Care Home: Surrey Hills Nursing Home

What the care home does well Prospective residents who may wish to use the service have up to date information about the home and have a full needs assessment prior to using the service in order to ensure that the homes staff have the skills and abilities to meet their assessed needs. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. The staff provide good personal care related to the residents assessed needs. The homes complaints and safeguarding adults procedures promote the rights and protection of residents. The homes furnishings are of a high comfortable standard. The physical layout of the home meets residents mobility needs. The control of the spread of infection and cleanliness is generally well managed. The recruitment and vetting of staff to protect the welfare and safety of residents is well managed and staff receive training to ensure residents needs are appropriately met. The management and administration of the home is good and the home continues to be run in the best interests of the residents. Residents views and opinions and those of others associated with the home are sought. Residents welfare is promoted through monitoring of health and safety in the home. What has improved since the last inspection? The home have commenced updating residents care plans to reflect a more person centred approach. Communal areas and some residents bedrooms have been refurbished and decorated to offer an improved environment for residents to enjoy. A hand held telephone has been made available for residents to use. The home have retained permanent agency staff who have become part of the team in order to offer residents continuity of care. What the care home could do better: All residents must have their call bells or have another method of summoning the assistance of staff should they need to in order that their needs can be met promptly and efficiently. The staffing levels and deployment of staff meet the needs of the residents yet need to be regularly reviewed dependant on the needs of the residents. Key inspection report Care homes for older people Name: Address: Surrey Hills Nursing Home Brook Road Wormley Godalming Surrey GU8 5UA     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: Suzanne Magnier     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Surrey Hills Nursing Home Brook Road Wormley Godalming Surrey GU8 5UA 01428682346 01428682054 surreyhills@carehomesofdistinction.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr L K Hasham,Mrs N Hasham care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category/ies of service only: Care home with nursing - N 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 Surrey Hills is a registered care home, one of a group of similar services run by Care Homes of Distinction, in the area. The home is a large detached premises situated in the village of Wormley. There are twenty-nine single bedrooms, two of which have full en-suite facilities, and eight double bedrooms. There are a number of bathrooms and toilets situated on each floor. Nursing care is provided on two floors served by passenger lift and stairs for forty-five older service users with dementia. There are road and train links to the village and the home provides car-parking facilities. Catering is in-house. There is a staff team with nurses and carers who are supported by a wider network of health care professionals offering holistic care. Care Homes for Older People Page 4 of 32 Over 65 0 45 Brief description of the care home Care Homes for Older People Page 5 of 32 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 Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The last inspection on this service was completed on the 14th January 2008. This inspection of the care home was an unannounced Key Inspection. Ms S Magnier Regulation Inspector carried out the inspection and arrived at the service at 09.30 and left the service at 15.30. The service was represented by the registered manager. The inspection was a thorough look at how well the service was meeting the Key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. For the purpose of the report the individuals using the service are referred to as residents. Care Homes for Older People Page 6 of 32 Surveys were sent from the commission to the home to gain the views and opinions of residents and others associated with the home. The commission received six completed written surveys from residents, two from health care professionals and four from staff. The comments of which have been included within the report. The registered manager had completed the Annual Quality Assurance Assessment AQAA which had been received by the commission within the timescales set. The information within the AQAA was well recorded and formed part of the inspection process and references from the AQAA have been included within this report. The information contained in this report was gathered from speaking with a number of residents, care staff and the registered manager during the inspection and senior managers following the inspection. A tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, some residents care plans, daily records, risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. There is currently a safeguarding vulnerable adult concern which prompted the inspection. No formal complaints have been received by the home about the services and facilities provided since the previous inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in January 2008 have been complied with to improve the services to the residents receiving care and accommodation at the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All residents must have their call bells or have another method of summoning the assistance of staff should they need to in order that their needs can be met promptly and efficiently. The staffing levels and deployment of staff meet the needs of the residents yet need to Care Homes for Older People Page 8 of 32 be regularly reviewed dependant on the needs of the residents. 