Care Home: Sutton House Nursing & Residential Home

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What the care home does well The home always made sure that people had an assessment before they were admitted and obtained assessments and care plans completed by the local authority. This enables staff to have full information about people prior to admission. The home continues to provide a clean and pleasant environment for people to live and work in. It had a friendly and homely feel and people were able to bring in small items of furniture, pictures and ornaments to personalise their bedrooms. The staff were described as friendly, caring and `willing to help` and they knew the residents needs well. The staff provided care and support in ways that promoted peoples` privacy and dignity. They were observed supporting people in a sensitive way. The staff kept in touch with relatives and kept them up to date with important information. People who lived at the home stated they liked the meals and drinks provided. Alternatives were available if they did not like what was on offer for the main meal. Complaints were dealt with and documented. The administrator manages finances well and clear records are maintained. What has improved since the last inspection? Some of the requirements and recommendations issued at the last inspection have been met. The redecoration plan has continued with some areas of the home completed since the last inspection. Maintenance personnel check any bedrails in use to ensure they continue to be safe. Staff have received training in how to safeguard vulnerable people from abuse and the number of care staff that have gained a national vocational qualification in care has increased from 31 to 47 percent. What the care home could do better: The home needs to have a manager in post to ensure consistent management. The care plans should be more detailed and individualised further to include peoples` preferences regarding the way they wish to be supported and cared for. Also monitoring charts, obviously in place for a reason, should be completed thoroughly and consistently so there is evidence of sufficient nutritional intake and pressure relief. Risk assessments must be kept under review and updated when significant changes occur. This will make sure that staff have up to date information. Medication management must be improved so that residents` medication does not run out of stock and record keeping is accurate. There are some activities and stimulation for people but this does not meet all the residents needs. Limited provision of activities impacts on the choices people are able to make. People told us they would like to have more to do. There must be sufficient care staff on duty all the time. This had fluctuated on some days and staff were short, which could affect care provided to the residents. Staff must receive sufficient training to give them the skills required to care for people in the home. There were gaps in mandatory training such as first aid, basic food hygiene and infection control and very little training for staff in the conditions affecting older people and the health conditions affecting some of the people living in the home. Staff should also receive formal supervision a minimum of six times a year. This will help management to monitor their work and enable staff to discuss any problems. Although staff recruitment was generally good, there was an occasion noted when the person interviewing a potential employee had aslo provided them with a reference. This was a conflict of interest. The interview for new staff could be more thorough. The quality assurance system should be expanded with questionnaires sent to staff and visiting professionals to obtain their views on how the home is conducted. Also action plans with evaluation dates should be produced to address shortfalls identified in questionnaires. This will help to complete the quality assurance cycle. Key inspection report Care homes for older people Name: Address: Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL 01482784703 01482377881 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Barry Potton care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Sutton House is a large elegant looking period building set in extensive grounds. It is located in the village of Sutton and is tucked away discreetly from the main road. The home is a registered care home that is also able to provide nursing care to people. Accommodation is provided over three floors serviced by a passenger lift and stairs. The ground floor has communal areas consisting of a large lounge divided into two distinct areas, a small sitting room, a large dining room and a quiet sitting area in the foyer. The home has a large garden with mature trees and shrubs, a patio area with furniture and ample space for parking. The home has eight shared bedrooms and three single bedrooms on the first floor and Care Homes for Older People Page 4 of 32 2 6 1 1 2 0 0 8 38 0 38 Over 65 38 38 38 Brief description of the care home seven shared and five single on the second floor. All bedrooms have a separate room with en-suite facilities consisting of a toilet and washbasin. The home has two bathrooms and a shower room on the first floor and one bathroom and a shower room on the second floor. Equipment and aids/adaptations are in place to ensure people are cared for in a safe manner whilst allowing them to be as independent as possible. Information about the home and the services it provides can be found in the statement of purpose and service user guide. Both these documents as well as the latest inspection report are on display in the foyer and copies are available from the manager. The fee level advised at the time of the visit was between 379.50 and 399.50 pounds per week with a top-up of 20 pounds per week for a shared bedroom and 40 pounds per week for a single bedroom. Nursing clients also pay their nursing band determination on top of the basic fee. There are additional charges for hairdressing, private chiropody treatment, toiletries, outings and newspapers/magazines. