Care Home: Sunrise Operations Eastbourne Ltd

What the care home does well A large number of the service users take part in various activities which are available daily. During the morning of inspection for example it was good to see the interaction between staff and service users, which had positive effect on their general mood. Staff were heard speaking to the service users about events happening in the home and in the world generally and this helped to generate conversations between service users. Staff encourage service users to make their own choices regarding what to wear, what to do and what to eat during the day. Decisions were not automatically made for service users, and this takes time and patience on the part of staff, but observation indicated that this was a natural way of life within this home. The home maintains a suitable environment for the service users that live there. It has given thought to the various stages of dementia people experience and for example has provided sufficient space for people to walk freely, with items that they may touch and handled; as well as items that may jog the memory of times gone past. It also has a snozzlem room, which can have a very calming effect on service users, with soothing music, soft fabrics and sensory lighting. At meal times the service users are offered plenty of choices, and most meals are freshly cooked in the building. Staff show service users the meal plated so that people with dementia can make a more informed choice. The home was also extremely clean throughout. What has improved since the last inspection? Since the last inspection the home has made significant improvements, it now needs to sustain these improvements to benefit the quality of life for the service user in the home. The statement of purpose and service user guide have been reviewed and now contains the information needed for service users and there family to make an informed choice. Medication is being given as prescribed and staff are now documenting when mediation is not given for a specific reason. The instructions given on MAR sheet (medication administration records) matched those on the medication itself. Care plans are person centred and written with the service user and or family. Care plans give clear instructions to staff so they can support the service users in the agreed way. Care plans crossed referenced with other documentation on file. Care plans are reviewed and amended when individual care needs change. The home now has a comprehensive risk assessment and management strategy form devised by the appointed manager to ensure all risks are dealt with and recorded appropriately. These with the specific risk assessment documentation for falls, nutrition and moving and handling are now fully completed and reviewed in a timely way. There is now an activity programme on display and activities are provided through the day, both in groups and on an individual level for those service users who prefer or need one to one motivation. The activities are recorded for each individual service user, both when they are enjoyed and when they are refused. The home has not had the use of a mini bus recently as they had no qualified driver; however they have still arranged outings for service users by taxi. The mini bus has recently become available again and outings will be planned several times a week. The home has made sure that there is suitable snacks available during the day outside of meal times for all service users. It is easily accessible so service users can help themselves if they are hungry. All service users have had a DOLS assessment, (Deprivation of Liberty Assessment) and staff have been trained to ensure that service users are not having their liberty deprived in anyway and appropriate action will be taken if it is. Waste bins that were identified during the last inspection as faulty have been replaced and bin liners were seen in all bins used around the home. The appointed manager has reviewed the staff rota to ensure that there is sufficient staff to meet the needs of the service user. The home is currently supporting 19 service users and staffed it accordingly, although the service is registered for 29 people. The manager is aware that as the service users` numbers increase the staff support will need to be increased accordingly. Recruitment and new staff training is currently ongoing to ensure enough suitably trained staff are available to meet the needs of all service users living in the home. The home is committed to increasing the number of staff with an NVQ, National Vocational Qualification level 2 or above in care, they currently have nearly 50% of staff with the award, and once the staff currently undertaking the award have completed the home will have in excess of that number. They will continue to put staff forward to undertake this NVQ training. The recruitment of staff within the home was found to be robust as was the checks and training carried out for volunteers helping in the home. Training records showed that staff are undertaking dementia and infection control training as part of their induction training, and more in depth dementia courses are also being rolled out to all care staff. What the care home could do better: A protocol for medication that is to be administered as needed (PRN) to service users needs to devised giving staff clear instructions. Staff must record accurately the medication that comes into the home for service users on the medication record sheet. They must also record the amount of medication left in stock from the preceding 4 week period so that auditing can take place to monitor that service users are receiving the medication they are prescribed.The home offers choices at meals times however the menus need to be reviewed to ensure that service users understand the names of meals they are being offered. The food should be served to the service users hot, and there should be a range of alternatives to the menu on offer other than just sandwiches. Menus should be available in the home prior to the meal being served and be available on the table at meal times. Key inspection report Care homes for older people Name: Address: Sunrise Operations Eastbourne Ltd (Reminiscence Neighbourhood) 6 Uppers King Eastbourne BN20 9AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Hall     Date: 2 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunrise Operations Eastbourne Ltd (Reminiscence Neighbourhood) 6 Uppers King Eastbourne BN20 9AN 01323525000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Eastbourne Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Sunrise