Care Home: Sunningdale House, Perranporth

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What the care home does well Regular activities that encourage physical exercise are available to residents 3 times a week. Visitors are welcomed to the home at any time. Individual care needs are assessed prior to the person moving into the home to ensure that their care needs can be met. Residents told us that they enjoy the food that is provided within the home. The home is clean, hygienic and free from odours. Residents and their representatives told us, both during the inspection and within surveys `The staff are kind and caring`, `On the whole the premises are clean and welcoming`, `They provide the appropriate care very well` and `I am very pleased with the care my mother is receiving, I hope the good standards continue`. Staff made positive comments with completed surveys regarding their recruitment, induction, ongoing training and support from the manager. We asked the staff in the survey `What does the home do well`? and were told: `Very nice care home for people`, `everything very well`, `friendly atmosphere`, `food` and `the activities group`. External professionals who visit the home and completed surveys for us prior to the inspection commented `the staff have a caring attitude to the residents`, `most staff are empathetic towards the residents in a caring way` and `amongst the regular care staff there is a genuine commitment to try to deliver good care` What has improved since the last inspection? The last inspection made 4 requirements where breaches of regulation had occurred. Of these 1 regarding staff supervision, had been met. 9 recommendations were made, of which 6 were fully met and 1 partly met. These were regarding the medication storage, activities, staff training, storage facilities for residents, staff recruitment and the provision of information to CSCI (the previous commission for social care inspection) regarding the management arrangements. At this inspection staff responded extremely promptly to alarmed exits being opened. Supervision is in place and is ongoing for all staff. Private storage is in place for all residents in their own bedrooms. The locks to the bedroom doors have been serviced and are now easily operated should a resident wish to hold the key and secure their bedroom. What the care home could do better: Attention must be given to ensuring that requirements identified during inspections are met. There are 3 requirements outstanding regarding care planning and the safety of residents e.g. access to extremely hot water and unguarded radiators. The health and safety of residents must be protected. Where there is access to hot surfaces e.g. radiators and hot water suitable measures must be taken to reduce the risk of scalds and burns to the residents. Attention must be paid to the entry and exit points of the building, particularly on the ground floor where residents could easily leave the building, without the staff being aware, through bedrooms. Fire exits must be clear at all times and not blocked by the storage of equipment. The service users guide and statement of purpose should be developed to include detailed and informative information to prospective and current residents and / or their representatives. Care plans should be in place for all residents that inform and direct staff regarding the actions they must take to meet peoples assessed care needs. Residents and their representatives told us, both during the inspection and within surveys `They have a beautiful fenced garden and terrace, but it is rarely used by residents -possibly due to lack of supervision` We asked staff what they felt the home could do better? and were told `Individual needs / activities`. External professionals who completed surveys commented `at times, there are insufficient numbers of staff on duty, which can impact upon the care provided to residents`, `sometimes clients are admitted who would be more suited to a care home with nursing than residential care`, `there have been a couple of good onsite managers who unfortunately have been unable to be retained` and `staffing levels are poor at times`. Key inspection report Care homes for older people Name: Address: Sunningdale House, Perranporth Boscawen Road Perranporth Cornwall TR6 0EP     The quality rating for this care home is:   one star adequate 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: Melanie Hutton     Date: 1 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 35 Information about the care home Name of care home: Address: Sunningdale House, Perranporth Boscawen Road Perranporth Cornwall TR6 0EP 01872571151 01872572633 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welling Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: One service user may be admitted aged 55 years to 64 years Date of last inspection Brief description of the care home The registered provider for Sunningdale House is Welling Ltd; the responsible individual is Mr Alan Beale. Sunningdale House provides care for up to 36 older people. This includes registration for six people with dementia and six people with a mental disorder. There is currently no registered manager at the home. At the last inspection there was a manager who was due to make an application to the Commission for Social Care Inspection to be the registered manager. This person left the home prior to registration. There is currently an acting and temporary manager from within the Care Homes for Older People Page 4 of 35 1 6 0 3 2 0 0 9 0 0 0 Over 65 6 6 36 Brief description of the care home organisation, providing management support. We have been informed that a manager has been appointed and is waiting on recruitment checks prior to starting work. The home is situated near the centre of Perranporth with easy access to shops and other local community facilities. The home has a front garden with seating provision overlooking the boating lake. The car park is steeply sloping and there is ramped access from this to the main entrance. There is a passenger lift to the bedrooms on the first floor. The majority of bedrooms in the home are en suite. The home has a choice of communal areas including a sun lounge. The home provides some day and respite care. The front door to the home is locked at all times. The visiting arrangements are flexible. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on Monday 12 October 2010 by 2 inspectors. We received a detailed Annual Quality Assurance Assessment (AQAA) when requested. This informed us of developments that have been made by the home since the last inspection and also areas where improvements are planned. We noted that the people who use the service are generally referred to as residents, we also observed that some people who use the service refer to themselves as residents. Therefore for the purpose of this inspection, we shall respect this terminology. We sent out quality assurance surveys to residents, staff and external health professions prior to the service. We received 2 completed surveys from residents and / or their representatives, 2 from staff and 3 from external health professionals. The last inspection of this service was a random unannounced inspection that was completed on 16 March 2009. Care Homes for Older People Page 6 of 35 Since the last inspection, the manager has left the home and a temporary manager is overseeing the day to day management of the home. We are told a new manager has been appointed but is yet to commence duties. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Attention must be given to ensuring that requirements identified during inspections are met. There are 3 requirements outstanding regarding care planning and the safety of residents e.g. access to extremely hot water and unguarded radiators. The health and safety of residents must be protected. Where there is access to hot surfaces e.g. radiators and hot water suitable measures must be taken to reduce the risk of scalds and burns to the residents. Attention must be paid to the entry and exit points of the building, particularly on the ground floor where residents could easily leave the building, without the staff being aware, through bedrooms. Fire exits must be clear at all times and not blocked by the storage of equipment. The service users guide and statement of purpose should be developed to include detailed and informative information to prospective and current residents and / or their representatives. Care plans should be in place for all residents that inform and direct staff regarding the Care Homes for Older People Page 8 of 35 actions they must take to meet peoples assessed care needs. Residents and their representatives told us, both during the inspection and within surveys They have a beautiful fenced garden and terrace, but it is rarely used by residents -possibly due to lack of supervision We asked staff what they felt the home could do better? and were told Individual needs / activities. External professionals who completed surveys commented at times, there are insufficient numbers of staff on duty, which can impact upon the care provided to residents, sometimes clients are admitted who would be more suited to a care home with nursing than residential care, there have been a couple of good onsite managers who unfortunately have been unable to be retained and staffing levels are poor at times. 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 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose and service users guide do not provide sufficient information to help people to make an informed choice about the home. The detailed care needs assessments that are undertaken by the home ensure that peoples assessed care needs can be met. Evidence: The home has the current certificate of registration displayed on the wall behind the reception desk in the entrance to the home. We asked to view the current statement of purpose and service users guide. The manager provided us with a brochure about South West Care Homes plus additional information in a document entitled Sunningdale House, Service Users Guide and Statement of Purpose. The document needs to be revised and updated, to ensure that current and accurate information is provided to prospective residents and their representatives e.g. the most recent Care Quality Commission (CQC) inspection report, the residents views of the home, the number, relevant qualifications and experience of staff working at the home, the Care Homes for Older People Page 11 of 35 Evidence: current manager status and procedures for emergency admission. There is a comment included, that states that staffing levels have been agreed with CSCI (the previous commission for social care inspection). CSCI did not and CQC do not agree staffing levels - the staffing must be reviewed regularly by the registered persons and reflect the dependency of the current residents care needs. We (the CQC) will review staffing arrangements and residents care needs at each inspection visit and may seek reassurance from the registered provider throughout the inspection process that staffing levels are sufficient to meet residents needs. The manager told us that each prospective resident and their representative is given a copy of the above documentation. We were able to see from care records held within the home, that a summary of potential residents care needs is obtained form the referring body e.g. the Department of Adult Care Services (DACS) or health, prior to their admission into the home. A pre admission care needs assessment is undertaken by the manager prior to the person moving into the home, whenever possible. We were able to see electronic records that the manager had developed following discussions with hospital staff for a resident who had been recently admitted from hospital. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not consistently direct and inform staff of the action that they must take to meet residents care needs. Residents health care needs are met with the support of external professionals. The privacy and dignity of residents is usually respected. Evidence: The manager told us that all of the care plans are being revised and will be provided to staff in a new format - we were able to see two care plans that had been developed in this style. These were detailed and informed staff of the action they must take to meet peoples care needs. These care plans also identified the residents preferences and choices. We were concerned that one recently admitted resident did not have a care plan on the morning of the inspection. Staff were not fully aware of this persons medical history and therefore their individualised care needs. The manager arrived at lunch time and was then able to print out a full and detailed care plan for this person. We observed this person many times during the day asking staff to assist them to use the telephone and wanting to go home - the staff, whilst responding kindly to this person, each time directed them back to the lounge to sit down. Several of the care Care Homes for Older People Page 13 of 35 Evidence: plans that we inspected were lacking in detail to direct the staff, examples included no reference to one residents dementia care needs, another resident needed encouragement with food but the care plan did not specify the action staff should take. We saw incident reports relating to another resident following aggressive outbursts but there was no information contained within the care plan of how staff should assist this resident at such times. Several care plans, although personal care was identified as a care need, did not reflect the residents preference of a bath or shower or how frequently this should take place or the assistance needed from staff. Care plans are reviewed regularly and changes noted but the care plans are not consistently updated to reflect these changes. There was no evidence to support that residents and / or their representatives are involved or in agreement with the care plan. Daily records varied in the detail recorded. A number simply said care as plan. We noted that for one resident who had recently been admitted, where the daily record stated care as plan there was not a care plan in place. The daily records generally did not show that residents preferences and choices had been respected and there was limited detail regarding the bathing provided to residents. We were able to evidence from written care records that external professionals access the home to meet the residents health needs e.g. community nurses, community psychiatric nurse, general practitioners and chiropodist. Information regarding pressure sores is recorded within care plan documentation. However for one resident, this was not clear and the daily records seemed to contradict the care plan. Nutritional assessments are completed at admission and reviewed monthly. We observed that one resident had a hourly fluid and diet chart, situated in their bedroom, to be maintained due to their reduced appetite and fluid intake. We were concerned to note that at 10.30 hours the chart showed that this person last had fluid given to them at 06.00 hours. However, at 12.05 hours this chart had been completed retrospectively with an entry at each hour, from 06.00 to 12.00 hours. At 15.30 hours we observed that the last entry made on this chart was at 13.00 hours. Limited evidence was available to show that continence assessments have been undertaken, are up to date and show the type of incontinence pad used by individual residents and when they need support with managing their continence. The manager told us that the community nurses are involved with the assessment of residents continence needs and supply of pads. The team leaders administer or assist residents with their medication and have been provided with medication training. The home has a policy and procedure in place to inform staff. Individual medication administration records (MAR) are in place for each resident and these were generally completed fully. We discussed with the team leader on duty the need to ensure that each day is completed fully and appropriately on the Care Homes for Older People Page 14 of 35 Evidence: MAR sheet. A system is in place to show medicines received into and out of the care home. A homely remedies policy is in place with a list of homely remedies signed by a general practitioner - although we were told that this is not currently in use. Controlled drugs are stored appropriately and the controlled drugs register meets current legislation and the recording within this register was seen to be up to date. A medication room is situated within the home, this provides good storage facilities for all medicines and handwashing facilities for the staff. In appearance this room is disorganised. The medicines trolley is stored within this room and this is then used to transport medication throughout the home. Residents told us that staff are polite and kind, although one person said that on occasions staff can be in a bad mood and rushing. We observed staff knocking on bedroom doors prior to entering but on several occasions they did not seem to wait to receive a response from the resident in the bedroom. One resident had a hand written sign on their door saying please knock. We observed a bath list in the upstairs bathroom that detailed the names of residents and the days they had a bath. This should be stored securely and only accessible to the staff. We observed that staff spoke kindly to the residents and were helpful and welcoming to all visitors to the home. We saw that some residents have their own telephones in their bedrooms for their own private use. One resident was observed being supported by staff to use the homes telephone is a quiet area. Residents clothes looked well laundered and 2 residents told us that they were satisfied with the laundry service provided. Each room has a lock, with residents able to hold their key if requested and a risk assessment is satisfactorily completed. The locks have been serviced and can be opened by staff from the outside if necessary in an emergency situation. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of activities is provided within the home and residents are supported to take part in this. Residents receive a balanced and nourishing diet. Visitors are welcomed to the home. Evidence: A programme of activities is in place for residents. A member of staff (also the maintenance person) spends 1 hour 3 afternoons per week leading activities. On the day of inspection a game of skittles was held that 12 residents took part in. Further activities are posted on the noticeboard including arts and crafts once a week, music and movement once a month and a visiting singer periodically. Other activities listed included reading newspapers, watching a movie and manicures. Staff also told us that a tai chi session takes place and there have been flower arranging sessions. Records show who attended activities but do not evidence the level of participation or perceived enjoyment of the resident taking part. Residents made the following comments about the activities We go out sometimes and I like to read, I am treated like a child, there is nothing to do here, I have jigsaws to do that my family help with, activities go on in the home.......the home is like a hotel and We are just left to sit here with nothing to do Several people told us that they prefer to stay in their own Care Homes for Older People Page 16 of 35 Evidence: rooms and read or watch the television as there are little opportunities to speak with other residents or staff in the lounge areas. During our visit, we observed that one resident requested to go out of the building for a walk - a short time later one member of staff and the resident went out for a walk to the boating lake, returning about 20 minutes later. The resident told us that they had enjoyed this walk and like to get out in the fresh air. Visitors are welcomed to the home and the visitors book shows that the home receives many visitors. Visitors are assisted by a staff member to get in and out of the home as the front door is secured and opened by a key pad. We have received some comments, prior to the inspection, within surveys, that sometimes the door bell is not answered promptly. We did not perceive this as a problem during the inspection apart from on one occasion the door bell was not answered promptly and a visiting community nurse exiting the building let the visitors in. The home does not act as an appointee for any of the residents. Relatives and representatives are encouraged to fulfill this role for anyone who cannot manage their own finances. Residents told us that they are able to get up and go to bed when they choose and one resident told us that they can choose when to have a bath or shower, they further added that this is usually on the same day once a week. Many bedrooms were observed to be personalised with the residents own possessions and a list is maintained of personal belongings brought into the home by individuals. We did not evidence that residents and / or their representatives are advised how to contact external advocates should they require this service. Residents are able to choose whether to eat their meals in the dining room, lounge dining area or in their bedrooms. We noted that the dining room was set for 14 people to eat and that the lounge dining area set for 2 people. One person ate their meal in the lounge dining area. A menu board is in place on the wall near the dining room. We observed that this was not filled in until nearly lunchtime. Residents told us that they liked the food in the home but were not able to tell us what their meal was going to be. We were told we order our food the day before but I never remember what it is, lunch is a surprise every day but the food is good, I dont always get asked what I want for lunch, sometimes they ask the day before, sometimes on the day it is usually good although sometimes a bit cold and the food is good here. The menu is rotated to offer variety. We observed staff providing assistance to residents when eating their meals. We saw one member of staff standing up when assisting a resident with eating their meal, although they did eventually get a chair and sit down with the resident. We discussed this issue and the fact that the carer did not remove their gloves when assisting the resident with their meal which did not appear to be the normal practice Care Homes for Older People Page 17 of 35 Evidence: within the home. The food was well presented and the portion sizes were good. People who need specialised diets are supported e.g. diabetic and pureed food. The pureed food is attractively presented. We observed the main meal being served and noted that very little social interaction between the staff and residents took place, with staff only informing the resident what their meal was. Little social interaction took place between the residents. The dining room is spacious and attractively decorated and furnished, with music played throughout the meal. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not consistently know how to make a complaint or feel that they are able to complain. Staff must all be provided with training regarding safe guarding adults in order to ensure that residents are protected. Evidence: The registered provider informs people how to make a complaint, should they need to do so, within the statement of purpose and by displaying the policy and procedure on the notice board of the home. The Annual Quality Assurance Assessment (AQAA) informed us that the home has received 2 complaints since the last inspection. We have been informed of 2 concerns raised by relatives of residents at Sunningdale since the last inspection. Both of these issues related to the care of their relative whilst resident at Sunningdale. These concerns were addressed by the home and the Department of Adult Care. Residents we spoke with during the inspection told us that they knew how to make a complaint. 1 resident said they would not make a complaint as the staff would be cross. 1 survey we received completed by a resident before the inspection, said they did not know how to make a complaint. There is a procedure for safeguarding adults, that includes whistle blowing and restraint. The home also has a copy of the local multi agency procedures available. We saw training records for most staff regarding safe guarding adults, a number of staff attended sessions that incorporated mental capacity act and deprivation of Care Homes for Older People Page 19 of 35 Evidence: liberties training. This should be provided to all staff. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, hygienic and free from odours. Not all areas of the home that the residents have access to are free from hazards to their safety. The home is comfortable, homely and many areas have been refurbished to a good standard. Evidence: Sunningdale House is located in a pleasant residential area near the centre of Perranporth, with the local facilities and services nearby. The main reception area and corridors are spacious, attractive and well-maintained. The car park at the front is very steeply sloping to the front door. There is a ramp from here to the main entrance for people using wheelchairs or who have poor mobility. Many of the rooms on the ground floor have doors that open out onto the communal paved patio area, which circles the home. The home overlooks the boating lake. An area of garden at the front of the home is attractively landscaped and provides a pleasant seating area for residents to use. This area is secure and accessible from the dining room. One survey that we received from a resident or their relative, commented on this area: They have a beautiful fenced front garden but this is rarely used by residents (possibly due to lack of supervision). The front door to the home is locked, residents and relatives / representatives require assistance to gain entry or to leave the home. There is a flat on the second floor which is not registered, this is used to accommodate staff. There is Care Homes for Older People Page 21 of 35 Evidence: no designated separate entrance and tenants walk through the main area of the home. One member of staff was observed entering a bedroom on the ground floor as their accommodation. The manager was not aware of any recent visits from the environmental health or fire officers. As previously stated, she has only been in position for a short period. The residents personal accommodation was observed to be homely and comfortable. A number of bedrooms have been refurbished and are attractively decorated. New bedroom furniture has been purchased which is domestic in nature and provides lockable storage space for the resident. Most of the rooms downstairs have been provided with an attractive notice to help residents identify their room. It is recommended that this continues throughout the home e.g. upstairs. A number of carpets have been replaced throughout the home. Most residents bedrooms are carpeted, with a minority having hard flooring if this is deemed necessary. Individual rooms have a door lock and residents are provided with a key if they request this, unless their individual risk assessment suggest otherwise. The locks to the doors can be opened by the staff from outside if needed e.g. in an emergency. The locks have been serviced and are easy for residents to use. All of the bedrooms in the home are naturally lit and ventilated with windows that have restrictors fitted. We noted that the window on the mezzanine level did not have a restrictor fitted. Since the last inspection hot water pipes have been blocked in to prevent the risk of burns. Some radiators have been guarded since the last inspection. We observed that radiators on the landing and hallway were not guarded. These radiators were not turned on. The water systems have been tested for legionella as required by legislation. We were told that pre set valves are in place for bathing facilities to ensure that the water does not exceed 43 degrees centigrade. There is a spacious and attractively furnished conservatory at the front end of the home. This appears to be little used and during the inspection we used this area to complete some paperwork. It was a warm sunny day and the temperature in the conservatory was very uncomfortable as it was extremely hot. There were no blinds / curtains in place and all of the windows, with the exception of 1, was locked. The fire exit to outside is alarmed and on opening this a member of staff responded extremely promptly. The home appeared to be clean, hygienic and free from odours. Residents told us that they were satisfied with the cleanliness of the home. The laundry is undertaken by the domestic and care staff and is situated at the rear of the home. On the day of inspection it appeared disorganised and cluttered. This may be due to time constraints upon the staff as the laundry will be done as well as the Care Homes for Older People Page 22 of 35 Evidence: caring and domestic duties. Residents told us that they were satisfied with the laundry systems within the home. Hand washing facilities with liquid soap, paper towels and sanitising gel are available throughout the home. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the homes robust recruitment procedures. Residents generally feel their needs are met by the current staff group. Evidence: On the day of inspection there were five carers and a team leader providing care to the residents in the morning. Additional care hours are rostered at peak times of the day e.g. 07.30 - 10.00 hours if required. On the day of inspection these hours were provided. A team leader is on duty for each shift. The current manager is available during the week from Monday lunchtime through to Friday evening. Additional members of staff in the home on the day of inspection were the chef, a kitchen porter, one domestic and the maintenance / activities person. The duty rota identified that there is usually 1 team leader and 3 carers for the afternoon and evening shift plus 2 waking night staff from 20.00 to 08.00 hours. Residents told us that the staff meet their needs. We observed that during the morning when a number of residents were seated in the lounge areas, that staff did not interact with them when using the lounges as a thoroughfare whilst going about their duties. A number of residents were walking about the home and at times appeared disorientated and the staff returned them to the lounge. The personnel records relating to 5 members of staff were inspected fully. These personnel files evidenced that a robust recruitment procedure takes place prior to Care Homes for Older People Page 24 of 35 Evidence: appointment. We were able to see that CRB checks and references are obtained. Training records showed that new staff are provided with an induction training that includes moving and handling, fire safety and infection control. Ongoing training is provided. Notices in the staff room informed us that update training regarding moving and handling, fire safety and infection control is booked for the near future. A number of staff are currently undertaking dementia care training. This is led by the manager who has received training from the Alzheimers Association to deliver this training. Staff we spoke with made positive comments about this training. All staff have received training in safe food handling. Most of the training provided to staff is completed using training DVDs, workbooks and discussion. The AQAA provided information regarding NVQ training. Of the 14 staff, 9 have achieved NVQ level 2 or above. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been without a registered manager for a period of time. A number of managers have been in post which does not provide consistency to the staff and residents. The safety and welfare of the residents is compromised in some parts of the home. Evidence: In the past 2 years there have been 2 managers, neither of whom completed the registration process with CQC and previously CSCI. Currently a manager has been moved from another home within the organisation to provide leadership and support to the staff whilst a new manager is recruited. We were told that a new manager has been appointed who will be applying for registration with CQC. This person has yet to commence duties as the registered person is waiting for the recruitment checks to be completed. Staff and residents were positive in their comments about the manager in post and told us that a staff meeting had been held and was well attended. The responsible individual told us on the telephone after the inspection, that a process had been implemented to encourage the manager to commit to a period of time at the Care Homes for Older People Page 26 of 35 Evidence: home to provide continuity to staff. This will also ensure a consistent and strong leadership is in place. Residents views are sought regarding the operation of the home through residents meetings and quality surveys. Surveys have recently been sent out by the home to residents and their representatives. These surveys are yet to be returned. The regional operations manager visits the home each month and provides a report based on speaking with residents, staff and observations. We were told that the registered person does not act as an appointee for any residents for their benefits or manage any savings accounts for residents. We were told that the home provides a safe keeping service for residents personal allowances. Records are kept of money paid in e.g. by relatives, amounts paid out on behalf of the resident and a running balance. A sample audit of some of these individual records was undertaken and found to be accurate. A system for supervising staff is in place, with named supervisors for individual staff members. We were able to evidence the written records of these supervision sessions within staff personnel files. We also heard from staff that their practice is observed by their supervisor and discussed. Annual appraisals do not appear to have been conducted as yet. The AQAA detailed maintenance information and we were able to check this information against written evidence held in the home. Checks are made on the fire safety equipment and warning systems in the home. We observed that a fire exit on the first floor was blocked by a portable hoist. During the inspection we exited the building through alarmed doors and staff responded extremely promptly to the alarm. Environmental risk assessments are in place to show how identified hazards to the residents are addressed. These included unguarded radiators. These should be available at all times and reviewed regularly, with regard paid to perceived risk to the current residents. The registered provider forwarded risk assessments re bathing facilities and areas where plugs have been removed to us following the inspection. We were told that pre set thermostatically controlled valves are fitted to hot water taps on the baths. We noted that the water in one bathroom was very hot. There was not a thermometer available in this bathroom to test the temperature. A number of handbasins provided very hot water and signing was in place to warn the user of this. We were concerned to note that some bedrooms accessible to all mobile residents, were able to be exited through an external door. The doors were secured by a Yale lock and did not appear to be alarmed. Care Homes for Older People Page 27 of 35 Evidence: In some of these ground floor rooms, windows were open and did not have restrictors fitted. The size and position of these windows would allow an intruder access into the home. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 It is required that the 07/12/2009 registered person shall compile a statement of purpose including all aspects of Schedule 1. This will inform prospective service users and their representatives about the home and enable them to make an informed choice as to whether the care home can meet their assessed needs. 2 7 15 It is required that the 07/12/2009 registered person shall prepare for each service user, a written plan - the care plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall, make the service users plan available to the service service user and update if Care Homes for Older People Page 30 of 35 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 necessary following the regular monthly review. This will ensure that staff are informed and directed on the action they must take to meet the assessed needs of service users. 3 18 13 The registered person shall make arrangements, by training staff, to protect service users being harmed or suffering abuse or being placed at risk of harm or abuse. All staff must receive safeguarding adults training to ensure that they are knowledgeable about the action they must should there be any suspected abuse identified. 4 38 23 It is required that the registered person shall ensure that unnecessary risks to the health, safety and welfare of service users are identified and so far as possible eliminated. Some parts of the home are able to be exited by residents without the staff being aware they have left the building - this may be a risk to the resident. Adequate arrangements 04/01/2010 07/12/2009 Care Homes for Older People Page 31 of 35 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 must be made to ensure that people who use the service are safeguarded from intrusion through downstairs windows. (Previous timescaled for action 14.04.09) 5 38 23 It is required that the registered person, following consultation with the fire authority take adequate precautions against the risk of fire and provide adequate means of escape. Equipment must not be stored in front of fire exits. 6 38 13 The registered provider shall 04/01/2010 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Windows that are accessible to service users should be fitted with restrictors. 7 38 13 The registered provider shall 04/01/2010 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. All bathing facilities must be fitted with thermostatic valves that ensure the water 04/01/2010 Care Homes for Older People Page 32 of 35 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 temperature does not exceed 43 degrees centigrade, in order to protect residents from scalding. (Previous timescale for action 1.1.08) 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 7 It is recommended that the resident and / or their representative sign the care plan to demosntrate their agreement with their planned care. It is recommended that monitoring charts for individual residents is completed at the time stated on the chart and not retrospectively to ensure accuracey of the document. It is recommended that assessments and detailed care planning is in place to provide staff with information regarding the promotion of continence e.g. the type of incontinence pad used and when. It is recommended that the medication administration charts are completed fully and accurately e.g. that no gaps are left or completed on the wrong day. It is recommended that the privacy and dignity of residents is fully respected by waiting for a response prior to entering bedrooms or bathrooms. It is recommended that written information relating to residents personal care be stored securely. It is recommended that records relating to activities not only identify who attended the session but also their perceived or stated enjoymnet and participation. It is recommended that residents and their representatives are informed of the contact details of independent advocates. Page 33 of 35 2 8 3 8 4 9 5 10 6 12 7 13 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 8 14 It is recommended that the system of informing residents of the menu choices is reviewed as the current system is not meaningful for the residents as nobody knew what the lunchtime menu consisted of. It is recommended that the manager ensure staff assist residents with their meal in an unhurried and sensitive manner e.g. by sitting with the resident (not standing) and removing their plastic gloves. It is recommended that the registered person ensure that all service users and their representatives know how to make a complaint and feel supported to do so. It is recommended that notices on bedroom doors are continued throughout the home e.g. upstairs, to help residents and their representatives locate their bedrooms. It is recommended that radiators be guarded or of a low surface temperature. If the registered provider chooses not to guard radiators a detailed and up to date risk assessment must be available that details how the risk to current residents is reduced. It is recommended that annual appraisals for all staff take place. 9 16 10 24 11 25 12 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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