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 32 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 32 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. Prospective residents who may wish to use the service have up to date information about the home and have a full needs assessment prior to using the service in order to ensure that the homes staff have the skills and abilities to meet the individuals assessed needs. Evidence: The homes Statement of Purpose and Service User Guide provide up to date information for a prospective resident or their representative to make an informed choice about using the services and facilities provided by the home. Information packs are given to residents on admission to the home which include a contract, terms and conditions, the statement of purpose and service users guide, the homes complaints procedure and the identified accommodation costs and agreed care provision. The home have an admission and assessment procedure. Four care plans were Care Homes for Older People Page 11 of 32 Evidence: sampled which evidenced that the registered manager and general nurses understood the importance of having sufficient information in the completion of a full needs assessment for all prospective residents considering admission to the home. There was evidence to support that the care needs assessments had been completed with the prospective resident or their representative prior to admission to the home and admissions to the home only take place if the assessment team are confident that the homes staff have the skills and experience to support the individuals assessed needs. The home does not offer intermediate care yet the home continues to offer respite care for residents. Care Homes for Older People Page 12 of 32 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. The care planning system, monitoring of risk assessments and medication procedures of the home ensure that residents health, safety and well being is promoted. The staff provide good personal care related to the residents assessed needs. Residents receive a good provision of health care and are supported in a way that protects their rights to respect, privacy and dignity. Evidence: The four care care plans sampled evidenced that each of the residents had had their care plan developed from the pre assessment documentation. The registered manager advised that the kardex system of care planning was currently being reviewed to include some of the residents additional information in order that information regarding the resident was all within the one document. The registered manager advised that the home activities co-coordinator had started to compile, with residents and their representatives, a life story booklet which would be available to all residents in the home to incorporate their individual life history in order Care Homes for Older People Page 13 of 32 Evidence: to assist staff to have a greater knowledge of the individual and for the home to be able to offer more of a holistic and person centred approach to the care of the individual. The AQAA states that it is the intention of the homes management to continue to further develop person centred care plans with each resident, their families and relatives so as to promote the highest quality of care delivery. The care plans included the residents health, medical, personal and social care needs, their likes and dislikes, their lifestyle choices including daily routines for example what time they like to get up and retire at night, their moving and handling needs, style of communication, involvement of health care professionals, nutritional assessments, fluid analysis, continence management, use of bed rails, evidence of deprivation of liberty assessments, history of falls, wound care, weight charts, the residents tissue viability, previous occupation, how the resident likes to be addressed, their spiritual, ethnic and cultural needs and choice regarding gender specific care. The registered manager confirmed, and documentation was evidenced, to support that the home have implemented an audit system whereby care plans are spot checked and reviewed regularly to ensure that the information is up to date and any changes in the residents care are recorded and the care provided to residents meets their current needs. It was noted that two of the care plans had not been fully signed by the staff member completing the documentation and the care plans had not been signed by the resident or their representative. The home are reminded that where a resident is unable to sign a care plan this is recorded within the residents care plan to illustrate that the staff have considered the resident during the formation of their plan of care. Following the inspection the homes senior managers have been proactive and have introduced a documented action plan that advises that a new system of auditing of care plans, to ensure that plans are agreed by the resident or their relatives, has been put in place and will be audited and maintained by the homes staff. Staff on duty during the inspection were vigilant to residents who required turning whilst they were in their beds to relieve their pressure points. It was observed that a significant number of residents in their bedrooms did not have their call bells available to them and this was brought to the registered manager and nurses attention and immediate action was taken. It has been required that residents must have their call bells or have another method of summoning the assistance of staff should they need to in order that their needs can be met promptly and efficiently. During the tour of the premises it was noted that some residents were waiting for staff Care Homes for Older People Page 14 of 32 Evidence: to attend to their needs for example getting dressed, support with breakfasts and tidying their bedrooms. These issues were discussed with the registered manager in person and the organisations business manager on the telephone during the inspection and immediate action was taken by the organisation to address the shortfalls. Evidence related to the concerns has been more fully documented in the staffing section of the report. Some residents daily records were sampled and the registered manager explained that the care staff document the residents daily care which they have received from staff and will report back to the registered general nurse on duty if there are any matters of change or concern regarding the residents well being. The registered nurse documents the specific care they have provided and staff confirmed that formal hand overs take place before each shift starts in order that they are made aware of the the current support and needs required by the resident. The care plans sampled contained up to date and documented risk assessments of hazards in residents daily lives which included the residents nutrition, mobility, use of bed rails, moving and handling needs, medication, eating and drinking and receiving personal care. The care plans contained body maps which are used to document any potential areas of tissue weakness it has been recommended that the staff also include any evidence of bruising within the