is a purpose built building situated close to the A22 on the outskirts of Eastbourne and is part of a retirement complex. This building is comprised of three floors with the upper floor as a registered as a service providing care and accommodation for people with a dementia type illness and the first and second floors are registered as a care home with nursing. Accommodation mainly comprises single occupancy bedrooms with larger suites for couples also available. All bedrooms and suites have full en-suite facilities and a kitchen area that includes a refrigerator and sink unit. Passenger lifts provide access to Care Homes for Older People Page 4 of 31 Over 65 0 26 0 2 1 2 2 0 0 9 Brief description of the care home all floors. The top floor is exclusively for those people who have a dementia type illnesses and is known as the Reminiscence Neighbourhood. There is a central kitchen and laundry which services both the nursing home and the Reminiscence Neighbourhood. Communal bathing facilities, including assisted baths and spar baths are available. In addition, there is a kitchen area, dining room and lounge within the Reminiscence Neighbourhood. There is also a number of areas on which inlcudes items designed to be used for reminiscence. There is a large enclosed veranda which includes a seating area and raised beds in which herbs and edible flowers are grown. The fees for accommodation are separate to those for care. Discussion with the executive director found that Sunrise is in the process of reviewing the fee structure although charges will still include a set number of care hours, laundry services, continence management and personal care. Additional charges are made for chiropody, hairdressing, guest meals and dry cleaning. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Inspector agreed and explained the inspection process with the appointed manager and senior carer. The focus of this inspection was to assess Sunrise Reminiscence Eastbourne in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The inspector used various methods of gathering evidence to complete this inspection: pre-inspection information such as the previous report and discussion and correspondence with the registered provider to assist in the planning process and to explore any issues of concern and verify practice and service provision. The home had completed an AQAA an annual quality assurance assessment questionnaire; this provided the inspector with information relating to what the home considers it does Care Homes for Older People Page 6 of 31 well, what they could do better and their plans for the future. It also gave other information about staff, staff training, maintenance and servicing etc. Documentation and records were viewed in the home, with time spent reading some written policies and procedures, care plans, risk assessments and other records pertaining to personal care. Other areas viewed included pre-admission assessments, activity records, menus, staff rota, training records and recruitment records. The inspector identified four service users for case tracking, speaking with one of them and their family whilst assessing the available information held in the home pertaining to the care provision for them. In addition the inspector spoke to other service users which gave a good opportunity to judge the quality of care being provided by the home and understand the impact the care provision has on the individual service users quality of life. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the last inspection the home has made significant improvements, it now needs to sustain these improvements to benefit the quality of life for the service user in the home. The statement of purpose and service user guide have been reviewed and now contains the information needed for service users and there family to make an informed choice. Medication is being given as prescribed and staff are now documenting when mediation is not given for a specific reason. The instructions given on MAR sheet (medication administration records) matched those on the medication itself. Care plans are person centred and written with the service user and or family. Care plans give clear instructions to staff so they can support the service users in the agreed way. Care plans crossed referenced with other documentation on file. Care plans are reviewed and amended when individual care needs change. The home now has a comprehensive risk assessment and management strategy form devised by the appointed manager to ensure all risks are dealt with and recorded appropriately. These with the specific risk assessment documentation for falls, nutrition and moving and handling are now fully completed and reviewed in a timely way. There is now an activity programme on display and activities are provided through the Care Homes for Older People Page 8 of 31 day, both in groups and on an individual level for those service users who prefer or need one to one motivation. The activities are recorded for each individual service user, both when they are enjoyed and when they are refused. The home has not had the use of a mini bus recently as they had no qualified driver; however they have still arranged outings for service users by taxi. The mini bus has recently become available again and outings will be planned several times a week. The home has made sure that there is suitable snacks available during the day outside of meal times for all service users. It is easily accessible so service users can help themselves if they are hungry. All service users have had a DOLS assessment, (Deprivation of Liberty Assessment) and staff have been trained to ensure that service users are not having their liberty deprived in anyway and appropriate action will be taken if it is. Waste bins that were identified during the last inspection as faulty have been replaced and bin liners were seen in all bins used around the home. The appointed manager has reviewed the staff rota to ensure that there is sufficient staff to meet the needs of the service user. The home is currently supporting 19 service users and staffed it accordingly, although the service is registered for 29 people. The manager is aware that as the service users numbers increase the staff support will need to be increased accordingly. Recruitment and new staff training is currently ongoing to ensure enough suitably trained staff are available to meet the needs of all service users living in the home. The home is committed to increasing the number of staff with an NVQ, National Vocational Qualification