their capabilities and these are considered when supporting them to enjoy their interests within and outside the home. There were detailed life maps giving staff a fuller picture of the individual and not just their personal or physical needs. Our expert noted that people had their own memory boxes outside their bedrooms with pictures and items of signifigance to them. This is especially useful foer people with dementia as it helps them orientate themselves and their private rooms on the suite. Care Homes for Older People Page 17 of 31 Evidence: There is provision for people to follow and maintain their own religious and cultural beliefs and support for them to remain actively involved. There is a monthly multi denominational service taken by local Anglican clergy and people may receive communion from them or their own priests. The Catholic priest will visit people who want this and also lay visitors. The local Methodist church also visits people living there. This provision helps make sure that the different spiritual and pastoral support needs of the people living there can be met as they prefer. Activities programmes are displayed on the units and in the entrance hall and there was also a seasonal activities programme for over the Christmas period in addition. The local nursery school was coming to sing carols and have mince pies with people living there. Outside singers were booked for entertainment and a community choir was coming to visit . The nursery has a lot of involvement in the home and also helped with the homes community garden and planting during the year. Some people living there like to spend time in the gardens and grow plants, vegetables and herbs. The home has its own monthly newsletter that also keep people up to date with what is going on in the home and with changes in staff and upcoming events and items of interest. One improvement in recreational opportunities has been the increased provision of week end activities. This helps people have more social opportunities supported by activities staff on alternate weekends. On Saturday there was a coffee/sherry morning and the Poetry club met in the afternoon. On Sunday there was an afternoon matinee of a film , this week it was Calender Girls, with sherry and chocolates provided during the screening. During the morning there are smaller group activities for board games, cards and dominoes. Some outings are arranged for people living there and some people go out socially with friends and family. Some people who wanted to had been out shopping with staff to do some Christmas shopping. Our expert by experience spent time with people taking part in activities and talking with them. They found there was good interaction between staff and people living there at all levels. They told her about their Christmas shopping trip in a limousine loaned to the home. One person spoke about not being able to attend some concerts they had used to enjoy attending in the town and that they would like to continue this. More than one person, who was unable to go out alone, told us and commented in their surveys, that they would like to go out more often. We discussed this with the manager and that this kind of choice was not as available as we found at our last inspection. The manager had already identified this as an area for improvement and had plans to address it as well as the need to encourage more community involvement. This was an area for improvement they told Care Homes for Older People Page 18 of 31 Evidence: us about in their AQAA and she was working to facilitate more outings and trips for people in line with their lifestyles. We recommend that the manager and activities and care staff continue to discuss with people what individual social outings are important to them and put resources in place to help them achieve their expectations and maintain their interests outside the home. People living there have good social profiles so there is no reason staff should not be aware of peoples individual social aspirations. From speaking with people living there, staff and visitors, looking at peoples care plans and observing daily life and routines it was evident that, overall, the emphasis is still upon the individual and providing a range of things to do in the home. There is good in house provision for group activities and one to one activities and on Wednesdays there is a Pamper Club and the hairdresser visits twice a week. There are communal telephone but most people have their own telephones in their rooms and all have their own numbers. We observed lunch time meals being served on the nursing unit and our expert by experience joined people living in the home for lunch. They found the tables attractively set with flowers for decoration and the menu on the table, showing a good choice. They noted that people were helped into the dining room well in advance of the meal time at 12.30 and so had to wait some time for the meal to be served. Fruit juice drinks were available during the meal and a hot drink afterwards. Some teacups already had milk in them suggesting people were not routinely asked if they wanted this. It would be better practice and give more individualised support if staff did not assume how people want their hot drinks served but ask them individually, even if they believe they know their preferences. On the nursing unit we found the lunch time meal to be relaxed and staff did not hurry people with their meals. Where people needed assistance with cutting up or eating their meals staff did so in a friendly and discreet way and second helpings were offered. The food is freshly prepared in the homes kitchen each day and people have a choice of meals including any special diets. People may take their meals where they wish. People made varied comments on the food provided to our expert by experience, including, Very good usually and foods a bit bland also No salt in anything and Sometimes the vegetables are over cooked. We also spoke to relatives and other people living there during our visit and they also commented on food, one told us in conversation there was Good food, good company and a good service. Survey responses we received indicated that people liked the meals in the home, one person commented On the whole the food is good but it would be pleasant to have more seasonal fruit and vegetables another told us, We are well fed and cared for. The Care Homes for Older People Page 19 of 31 Evidence: home uses a menu master system that seeks to involves people living there to make suggestions for menus. The Nite Bite system lets people chose what they eat when they feel like it to give a choice of food in the evening and at night. At the last inspection by the Environmental Health department the home achieved a 5 star rating. Care Homes for Older People Page 20 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home know how to raise a complaint through an effective and accessible complaints procedure and are confident that their concerns will be listened to and acted upon to make sure they are safe and protected from harm. Evidence: The home has a clear complaints procedure and this is provided to all people living in the home and is on display