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people that use this service experience adequate quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 26th November 2008 and a site visit to the home, which lasted approximately nine and a half hours. We had received concerns about the management of the home and because of this we could not be sure that the requirements issued at the last inspection had been met. In light of this we explained to the person in charge, and later the provider, that the visit would entail collecting evidence under the police and criminal evidence act (PACE) that could be used for enforcement action against the home if regulations continued to be breached. We ensured they were fully aware of the procedure and gave them a list of any documents we copied. Care Homes for Older People Page 6 of 32 The provider, management and staff team were helpful and provided us with the documentation we required. Although we did find some continuing issues with medication and staff training there had been improvements in other areas. We believe that shortfalls in some management systems and a continued quality rating of 1 *star has been the result of the home not having consistent management for the last few years. We spoke with the provider and we were assured that they wanted to work with the Commission and improve the outcomes for the residents. A new manager has been appointed and is due to start in the new year. They attended the home on the day of the inspection to listen to the feedback from the days visit. The home will receive a warning letter about the continued breaches and must send us an improvement plan. The home may have a further visit to check out the improvement plan has been completed. Throughout the days we spoke to people that lived in the home to gain a picture of what life was like at Sutton House. We also had discussions with the nurse in charge and staff members from each department. We also received surveys from residents, relatives and staff members. Comments have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were, medication practices, risk management, activities organised, nutrition, complaints, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked to see how residents were consulted with in how the home was run and how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. The provider had returned their annual quality assurance assessment (AQAA) within the required timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Sutton House, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us and completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. 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: The home needs to have a manager in post to ensure consistent management. The care plans should be more detailed and individualised further to include peoples preferences regarding the way they wish to be supported and cared for. Also monitoring charts, obviously in place for a reason, should be completed thoroughly and consistently so there is evidence of sufficient nutritional intake and pressure relief. Risk assessments must be kept under review and updated when significant changes occur. This will make sure that staff have up to date information. Medication management must be improved so that residents medication does not run out of stock and record keeping is accurate. Care Homes for Older People Page 8 of 32 There are some activities and stimulation for people but this does not meet all the residents needs. Limited provision of activities impacts on the choices people are able to make. People told us they would like to have more to do. There must be sufficient care staff on duty all the time. This had fluctuated on some days and staff were short, which could affect care provided to the residents. Staff must receive sufficient training to give them the skills required to care for people in the home. There were gaps in mandatory training such as first aid, basic food hygiene and infection control and very little training for staff in the conditions affecting older people and the health conditions affecting some of the people living in the home. Staff should also receive formal supervision a minimum of six times a year. This will help management to monitor their work and enable staff to discuss any problems. Although staff recruitment was generally good, there was an occasion noted when the person interviewing a potential employee had aslo provided them with a reference. This was a conflict of interest. The interview for new staff could be more thorough. The quality assurance system should be expanded with questionnaires sent to staff and visiting professionals to obtain their views on how the home is conducted. Also action plans with evaluation dates should be produced to address shortfalls identified in questionnaires. This will help to complete the quality assurance cycle. 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. Peoples needs were assessed prior to admission, which means that staff have the information required to decide whether needs can be met safely and completely in the home. Evidence: We examined three care files during the visit, one of which was for a person recently admitted to the home. There was evidence that the home had obtained an assessment and care plan for the person, which had been completed by the local authority. The deputy manager had also completed the homes own assessment documentation. There was clear evidence that the assessment had taken place prior to admission. The assessment documentation had been reviewed and had improved since the last inspection. This assessment process enabled management to decide whether needs could be met in the home. It was noted that the persons plan of care was completed quickly within three days of admission. Care Homes for Older People Page 11 of 32 Evidence: People admitted for nursing care have an assessment completed by a nurse employed by the primary care trust regarding the level of nursing care they require. This will determine the health authoritys financial contribution to the persons care. The home does not provide intermediate care services so standard 6 does not apply. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in updating care plans and risk assessments may mean that staff do not have full and current information about peoples needs. This could mean that care will be missed. Shortfalls in recording, and in two instances, stock control of medication means that it is difficult to be certain people are consistently receiving medication as prescribed. Evidence: We examined three care files during the visit and care plans were produced for each resident. Generally these contained all assessed needs and were completed in a timely manner. However, to improve the care plans could include peoples preferences for how they wish their care to be provided. The care plans also need to be evaluated, as there was an inconsistence noted with this. There was evidence, however, that some changes had been made to care plans, for example following instructions from a health professional in one of the files examined. There were also details missing in one of the care plans regarding catheter Care Homes for Older People Page 13 of 32 Evidence: management, frequency of positional changes and communication. For example, there was no information about the size of catheter required, positioning, frequency of bladder washouts or catheter changes and the catheter record chart had not been completed. The mobility plan gave directions for staff when transferring the person and guided them to, ensure moved and positioned in bed as unable to move self but did not state the frequency of the positional changes. The communication plan did not refer to any non-verbal means the resident uses to communicate. We also observed that staff did not follow the care plan regarding a residents seating requirements. This had to be pointed out to the deputy manager to address. Recording in care files had improved but was not always up to date, for example hygiene charts had gaps in them and some staff were more comprehensive than others when completing monitoring charts. There was evidence that peoples health needs were met and residents had access to a range of health and social care professionals. However, the risk assessment for one resident completed on 10.10.09 states they require to sit in a kirton chair, which restricts their ability to stand up unassisted. The document states the person requires an assessment by an occupational therapist to confirm this is the most appropriate form of seating for them. This assessment has not taken place yet and needs to be completed quickly. Peoples weight was monitored and referrals made to the dietician as required. A Tissue Viability Nurse (TVN) from the local primary care trust had been involved regarding advice for one of the residents who had been discharged from hospital with a pressure ulcer. Although referral to the TVN could have been made sooner by the home, the residents pressure ulcer was healing well. There were risk assessments for areas such as moving and handling, nutrition, pressure ulcers, falls and the need for bed rails. Care needs to be taken to ensure the risk assessment are kept up to date and reviewed when significant changes occur. For example, one residents catheter was removed which increased their risk of developing pressure ulcers but the risk assessment was not updated and a care plan was not produced to guide staff in any extra care required. People spoken with were happy with the care provided and said it was delivered in ways that promoted privacy and dignity. Out of eight surveys received from residents, five stated they received the care and support they required, always and three said this was, sometimes. Seven people said they received the medical support they Care Homes for Older People Page 14 of 32 Evidence: need, always and one person said, sometimes. Comments from relatives were, regular baths and showers, the excellent nursing staff and care workers have tended to all her needs and so caring and they sit and chat to the residents. At the last inspection there was a requirement to improve the management of medication. We found there were still some medication issues to address. These included ensuring that all medicines were consistently signed into the home and when hand writing instructions on the medication administration record (MAR), the full details of dosage should be included. The amount of medication remaining needs to be carried forward onto the next MAR to enable good stock control and audit. One persons MAR for painkilling medication stated, use as directed but the box the medication was delivered in stated, 1-2 every six hours. There was no evidence that any of this medication had been offered to the resident. There was also evidence that some residents declined to take some of their pain killing medication on a regular basis but no evidence that this had been discussed with the GP to re-write this as and when required. The home had run out of medication for two residents. One resident had missed 22 doses of a specific medication and another had missed one days supply of two oral medicines and one topical product. It is important that stock control is managed well and recording improved to ensure that residents received their medication as prescribed. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Limited activities were provided to people especially those with dementia care needs. This could mean that people will be bored and their quality of life affected. Evidence: The home has an activity coordinator, although their role has been one of overseeing staff as well. This has led to a dilution of their main role and it was clear from discussions with residents, surveys received from them and their relatives, and also discussions and surveys from staff, that the provision of social stimulation could be improved further. There was evidence of some activities such as bingo, quizzes, manicures, monthly reminiscence sessions and occasional sing-a-longs. We were unable to see the records of activities, and who had participated in them, as the log had been misplaced and individual records in care files had only limited information. However, comments from people were, I would like to do more activities, more activities are needed for the residents, there is not enough stimulation, only bingo once a week, the residents are bored, the home provides good day to day care - more days out of the home are needed, there is not much to do, they organise things in fine weather like walks and we get the odd entertainer and we had bingo today but recently we have not done Care Homes for Older People Page 16 of 32 Evidence: much the last few months. One relative stated, it would be nice if they could get a few more activities for the residents to do and really had a minibus to take them out. At the last inspection we stated, although a positive start the range of activities could be broadened to include more occupational pursuits for people. For example assisting those who want to, to participate in small household tasks, preparing their own sandwiches for tea, baking or making their own drinks. People with dementia care needs and those who spend large portions of the day in bed could receive more tailored stimulation suitable to their needs and capabilities. This situation remains and must be addressed to ensure everyone, that wishes to participate can do so. Staff need to assess residents social care needs to enable an activity programme to be planned and implemented. Routines were flexible although staff did comment that when they were stretched this did impact on the choices people could make about rising and retiring. People spoken with were happy with the times they got up and the majority of surveys from residents stated that staff listened to them and acted on what they had to say. There was evidence that people could make choices about aspects of their lives, for example bedrooms were personalised and some people had brought in items of furniture and had their own telephones installed to keep in touch with friends and family. Visitors were welcomed at any time and relatives stated in surveys that they were kept informed of issues affecting their loved one. People spoken with liked the food provided and surveys confirmed this. Seven of the eight surveys returned from residents stated that they liked the food, always. Catering staff received information from care staff regarding special diets and stated they had an, unlimited budget and that they had never been prevented from ordering items. The catering staff had a good knowledge of the residents individual needs. The dining area was set out with individual tables and chairs and cloths decorated the tables. Some people chose to eat their meals in their bedrooms. Care Homes for Older People Page 17 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 home provided an environment were people felt able to complain. The home ensured that people were protected from abuse by staff training and adherance to policies and procedures. Evidence: The home had a complaints policy and procedure which was on display. There was a complaint form for staff or the complainant to complete and a complaint handling checklist for the manager when auditing any complaint through the process. This has scope to record complainant satisfaction. The homes Annual Quality Assurance Assessment (AQAA) states there have been no formal complaints received by the home since the last inspection. However, there has been complaints received by the Commission and local authority. These have been investigated, advice given to management and no further action planned. Staff spoken with knew what to do if concerns or complaints were raised with them and residents spoken with stated they felt able to complain if they needed to. One person said, yes, they would sort things out. However, three residents in surveys stated they did not know how to make a complaint. Management need to ensure this is addressed. The home had copies of the multi-agency safeguarding policies and procedures regarding safeguarding vulnerable adults from abuse. Staff have received training in Care Homes for Older People Page 18 of 32 Evidence: safeguarding since the last inspection and the deputy managers, in temporary charge of the home, are aware of what to do should any allegations of abuse or poor practice be reported to them. They still had not completed the local authority training regarding local procedures specifically for managers but it was confirmed that this had been booked for the next available course. There had been three safeguarding referrals made since the last inspection. All had been investigated, advice given and no further action planned. Staff within the home have contacted the Commission in the past to pass on concerns and these were checked out by the local authority. Care Homes for Older People Page 19 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 home continues to provide a clean and comfortable environment for people. Evidence: The home continues to be well maintained and had a rolling programme of redecoration and refurbishment. Staff reported that when they requested replacement items these were provided. Overall the home was clean and free from any malodours. In surveys seven of the eight replies stated the home was clean and fresh, always, one person said, sometimes. People had a large lounge to use that was divided into two distinct parts via seating arrangements. A large television was at one end and a music centre at the other. There was also a separate seating area just outside the lounge in the foyer for people to see their relatives in private. Other communal rooms consisted of a separate dining room, an additional quiet lounge and a hairdressers room. All were nicely decorated and furnished. Bedrooms continue to be pesonalised to varying degrees dependent on the choice and taste of the occupant and shared bedrooms had dividers in place. Most of the people admitted for nursing care had special profiling beds and pressure relieving equipment. People spoken with were happy with their home and bedrooms, Im very happy thank you, I like the home and staff look after you well, I help to tidy my room. Care Homes for Older People Page 20 of 32 Evidence: The laundry was well supplied with equipment and suitable for the size of the home. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in consistent numbers of care staff during the day and gaps in training could mean that care will be missed and staff may not have the required skills to care for people fully. Evidence: Discussions with staff members from each section of the home took place during the day and surveys were received from twelve staff. It appears from discussions, rotas and surveys that there have been staffing issues in the past but staffing numbers are improving. Generally there is one nurse and five care staff in the morning, one nurse and four care staff in the afternoon and one nurse and two care staff at night. In October there were days when there was only three care staff in the afternoon and on one occasion this was only two care staff. It is acknowledged that staff sickness can occur at anytime but a reliable back up system needs to be developed to ensure staff can be called upon to support at short notice. One staff member in a very recent survey did state, they are catching up now and employing more staff. However, they also expressed that consistency regarding the correct numbers of staff enabled a better quality of care. The home had sufficient domestic staff and they obviously worked hard to maintain standards. The home had suddenly found itself without a main cook and steps had been taken to recruit a replacement. In the meantime this was covered by a chef Care Homes for Older People Page 22 of 32 Evidence: known to the company. Staff spoken with and information from surveys suggest that generally the needs of residents were met but management decisions had affected staff morale. They also commented that staffing levels could impact on choices, for example the time people wish to rise and retire, and the activities they participate in. The home had a training matrix that detailed who had participated in training and this highlighted gaps that needed to be actioned. For mandatory training the gaps were first aid, basic food hygiene and infection control. There was very little training for staff in the conditions affecting older people and the health conditions affecting some of the people living in the home. An audit of staff training needs should be completed gained via staff supervision and appraisals and a training plan produced to meet identified shortfalls. Records provided by management indicated that nine care staff had completed a national vocational qualification (NVQ) in care at levels 2 and 3. This equates to 47 percent and is a good achievement and gives staff a basic knowledge of how support and care for people. Further care staff were progressing through the course. There were some shortfalls in recruitment practices noted during the day. People completed application forms, were selected via an interview process, and references and criminal record bureau checks were obtained. However, two staff members had worked at another residential home and references had not been obtained from this previous employer. There was also a staff member interviewed by someone that had provided a reference for them. The interview process in one of the staff recruitment files examined consisted of a tick box answer sheet rather than a robust interview to determine if the person was right for working in the home. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not had consistent and effective management in the year since the last inspection. This has led to shortfalls in management systems such as quality monitoring, staff training, and staff supervision and support. Evidence: The home has had inconsistent management and direction for the last few years. This has impacted on relationships between staff members, and between staff and management. People spoken with and surveys received from them indicated that staff morale was very low and management support has been patchy. Staff said that the interim manager, in post whilst recruitment has taken place for a new manager, has been approachable. Comments from discussions and surveys about how the home has been managed were, the home isnt run very well, the atmosphere has not been good lately, we need better management of staff time and more effective control of staff and we dont feel supported. A relative stated, high turnover of matron/management causes inconsistency of care, as there is often periods (months) with no true leadership. Care Homes for Older People Page 24 of 32 Evidence: A new manager has been appointed and is due to start working in the home in January 2010. She is an experienced manager with a proven track record in managing care services so the shortfalls in management should be addressed. The appointment of the new manager should bring some stability to the home. Staff supervision records were examined and it was noted that this area had slipped as a result of management shortfalls. Staff had only received one formal supervision session in the last year, when the standards expect at least six sessions a year. Day to day work was overseen by nursing staff but as the nurses were completing a shift there was little time for management tasks. One supervision record for a nurse highlighted training needs but these had not been planned for yet. There had been some attempt to monitor the quality of service provided by consulting with residents and relatives. Thirty-two questionnaires were sent out in April 2009 to people and seven were returned. The questionnaires had not been analysed so any shortfalls had not been identified or addressed. Questionnaires had not been sent to staff or visiting professionals. This would give a broader view of the service and how it is managed. Some audits were completed monthly, for example finances, and maintenance personnel had a workbook they completed when issues were identified as needed repair or replacement. Housekeeping had cleaning schedules that were adhered to. Residents/relatives meetings