level 2 or above in care, they currently have nearly 50 of staff with the award, and once the staff currently undertaking the award have completed the home will have in excess of that number. They will continue to put staff forward to undertake this NVQ training. The recruitment of staff within the home was found to be robust as was the checks and training carried out for volunteers helping in the home. Training records showed that staff are undertaking dementia and infection control training as part of their induction training, and more in depth dementia courses are also being rolled out to all care staff. What they could do better: A protocol for medication that is to be administered as needed (PRN) to service users needs to devised giving staff clear instructions. Staff must record accurately the medication that comes into the home for service users on the medication record sheet. They must also record the amount of medication left in stock from the preceding 4 week period so that auditing can take place to monitor that service users are receiving the medication they are prescribed. Care Homes for Older People Page 9 of 31 The home offers choices at meals times however the menus need to be reviewed to ensure that service users understand the names of meals they are being offered. The food should be served to the service users hot, and there should be a range of alternatives to the menu on offer other than just sandwiches. Menus should be available in the home prior to the meal being served and be available on the table at meal 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 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. Service users are given sufficient information by the home to make an informed choice about whether the home is right for them. Service users can feel confident that if offered a place at the home following the assessment process, staff will have the skills and knowledge to meet their needs. Evidence: The appointed manager confirmed that service users and their families are given the Statement of Purpose and Service User Guide to help them make an informed decision about whether the home can cater for there needs and is suitable for them. The Statement of Purpose has been reviewed and updated recently and is available in different formats which includes large print and a recorded version. The information contained in the statement of purpose makes clear the services that are available from the staff in the home and those which would be accessed from the community i.e. district nurses. Care Homes for Older People Page 12 of 31 Evidence: Since the last inspection just one new service user has been admitted to the home. The pre admission assessment was viewed and evidence from this demonstrated improvement had taken place in this process. The pre admission assessment had enabled the manager to make a judgement about the needs of the individual and whether the service and the staff were able to fully meet the needs of the individual. Although the assessment is mainly a tick box form the manager had expanded upon the individuals information to include more specific detail such as likes and dislikes. The home uses the pre assessment to determine the level of care required to meet the individual needs. The assessment also provides evidence to determine if the home has sufficiently trained staff that are able to provide for their needs. Other information is also gathered from the individuals GP and in this most recent pre assessment case information from the local authority who had also undertaken an assessment of need. Upon admission, the assessment process is ongoing with the information from all the assessments informing the care planning. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being competently assessed and supported with regard to their health and personal care needs. They can be confident all their needs are recorded on care plans and risk assessments which are kept under review and include their wishes and preferences. Service users can feel confident that they will receive the medication they are prescribed however staff need to improve the way they document medication. Evidence: Four care plans were selected, most recent service user admitted to the home and three others at random. All contained evidence of individual needs assessments and care plans that had been reviewed. The plans of care were person centred and written describing the assistance that is needed to provide the identified care. The care plans included the service users wishes and preferences which ensured that they are individual to the person. The care plans had been reviewed when changes to a persons care needs had changed. This was not routinely done on a monthly basis and this was discussed with the appointed manager who will ensure that outcomes are recorded at the monthly review. On cross-referencing the plan of care with the Care Homes for Older People Page 14 of 31 Evidence: reviews and daily notes it was apparent that when changes have occurred that required the care plan to be updated this had actually been documented. Staff spoken to showed good understanding of the care needs of individual service users and were aware of the individual changes made to their care and support. Individual service user files contained the main areas of risk assessment such as falls assessment, nutritional screening, mobility, where the general assessment had indicated this may be necessary. Risk management strategies were available as part of the individual service plan (plan of care). When risks had been identified outside of the main risk areas, as above, the home has devised a risk assessment and management strategy form. These were viewed on several service user files and gave information about the risk, who it affected and the level of risk. The form gave detailed instructions to staff on how the risk could be minimised. It was also evident on the form that the risk had been reviewed regularly, the form does need to include the future review date and this was discussed with the appointed manager. The daily record written by staff about the care they provide for each individual was detailed and gave an indication of the care provided and recorded observations of how much a person had eaten, any concerns and highlights the service users day. Other records providing information about weight, fluid and food intake charts were also seen having been completed by care staff appropriately. The daily notes are written by care staff soon after delivering support to an individual while there observations are is still