documents in order to ensure that residents well being continues to be monitored. Residents and their relatives or friends comments regarding the care and facilities offered by the home included In my opinion the home is exemplary, well staffed, very caring and no complaints. My relative and I have no complaints about the nursing care they always treat my relative with dignity and respect. If I ask any questions about my relatives care the staff always give me the answer. My relatives room is always clean and tidy and if my relative was not happy they would tell me and the staff would know about it. As far as I am concerned the staff are very caring, they keep my relative clean and encourage them to eat and drink.Everything is done OK. My relative is happy at Surrey Hills and often thinks it is their old home. The recent redecoration has brightened the home up and the change of having a dining room to inter spacing dining tables into lounges is another improvement. The home always seems to be looking to further improve the place. The staff always welcome me. The staff always keep me informed and I am very happy with the difficult choice I had to make. They look after everyone very well and the staff are always helpful. There was documented evidence to support that appropriate health care appointments including weekly visits by the general practitioner had been attended and records indicated that the home continues to work in close liaison with other health care professionals for example physiotherapists, psychiatric consultants, dentists, speech Care Homes for Older People Page 15 of 32 Evidence: and language therapists, opticians, chiropodists, reflexologists and specialist services such as the tissue viability nurse and the diabetic nurse specialist. The home has a medication policy and procedure in place. The registered nurses were observed administering medicines in a methodical manner and took time to support residents with their prescribed medicines. The medication administration charts sampled were well documented and contained no gaps in signatures. The registered manager confirmed that the ordering, delivery and disposal of medicines had been maintained and a recent pharmacy audit from the dispensing chemist had been undertaken and the recommendations met. It was confirmed that residents have a right to refuse their medication and that the home promotes residents rights to independence, and where possible, following appropriate risk assessments residents would be supported to manage their own medication. During the inspection it was noted that residents were addressed in a polite and courteous way by staff and residents responded well and were engaged with staff. One incident regarding a staff members performance was brought to the registered managers attention and the business managers attention following the inspection and was resolved swiftly by the home. During the tour of the premises it was observed that in some residents bedrooms specific written guidance, addressed for staff, regarding the residents needs and working practises of staff were attached to the residents bedroom wall and in several rooms continence management aids had been left in full view. The registered manager was advised of the observation and assured that the notices would be removed and continence aids stored appropriately in order to promote the residents rights to dignity and privacy. Care Homes for Older People Page 16 of 32 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. Residents rights of choice and control their daily life is promoted yet must be maintained. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. Improvements in the mealtime arrangements must be maintained to ensure residents choice, dignity and well being. Evidence: The home was orderly throughout the day and some residents were observed moving around the home freely and having choices about where to be during the day which included staying in their room within some of the homes lounges or conservatory area. The staff and registered manager confirmed that the home has maintained professional bonds with residents relatives and friends and the written comments received from residents and their relatives were positive about the home. The AQAA advises that the home is intending to readdress interest in a Relatives Support Group, arrange an open day once all the redecoration and refurbishment works are completed, develop a quarterly newsletter to keep the stakeholders informed of changes and developments within the home, make the Tuck Shop a permanent feature, make arrangements for a Pamper Parlour, Reminiscence area and Music Care Homes for Older People Page 17 of 32 Evidence: Section within the home to benefit residents. The homes staff continue to support residents to have involvement with local churches and lay ministers provide a fortnightly service and Holy Communion is available to residents at their request. It was observed that there was an activities programme in the home yet due to the adverse weather conditions the activities organiser had not been able to visit the home on the day of the inspection yet the residents took part in a Seniorcise fitness event in the afternoon arranged by a visiting professional which was greatly enjoyed by several residents. The AQAA advises, and it was evidenced through talking with staff and residents, that the home has a varied programme to offer meaningful activities which includes visiting entertainers for example a pianist who encourages residents to join in sing songs, Karaoke sessions, Aromatherapy, Reminiscence sessions, Art and Crafts and Seniorcise. The activities organiser often brings her dog to the home and it is reported that the residents have become very fond of the dog and love him to sit with them and the home has several cats which the residents enjoy the company of. The activity organiser works with individuals and small groups and specialist themed events and social gatherings with recent attendance by the Mayor and Mayoress of Godalming have been held and birthdays of residents celebrated. The registered manager advised that the home have been supported by an Interiors Specialist who specialises in dementia friendly environments. It was observed that the main dining area included areas of interest for example, hat and coat stands, rummage boxes, historic pictures, a variety of clothing and books. Throughout the inspection it was observed that no residents were supported by staff into the main dining room to engage with the objects of interest prior to lunches being served. Residents who were in their bedrooms during the