around the home, in the entrance hall and within the statement of purpose and users guide. The policy states the timescales for managing any complaints and who deals with it at different levels in the organisation including its quality and compliance department. The manager has logged three complaints received in last 12 months. All have been investigated and we could see from the records that action had been taken where needed to resolve and prevent recurrence. The manager and/or deputy manager visit all suites on a daily basis and are available every Tuesday afternoon for drop in sessions. Anyone can use these sessions to talk with them and raise any issues, make suggestions or talk about matters generally within the home. People living there and relatives we talked to told us they knew how to make a complaint and the survey responses we received supported this view. One relative told us during the visit, I havent found anything to criticise as yet and also I am more than happy with the care provided but I am aware that I can raise concerns at any time They knew the procedure and where to find it. We talked with staff who told us Care Homes for Older People Page 21 of 31 Evidence: they had received training on safeguarding vulnerable adults and could tell us what they needed to do if they had any concerns. One carer told us they had also had a taster in adult protection and Deprivation of Liberty in their induction programme. Training records and programmes we looked at indicated staff were being given this training on induction and updated annually. We saw that there are clear policies and procedures in place on safeguarding vulnerable adults There are policies and procedures for staff on whistle blowing so staff can raise any poor practice issues and know they will be supported. Whistle blowing processes have been comprehensively reviewed to help ensure staff are comfortable coming forward to report any poor or unsafe practices they see. We know from actions the manager has taken as a result of staff participation that this has been effective and staff feel able to do so where appropriate. The service has a clear policy on gifts and gratuities that people may give to staff to protect their interests. Systems are in place to safeguard peoples finances and people are supported to maintain their own finances where possible and with families and representatives. the administrator invoices people for any bills and payments and keeps receipts. Three referrals have been made by the manager under safeguarding vulnerable adults to protect peoples interests and welfare. These were investigated with social services and prompt and appropriate actions agreed and taken to protect people. The regional manager for Bupa visits monthly to monitor quality, look at the premises and records and talk with people living there, staff and visitors and writes a report as required by regulations. Care Homes for Older People Page 22 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Summerhill enjoy a suitably adapted, clean, homely and comfortable environment that encourages safety and independence. Evidence: Summerhill is a well maintained home, it is well furnished, warm and comfortable. There is a high standard of decoration throughout the home. Repairs and maintenance are well planned and this ensures that the home remains an attractive and safe place for those living there to enjoy. The home has a rolling programme of redecoration and upgrading of bedrooms and communal areas. The home has its own maintenance person/gardener on site for day to day maintenance and safety testing. They maintain clear records of work done, safety checks , water temperature testing, emergency lighting, call systems, which were available for inspection. All areas of the home used by people living there have accessible call bells for them to summon assistance if they want it. Outside the gardens were well kept and tidy and had appropriate seating for people living there to use. There is ample communal space for people to use on the suites and these are all accessible by passenger lift. There are well lit and spacious dining rooms and lounges on all the four suites and these are warm and well furnished with seating for different needs. The lounges are arranged in an informal way that promotes small groups of seats and not around the room in an institutional manner. All areas of the home are Care Homes for Older People Page 23 of 31 Evidence: accessible to people using wheelchairs and there are appropriate aids and equipment provided to suit individual moving and handling needs and help maintain peoples independence. We saw a range of moving and handling equipment, bathing and toilet aids in use and nursing beds for ease of movement. Staff records showed staff had received training on safe moving and handling techniques and using the equipment and records also indicated regular servicing to help make sure equipment was safe and in good working order. We observed staff using the equipment to assist people and this was done at the persons pace and staff talked with them explaining what they were doing as they moved them and helped them into easy chairs. Our expert by experience spent time talking with people and looking at the general environment for people and they, like us, found the general environment to be very calming. One person told them that they enjoyed being in the home and could go to her room when she wanted. The bedrooms we saw were well furnished and people had brought personal items in to make their bedrooms more homely and individual. People are encouraged to personalise their bedrooms with their own possessions, furniture, ornaments, paintings and photographs from their own homes to help them feel at home. All the bedrooms are single occupancy and have en suite toilets and showers. There are also bathrooms with appropriate aids on each suite so people may have a bath if they prefer this or it suits their physical needs better. The home was clean and tidy with ample storage and smelt fresh and pleasant for the most part. The home uses a specialist microfibre cleaning system and there are sufficient cleaning staff to make sure it is kept clean and as free from odour as they can. Surveys we received back from people living there indicated that they found the home to be always fresh and clean. The home has infection control procedures in place and we saw staff on the units using protective aprons and gloves when attending to personal care and using appropriate clinical waste disposal. Records show that staff are given training on the prevention and control of infection and food hygiene training. We observed that staff followed good hygiene practices at meal times. The laundry for the home is on site and was clean and well equipped and has dedicated laundry staff to attend to all washing and ironing. There are separate entrances for dirty and clean laundry to reduce the risk of any cross infection. Our expert on experience found from speaking to people living there that the laundry is very well run with only the occasional slip up. Care Homes for Older People Page 24 of 31 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 in the home