clear in their minds. However, some information did not show the time when the care was actually given or the incident had occurred. This was discussed with the appointed manager and senior carer on duty. Observation of interaction between staff and service users throughout the visit showed that privacy and dignity was respected in the home. All staff observed communicated well with service users offering choice where possible and giving the service user time to collect their thoughts before making a decision. Staff were attuned to the body language and non verbal signs given by individuals and were seen responding to this as well as gauging responses to choices offered. The medication storage, handling and records were assessed. Care plans indicated the individual level of support needed with taking medication. Most medicines and medicine records had clear instructions on how and when medication was to be administered. Clear records were kept to show when people were given their medicines. If a medicine was not given this was recorded together with the reason why. Care Homes for Older People Page 15 of 31 Evidence: However the records of medicines brought into the home were not consistent and some medication had not been recorded and one example was seen of the amount being recorded incorrectly. A small audit of medicines did show some shortfalls regarding the recording of medication in the home on the current MAR medication record sheet, maybe because of this, three items of medication counted did not tally with the number of tablets that should have been left in stock. Overall service users are receiving the medication that they are prescribed. Medication was observed to be given correctly to people. All medicines were stored correctly for the protection of people. Some people were prescribed medicines to be given only when needed (PRN). For three out of four people the care plans or PRN protocols describing to staff when these medicines are to be given did not contain sufficient detail to ensure appropriate medicine administration. The appointed manager was made aware of the requirement regarding PRN medication and the short falls. The appointed manager and the senior carer undertook a full audit of medication straight away which was already diarised for that day. The home has been undertaking and documenting medication audits monthly the results of which are shared with the staff that are competent to give out medication. People identified as being allergic to any medicines had this information recorded on their personal detail sheet and on their medication administration records charts. This should prevent people being given a medicine to which they are allergic. Risk assessments were also in place for those service users who do refuse medication at times and these had been reviewed in a timely way. Many aspects of medication administration and recording have improved since the last inspection. However, these improvements must be embedded and sustained over time. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported to make choices and have a wide range of activities available to them. Service users can feel confident overall that they are offered a well balanced diet however the quality of the food is inconsistent and they may not recognise the name of the meal being offered. Service users can be confident that they will be supported to eat their food where necessary. Evidence: Service users are supported to live their lives as they choose. Routines are flexible and time is given to finding out from service users their likes and dislikes and their past routines prior to admission to the home. There is a variety of activities on offer such as art and craft, bingo, quizzes, exercise, card games, listening to music. Entertainers attend the home to play music or facilitate a sing song which service users join in with at their choice. There is an activity coordinator employed in the building and an assistant that solely works in this home with the support of the care staff. Individual records are kept of all activities undertaken or refused by service users. The activity programme that is arranged on a monthly basis is displayed in the home. If changes are made then service users are informed on the day when they are Care Homes for Older People Page 17 of 31 Evidence: reminded of what is happening. Service users choose if they wish to join in, many were happy to watch. Individual activities are also provided for those service users who due to their dementia or preference do not join in group activities. During the day several activities took place and service users were seen to enjoy these and engaged with other service users and staff. The manager explained that the home does have a mini bus; however this has not been in use recently as they did not have a qualified driver. That has now changed and trips out were to be resumed. The home has facilitated outings in the interim by taxi, however service users spoken to did not seem to associate these trips out with outings. Two service users said that they just like to go out for a car ride in the country. Two visitors on the day commented that the home is always welcoming to visitors and that staff and management are helpful. They liked the way they can make drinks if they want, or staff are happy to serve refreshments. They also confirmed that they have seen activities taking place during the days they visit. The menu was not available in the dining area until the lunch was served and then it was not available on the tables. This was commented upon by two service users who felt it would have been nice to look at the menu to decide what they wanted before staff came around and asked. Staff said there is copy of the weeks menu in the lift however the service users dont normally use the lift. There is a choice of drinks offered including alcohol free wine, sherry etc with the lunch time meal. The meal at lunch time includes a starter, main meal and dessert. Service users are asked what they would like for each meal when seated, rather than choosing in advance. Meals are cooked in the building and they are able to provide special diets. However the menus need to be reviewed to ensure they are offering meals that service users will recognise particularly as most service users suffer from dementia. We were invited to take lunch with four service users, however the meal served was not of a good standard and service users spoken to confirmed that the quality of the meals vary. The choices were lamb chop with rosemary gravy, plaice and prawn roulade, or ratatouille. It was