morning, prior to being supported to the communal areas in the home also had not been provided with any articles of interest for example newspapers, magazines, books or objects of comfort which the resident could engage in. As previously documented the commission are aware that the home is reviewing the care planning system and note that the current care plans of residents contain little information about how residents can maintain their daily living skills for example washing and dressing, setting tables, involvement in housework, preparing vegetables and it is recommended that these factors be considered within the homes improvement strategy to take forward some of the work already underway in the Care Homes for Older People Page 18 of 32 Evidence: home. The midday meal served looked well presented and appetising. There was a choice of meals offered to residents and it was observed that several residents, who did not want a midday meal were given beverages that they requested. It was observed that despite the homes intention of encouraging interaction and access to dining facilities, as documented within the AQAA only three residents were supported to use the small dining tables in the conservatory area and no residents were supported to use the main dining room despite tables having been set for a mealtime. It was observed that one resident sitting up at the table on their own had been given their meal on a tray despite the table having been prepared. The tables that were set did not contain any other crockery, menus, place mats, napkins, centre pieces and condiments which could act as a talking point and engage residents during their mealtime if they sat up at the tables. The registered manager was unsure why the resident had received their meal on a tray and advised that the staff did not have the time to support residents, who needed to be hoisted, to sit up to the tables to have their meals and that the majority of residents required staff support to assist them with their meals. The residents sitting in the lounge looked well groomed and wore protective clothing at the meal time. It was observed that one resident who said they were hungry had to wait for their meal whilst a staff member found a table for the residents meal and did not offer the resident a cushion for their back to assist them in sitting up to have their meal to improve their posture, safety and comfort. The dining experience was service led rather than being a meaningful opportunity for social engagement for residents. During the previous inspection in January 2008 it was highlighted that adequate supervision be provided in the dining areas for residents. Following the inspection the homes senior managers have been proactive and have introduced a documented action plan that advises that the deployment of staff and resources have been reviewed and that several residents were supported to have their midday meal sitting up at the dining room tables following the inspection. The commission have been advised that this practise will continue for all residents who wish to have their meals in this way and that sufficient staff are available to support residents to have their meals in a more pleasant, engaging and stimulating way taking into account residents rights to choice, dignity, respect and well being. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes complaints and safeguarding adults procedures promote the rights and protection of residents. Evidence: The home has an established complaints procedure which was evidenced as an up to date document and was available throughout the home. It was confirmed whilst speaking with the registered manager and sampling the complaints log that no complaints have been received since the last key inspection. Written information received by the commission from residents at the home regarding how to make a complaint stated that they knew the homes complaints procedures. The security of the home was robust and people entering the home signed the visitors book. Two staff files sampled evidenced that Criminal Record Bureau checks and Protection of Vulnerable Adult checks are carried out on all new staff. The home has a copy of the current local authority Multi agency Procedures for Safeguarding Vulnerable Adults. It was observed that two residents had been supported, following their personal care, into their arm chairs and the chairs had been placed against the side of the residents bed which could be viewed as alleged restraint. The registered manager gave assurances that neither of the residents had the ability to move unaided from their Care Homes for Older People Page 20 of 32 Evidence: chairs yet it has been recommended that the staff are reminded to reflect and be aware of how situations or scenarios could result in an allegation of restricting a residents rights to freedom of movement. The homes policy regarding the safeguarding of vulnerable adults was sampled and it was noted to be in accordance with the local authority procedures. It was confirmed that one safeguarding referral had been made since the last key inspection and had not yet been concluded. Records sampled evidenced that all staff had received safeguarding vulnerable adults training and where staff were due to attend the training this would been booked via the organisations training department. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any Safeguarding incidents. There was evidence within several residents care plans to support that the home are aware of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards in order to ensure the protection of the residents. Care Homes for Older People Page 21 of 32 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 homes furnishings are of a high comfortable standard. The physical layout of the home meets residents mobility needs. The control of the spread of infection and cleanliness is generally well managed. Evidence: The location and layout of the home remains suitable for its stated purpose and the home continues to provide pleasant surroundings for residents with suitable furniture and soft furnishings throughout the home for residents to use. The homes decoration plan was discussed with the registered manager and the upgrading of the furnishings in all communal areas and bedrooms has nearly reached completion which has offered an improved environment for residents. The AQAA advises that the home are readdressing the topic of developing an outdoor secure space for residents to potter around and take an interest in the raised flower beds if they wish to. The control of infection in the home was well managed and