were held, which gave an opportunity to exchange information and check if there are any issues. The management of residents finances was well organised and had not changed since the last inspection. Money for safekeeping was maintained in individual wallets and each resident had an account log. A copy of the account log was forwarded to relatives every four weeks to enable them to check what has been withdrawn and to top up the account if required. The local authority had recently given advice to the home regarding the need for best interest meetings, and care management involvement, should the need arise to purchase equipment or goods for people without capacity and relatives to support them. It had come to our attention recently that particular records had not been maintained for the length of time required. The home had taken advice and addressed the situation. The home was a safe place for people to live in and staff to work in. Maintenance personnel carried out fire safety checks and equipment used in the home was serviced as required. There were some areas of the environment that needed attention and Care Homes for Older People Page 25 of 32 Evidence: these were mentioned to staff. For example, the linen cupboard and bathroom on the first floor used as a store room needed locking and the store room used for catheter equipment was untidy and also unlocked. Staff do need to have up to date certificates in mandatory training. Care Homes for Older People Page 26 of 32 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 All medication must be 31/12/2009 signed as received into the home and stock controlled in a more effective way. This will evidence good recording and enable staff to manage medication more effectively so people do not run out of their medicines. Timescale of 31/12/2008 remains unmet. 2 30 18 Revised requirement. Staff 31/12/2009 must be provided with the training required to meet the diverse needs of people that live in the home. This will enable them to become up to date with mandatory training, and acquire information in the conditions affecting older people and the health needs of people living in the home. This will ensure that people will be confident their needs will be met by knowledgeable staff. An audit must be carried out and a plan produced by the timescale for action date. Timescale of 31/03/2009 Care Homes for Older People Page 27 of 32 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 remains unmet. Care Homes for Older People Page 28 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 8 13 Risk assessments must be kept under review and updated when significant changes occur. This will ensure staff have up to date information about peoples needs and will assist when planning and delivering care. 31/12/2009 2 12 16 Residents must have their social and occupational needs assessed to help identify past and current interests and also help to identify current abilities. This will enable activities to be tailored to meet needs, especially of people with dementia or memory impairment. 31/01/2010 3 27 18 There must be sufficient care staff on duty all the time. 31/12/2009 Care Homes for Older People Page 29 of 32 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 This will ensure that the needs of people living in the home are met. 4 31 12 The home must be managed 31/01/2010 in a consistent and effective way. This will help to ensure the safety and welbeing of residents and a well trained, supervisied and supported staff team. 5 37 17 All records required for the running of the home must be up to date and available for inspection. This will enable us to monitor the home and be sure it is being managed effectively. 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 31/12/2009 1 7 Care plans should be more detailed and individualised further to include peoples preferences regarding the way they wish to be supported and cared for. Monitoring charts, obviously in place for a reason, should be completed thoroughly and consistently. This will help to audit the care that is provided. Amounts of medicines should be carried forward to the next MAR. This will enable an accurate stock control. 2 8 3 9 Care Homes for Older People Page 30 of 32 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 4 9 Handwritten entries and changes to MAR charts should be accurately recorded and contain details such as the original date and authorisation for the change. The prescriber or community pharmacist should be asked to provide information when medication is asked to be given as directed. This makes sure that the medication is given correctly. A weekly or monthly at a glance log would alert staff to those residents that had not participated in anything so this could be addressed. Residents should have more choice regarding the activities and occupations that are able to participate, and the time they wish to rise and retire should be clearly indicated in their care plans. The home should continue to work towards 50 percent of care staff trained to NVQ level 2 and 3. Staff recruitment interviews should be robust and not completed by people that have a conflict of interest. This will help to ensure that recruitment is fair and thorough. References should be obtained from the applicants previous employer. This will give management a full picture of the applicants work history. The newly appointed manager should apply for registration with the Commission when in post. This will help to bring stability to the home and ensure their fitness to manage is tested. Action plans with evaluation dates should be produced to address shortfalls identified in questionnaires. This will help to complete the quality assurance cycle. The quality assurance system should be expanded with questionnaires sent to staff and visiting professionals to obtain their views on how the home is conducted. Care staff should receive a minimum of six, formal supervision sessions per year. 5 9 6 12 7 14 8 9 28 29 10 29 11 31 12 33 13 33 14 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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