apparent from observations that many service users did not know what roulade and ratatouille was and when shown although some showed more understanding it was evident that they werent sure. The lamb was served luke warm with gravy which did not taste of rosemary. The plaice and Care Homes for Older People Page 18 of 31 Evidence: prawns was very small and was not served with any sauce, it was served with the same vegetables as the lamb, roast potatoes and broccoli and cauliflower. One service user looked at it and said I am not eating that it looks horrible. The broccoli looked over cooked and had lost it colour. Several service users did say the lamb was nice but it was not to everybodys taste. One service user who likes small portions was asked to leave what they didnt want; she ended up eating nothing because it put her off. The meal took well over an hour to serve and service users were getting fed up in the end waiting for food to be served. Two service users also complained that there were no menus on the table, they said we could have been deciding before the staff come around to ask. The short falls that occurred during the lunch have been discussed with the appointed manager who is to look at the management of the dining room as well as the menu and quality of the meals served. The dining room is well laid out with tables attractively set, although service users can choose to take their meals in their rooms if they wish. There were staff supporting service users who needed assistance with eating. 0nce the meal is serve staff sit with the service users for there meal. The meal that service users choose on an individual basis is not always recorded in their daily notes; staff need to ensure an accurate record is kept of this. Care Homes for Older People Page 19 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. The home has an effective complaints system in place and service users can be confident their complaints will be taken seriously. Service users are protected by adult safeguarding policies and procedures Evidence: The home has a written complaints procedure and policy. Both service users and visiting families were asked about making a complaint, all said that if they were not happy they would complain. The relatives said that they felt confident that if they did need to complain that the appointed manager would take their concerns seriously. One relative said they had once had to speak to the staff but that their concern had been sorted out straight away, and that staff checked a few weeks later that they were still happy with the outcome. Staff were asked what they would do if a service user or relative said they wished to make a complaint. Staff spoken to said they would listen and try and sort out any problems, they said that they would record the complaint in the absence of the manager but also if it was serious in nature they would contact the on call manager so they could come in and talk to the complainant. The complaints file was seen, however the last record was dated December however it clearly showed the complaint and the action taken to reach a satisfactory conclusion within the time scale set with in the procedure. The home has the adult safeguarding policy and procedure in place. The staff have training regarding safeguarding during their induction training and it is repeated yearly the records confirmed. All staff asked Care Homes for Older People Page 20 of 31 Evidence: about what they would do if they witnessed a service user being abusing were clear about it being reported to the manager as soon as they were sure the service users was safe. Criminal Record Bureau Checks (CRB) has been obtained for all staff and a robust recruitment procedure protects service users. Care Homes for Older People Page 21 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. Service users benefit from living in a home that provides a safe, clean, high quality and homely environment. Service users choose from a variety of personal accommodation to suit their needs and have the use of very comfortable indoor and well tended outdoor communal areas. Evidence: The service is located on the third floor of the building with a registered residential nursing home below. The quality of the environment including furnishings and fittings is high and a lot of thought had been given to the aesthetics of the communal areas. The home has a snoozlem room, which is available to all service users. There are items around the home, which would date back to when the service users were young, things they would remember. There are around the home that the service user can rearrange and touch or just talk about whatever they wanted to do. They can be used for reminiscence by staff and families visiting the home. The bedrooms were well decorated and it was apparent that service users and their families had been given the opportunity to personalise their bedrooms. The home has mainly single rooms but they do have suites, which are suitable for couples for example, these consist of two rooms one which can be used for sleeping and one as a living area. There are two maintenance persons available during the day that covers the whole building not just this service. The maintenance staff take pride in there work and were seen several Care Homes for Older People Page 22 of 31 Evidence: times in the home. The lighting was of a domestic nature and although the communal areas are large it still maintains a homely feel. There is a large balcony which is partly sheltered with a seated area, which over looks the gardens below, service users can access the gardens if staff accompany them via a lift. The main laundry and the kitchens are contained within the service below. There is a small laundry in this home for the service users personal items. Sluice facility washing machines were available for soiled laundry. Everywhere was extremely clean and no offensive odours were detected. A company is contracted to collect clinical waste, sharps and medicines and they have the appropriate certificates for the disposal of waste. Care Homes for Older People Page 23 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. Service users can feel confident that their care, social and emotional needs will be met by care staff in sufficient numbers who have the skills, knowledge and training to meet their needs. Service users can be confident that they will be protected by the homes robust recruitment policy and procedure. Evidence: The home employs ancillary staff who work as cleaners, cooks, gardener/ maintenance staff. Thus allowing care staff the time