staff were seen to wear protective clothing for all tasks undertaken in the home, disposal of clinical and domestic waste was well managed and handwashing facilities were available to all Care Homes for Older People Page 22 of 32 Evidence: people throughout the home. The home was clean and the general standard of cleanliness was good. It was noted that during the inspection a malodour was detected in two bedrooms and this information given to the registered manager and staff during the inspection and raised with the business manager and quality manager following the inspection. Several residents bedroom doors were not closing flush and this was brought to the registered managers attention immediately informed the home maintenance personnel in order that the shortfall was rectified. The commission received written verification that all fire doors in the home had been checked and realigned following the inspection. The homes staff are reminded of the importance of the awareness regarding the health and safety aspects in the home and must report if any doors are not in good working order in order to ensure the safety and well being of residents in the event of fire. During the tour of the premises it was noted that a housekeeping cupboard used to store equipment and chemicals had been left unlocked. The commission received written verification to advise that immediate action was taken to ensure that the storage area was made secure and staff are reminded of their duty to comply with the control of substances hazardous to health (COSHH) guidance in order to ensure the safety and well being of residents. A storage cupboard in the home that used to be used as a linen cupboard was noted to be very warm in temperature and this was brought to the registered managers attention. The commission received written verification to advise that a risk assessment had been completed and all articles in the cupboard removed. Care Homes for Older People Page 23 of 32 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. The staffing levels and deployment of staff meet the needs of the residents yet need to be regularly reviewed dependant on the needs of the residents. The recruitment and vetting of staff to protect the welfare and safety of residents is well managed and staff receive training to ensure residents needs are appropriately met. Evidence: The home is currently supporting 35 residents and employs 12 care staff, which includes the registered nurses. The AQAA advises that it is the homes intention to strive to employ a full compliment of permanent staff, maintain the current workforce and only use agency staff in an emergency. As previously documented it was observed that the home did not appear to be adequately staffed and the deployment of staff was not well managed. The care staff had been allocated to several units within the home and it was noted that the majority of residents required the assistance of two staff members or their needs were such that they needed to have additional time for specific tasks. Several residents were observed to be waiting for staff assistance, beds were not made following staff supporting the resident, curtains in residents rooms were not drawn and some residents were receiving breakfasts late into the morning. Care Homes for Older People Page 24 of 32 Evidence: Staff confirmed that they felt pressured to get their work completed yet undertook their tasks in a methodical and planned way. These concerns were addressed with the registered manager during the inspection and also with the business manager and quality manager on the telephone following the inspection. The business manager confirmed that staffing deployment in the home had recently changed which had assisted staff yet this had not been maintained and would be reinstated with immediate affect in order to address the shortfall and ensure residents needs were being met and staff had the time to spend quality time with residents when providing their personal care. The commission received written verification following the inspection that a staff meeting had been held and a new routine had been discussed and would be put in place commencing 18th January 2010 that additional staff hours would be available during the morning peak times and allocation of the housekeeping staff to assist in the morning routines regarding making residents beds and tidying their rooms to relieve the care staff of these duties. It was also confirmed that the registered manager would work alongside staff in order to offer support and mentor good working practise. The commission advise that the staffing levels and deployment of staff must be reviewed at appropriate intervals with regard to the level of dependency of the residents in order to ensure that at all times the staffing numbers and deployment of staff is appropriate for the health and welfare of residents. Written comments received by the commission from residents and relatives regarding the homes staff included The staff are very attentive to my requirements. The staff are always friendly and care about the residents. The home should introduce some specific specialist training for staff. Written comments received from staff regarding the home included Surrey Hills is a very caring home and the staff all work well with the service users and their families making the home like a large family. The home obviously works well as comments from first time visitors say it has a lovely feeling and is very welcoming. The service users, families and staff all enjoy the parties and all like to be involved. We are all very proud of our home. I thoroughly enjoy working for the best of the service users and the home, to me it is not like going to work each day as I feel it is like home from home. Surrey Hills is a warm, welcoming and friendly home. We try to involve relatives as much as possible especially on our open days of which we have many. There is a real team spirit which I believe everyone feels on entering the home and therefore it comes across as a very happy and caring home. What the home could do better is to have a more permanent staff team than using agency staff and putting Care Homes for Older People Page 25 of 32 Evidence: more health care assistants on the floor at night and during the day. Nearly all the service users are encouraged to do things to promote their independence and their rights like all personal care, eating,drinking. The service users relatives are always welcome and if they choose they can have meals and drinks with their loved ones. The staff are all friendly and work well within the team. We provide parties for