are being supported by a well trained and experienced staff group and the robust recruitment procedures in operation mean that the safety and well being of people is promoted. Evidence: We looked at staff rotas on the four suites in the home and observed staff levels on the suites during the visit. These indicated that there were sufficient nursing, support and ancillary staff to make sure people received the nursing and physical care they needed. There were sufficient ancillary staff to make sure laundry is done promptly, that the home is kept clean and tidy and that there are nutritious meals available day and night. The staff we spoke with told us they enjoyed their work and one told us They are good to work for. Staff surveys we received indicated that staff felt there were generally enough staff to meet peoples individual needs. Morale amongst the staff we talked with appears to be good. BUPA Care homes have received IIP accreditation and this has been reviewed. People living there and relatives made comments to us about the staff in the home. One relative told us staff were Caring and look after day to day needs. Good friendly, caring staff. Another told us I am very happy with the way my Mum is looked after at Summerhill, the staff always do their best for her and another commented I am always made welcome whenever I pop in. One person living there told us The staff Care Homes for Older People Page 25 of 31 Evidence: are friendly and supportive. We looked at recruitment records for the newest staff and these were in good order with completed application forms, all necessary references taken up and interview records kept. All staff had appropriate security checks in place, a Criminal Records Bureau (CRB) check and a check on the Protection of Vulnerable Adults (POVA) register to help make sure that they were appropriate to support vulnerable people. Regular checks are made on nursing registration status with their professional body. From talking with staff, from the comments and responses on their completed surveys and from looking at training records it was evident that staff training and development is being given a high priority within the home. Staff have regular updates on mandatory training and in other important areas such as dementia care and palliative care. NVQ training programmes are well established with a high percentage of staff with NVQ level 2 or above in care. There is an on going and planned staff training and development programme, which we looked at, and the records of completed training. New staff follow an improved four day induction programme covering all relevant areas before they start work with people living there. The training is in line with Skills for Care induction standards with the core skills staff need to begin their work. All staff have their own learning portfolios and nursing staff we spoke with were being supported to maintain their professional development through a range of training opportunities. Care Homes for Older People Page 26 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Summerhill is well managed with systems, policies and procedures in place to help ensure the health and safety of people living there and staff are promoted and protected. Evidence: Summerhill has an appropriately qualified and experienced registered manager in post. She has undertaken regular training to update her knowledge and skills and undertakes staff training in adult protection. She is well supported by the deputy manager and nursing staff to help ensure the service is well run in the best interests of people living there. The manager has an open and inclusive management approach and a clear vision of maintaining and continuing to develop high standards in the home. Staff morale was seen to be good and one staff member told us We work well as a team and have good communication, we have regular meetings and good training opportunities. Records indicated that there are regular staff meetings and that staff received regular formal supervision to support them in their work and get feedback on their performance. Staff we spoke to and survey responses also indicated this was the Care Homes for Older People Page 27 of 31 Evidence: case. The manager also has daily briefings with staff to help keep all staff updated, deal with any issues that have arisen quickly and feed back organisational news and events. We looked at a sample of records required by regulation and found these up to date and in good order. The home does not routinely handle personal money for anyone living there, people are encouraged and supported to manage their own affairs. Some people have support from their families and representatives. We spot checked and discussed the personal allowances with the homes administrator. Money is held only for those residents whose family members live away and the Statement of monies held is available at any time. All transactions are signed in and out by 2 members of staff and checked weekly. The home has effective and comprehensive stated quality monitoring systems in place to get the views of people living there and their families and to measure the homes success in meeting their aims and objectives. The manager uses a range of assessment methods including internal and external surveys, regular day and night staff and residents meetings and internal and external audits to monitor important areas. These cover important areas including the environment, maintenance and health and safety and also review and update procedures as good practice and legislation changes. The manager also uses the Early Warning Audit Tool (EWAT) that includes audits of medication, care plans, catering systems, any incidents, wound management, pressure sores, staff training, health and safety and recruitment systems. This systematic approach helps provide consistency in monitoring performance. Bupa has regional and national experts for advice and guidance on such issues and includes health and safety and Fire management leadership. There are safe working practices in place to identify and minimise risks to staff and people living there and the home has a comprehensive range of policies and procedures to support current best practice. Records showed equipment is maintained under service agreements. Records also indicate mandatory staff training and fire safety training is up to date. The manager holds quarterly Health and safety meetings and one was due to be be held on the day of the visit. These have a standardised agenda that allows staff the opportunity to comment on any health and safety issues and have them fed back up the organisation. Care Homes for Older People Page 28 of 31 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 29 of 31 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 12 We recommend that the manager and activities and care staff continue to discuss with people what individual social outings are important to them and put resources in place to help them achieve their expectations and maintain their interests outside the home. Care Homes for Older People Page 30 of 31 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). 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