to meet the needs of the service users. The rota seen and the numbers of staff on duty appeared to be sufficient for the service users currently living in the home. Visitors spoken to said they believe there is now sufficient staff around when they visit during the day. However shortfalls were noted with regard to the majority of care staff achieving a NVQ (National Vocational Qualification) Level 2 or above care qualification. The manager confirmed that currently ten staff have the award out of the 23 care staff employed. However courses have been started by a further six staff and others are going to be booked to start the NVQ award within the next few weeks, so the home is working towards compliance. Dementia training has been part of the induction training; staff also undertake further more intensive training about dementia to enable them to support service users Care Homes for Older People Page 24 of 31 Evidence: further as their needs increase. Staff spoken to at the home said that training is made available to ensure they have the skills to care for the service users. They said that training is on going and they have plenty of opportunities to take courses that help them provide for the service users needs. The home showed that it undertakes a sound recruitment practice including submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. The files also contain CRB (Criminal Record Checks), interview notes and a photo and all the information as required under schedule 2 of the Care Home Regulations 2001. The recruitment process for the appointment of volunteers is robust, and they also receive suitable training. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that the appointed manager has the necessary qualification skills and experience to run the home in a way that promotes their quality of life. They can also be confident that their views and opinions effect how the home is run. Service users and their families can feel confidant that at all times their health and safety is protected as far is practically possible. Evidence: The new appointed manager of the home has 20 years experience working in care with the elderly and people with a learning disability and has undertaken, the Registered Managers award, Advanced Management in care and a diploma in Heath and Social Care and is currently working towards a degree in Health Social Care combined with Health Studies. From speaking with visitors to the home, service users and staff it was apparent that life has improved for the service users in the past few months. A visitor to the home Care Homes for Older People Page 26 of 31 Evidence: on a regular basis said that the home very much revolves around the service users and staff are visible now, certainly this was observed during the course of the day. Other than at lunch time when some issues were noted, staff were seen encouraging service users with activities, or just talking and listening to service users, they were seen reassuring them, staff included them in what they were doing and gave them choices. Throughout the inspection staff were open and honest and assisted in the inspection process. The appointed manager was made aware of the issues raised during this inspection and showed a commitment to work diligently to address them. The service users or their family that were spoken with expressed a great deal of satisfaction in living within the home and felt confident that their views and opinions were valued by the staff and management. The Area Director Residential Care regularly visits the home and completes what is known as Regulation 26 visits. Surveys are given out to service users and families annually to gain the their views anonymously on how well the home is providing their care. If the service users are not able to manage their personal monies then the home has systems in place to hold a small amount of money for incidentals. The money held is kept securely and administered by the concierge staff in the building on the ground floor, it is documented and staff sign for each transaction. Receipts for money spent when service users are with staff are kept and documented. However, if money is taken from the account when the service users is going out with family it is recorded but there are no receipts available for this money. It has been suggested that this be reviewed to ensure the system remains robust. However much of the time the staff said that the home pays the bills such as hairdressing, chiropody and the families or the responsible person is then invoiced at the end of the month. The inspector viewed the AQAA, Annual Quality Assurance Assessment, relating to Health and Safety, maintenance and servicing etc. and confirmed that action is taking place as required. Risk assessments are available for both the building and individual service users. The appointed manager has used her initiative, and where corporate documentation has been lacking then she has devised her own to ensure the home meets the standards required. The appointed manager and maintenance person stated that checks and servicing of fire safety equipment / emergency lighting had been undertaken at the required frequency. The home has in place policies and procedures, which have been reviewed annually to ensure they meet current regulations. Staff receive training regarding these during the Care Homes for Older People Page 27 of 31 Evidence: induction process. The appointed manager and staff spoken to confirmed this. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must be given clear 20/07/2010 instructions and guidance on when to administer medicines that are prescribed for service users, PRN, as required basis. All medication to be given when necessary must have a detailed protocol instructing staff when the medication should be given. 2 31 8 That the appointed manager makes an application to register with the Commission. To ensure there is accountability in line with the Care Standards Act. 20/09/2010 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 2 15 15 A review is needed to ensure that service users are served their food hot and when the service users are ready for it. Menus should be made available on the tables at meal times, and a weekly menu for the current week should also be displayed so service users and visitors can see what will be on offer through the week. The menus need to be reviewed to ensure they communicate what the choices are in a way understood by the services users in the home. 3 15 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. 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