summer and Christmas and have cakes for service users birthdays. The home could do with more staff so we can spend even more quality time with service users on a one to one, also do more activities with service users. We could also do with better beds and chairs that help service users that can stand and more money to help the manager to achieve all of this. We are trained to give care to a high standard, using all types of equipment and working with other health disciplines, communication is good between staff and relatives concerning the residents. Staff relationships with residents were observed to be professional and the use of terms of endearment supported trusting relationships between the resident and the staff member and residents preferences on how they liked to be addressed were documented in their care plans. The home has a recruitment and selection policy, which incorporates equal opportunities. Two staff files were sampled and each evidenced the vetting practises were robust in order to ensure the safety and protection of residents in the home. The files contained application forms, with two written references, evidence that face to face interviews had taken place and the staff job description in order that the staff member was clear about their roles and responsibilities. The managers affirmed that the home is committed to the ongoing training and development of staff and the staff files and training matrix detailed that staff attended induction, statutory training and some specialist training which supports staff to care for residents with dementia and other specific needs. Six of the permanent staff team have achieved their National Vocational Qualifications in level 2 or above. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is good and the home continues to be run in the best interests of the residents. Residents views and opinions and those of others associated with the home are sought. Residents welfare is promoted through monitoring of health and safety in the home. Evidence: The registered manager oversees the day to day management of the home and has been employed at the home for several years. The registered manager demonstrated, throughout the inspection, a knowledge and understanding of the day to day running of the service for the benefit of the residents. It was recognised during the inspection that the management structure of the home had changed in recent months with the loss of two registered nurses who had worked in the home for a significant period of time and who had worked closely with the registered manager. Their absence from the staff team had had an impact on the home and the registered manager was adjusting to the change. Care Homes for Older People Page 27 of 32 Evidence: Comments from residents, visitors to the home, health care professionals and staff regarding the management of the home included This is how all nursing homes should be run. Surrey Hills is run very efficiently and ensures that the residents are treated in a caring and dignified manner.As far as I am concerned the manager is excellent I can always talk to her and discuss anything with her. we have a great manager who is always there for support and takes an interest in the service users and is always willing to help out if needed. The manager is one of the best Ive worked with and is always supporting and encouraging staff with training and will give praise when needed but is fair if you do something wrong, she will tell you and help you so as not to make the same mistakes again. The home has an internal Quality Assurance process and there was evidence to support that the views from residents living in the home had been listened to for example the provision in house of a hands free telephone to support relatives to have privacy calls. photographs of all members of the staff team have been displayed in the homes reception area. A menu album has been developed which it is reported has been a success for residents as a visual aid. The home have continued to involve relatives and advocates in relation to all aspects of the care delivery. Regulation 26 records of unannounced visits by the organisations area manager were thorough in assessing the quality of the service and any issues identified were addressed by the organisation in order that appropriate action would be taken to rectify the shortfalls. The staff confirmed that records were kept of fire tests and equipment checks and signage was available within the home to show residents fire exits. The registered manager confirmed that the home ensures that residents and their relatives are aware that the home do not provide a facility for involvement of resident finances which remain the responsibility of the resident or their relative. The home have a current certificate of registration and insurance liability and the recording of accident and incidents has been maintained with the commission continuing to be informed promptly of any event which affects the well being and welfare living in the home. As recorded throughout the report a number of shortfalls of the overall management of the home were promptly addressed by the homes senior management and written verification received by the commission. The specific areas identified within the report Care Homes for Older People Page 28 of 32 Evidence: which were addressed during and following the inspection need to be monitored and maintained in order to demonstrate sustainability to protect and ensure the welfare and well being of residents. Care Homes for Older People Page 29 of 32 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 30 of 32 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 7 13 Residents must have their call bells or have another method of summoning the assistance of staff at all times. In order that their needs can be met promptly and efficiently. 01/02/2010 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 has been recommended that the staff include any evidence of bruising within the care plan documentation in order to ensure that residents well being continues to be monitored. It is recommended that maintainence of residents daily living skills be considered within the homes improvement strategy to take forward some of the work already underway in the home which benefits residents daily life. It has been recommended that the staff are reminded to reflect and be aware of how situations or scenarios could result in an allegation of restricting a residents rights to freedom of movement. Page 31 of 32 2 14 3 18 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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