Care Home: Sutton Village Care Home

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What the care home does well The home always ensured that peoples` needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons` needs. People had care plans that were detailed and gave staff information about how to care for them. Staff promoted peoples` independence provided care in ways that respected privacy and dignity. The staff members knew the residents and their families well and were observed speaking to people in a friendly and respectful way. One person said, ‘they are never nasty and speak in a nice way – full marks for that’. People liked the meals provided and said they had enough to eat and drink and there was variety and choices, ‘it is all home cooked’. Sutton Village Care Home provides a pleasant and homely environment for people. It was spotlessly clean, tidy and well presented. Domestic staff obviously work hard to maintain the standards. People were happy with their home and commented on the cleanliness, `its always clean and tidy` and `the cleanliness is very good`. The home managed peoples` personal allowance appropriately and maintained records of income and expenditure. The home has been awarded parts 1 and 2 of the local authority Quality Development Scheme and was graded, ‘A’ by environmental health officers when they assessed the food safety management systems in the home. The home was a safe place to live, as equipment was serviced and checks completed on the environment. Staff had also received training in how to safeguard people from abuse. What has improved since the last inspection? There have been significant improvements in the environment, as the entrance has been opened up, new carpets fitted throughout all corridors and communal areas, several bedrooms and the lounge redecorated and new equipment purchased. The proprietors have shown an ongoing commitment to improving the environment for residents and have further plans to lighten one of corridors and provide a managers office. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Care plans have been re-styled and although this process has only just started improvements can already be seen. They are much more detailed and personalised. The administration of medicines has improved, although there was still an issue with recording. See below. The information provided to people when they make initial enquiries has improved. The manager stated she is looking at improving this further and is planning to introduce a brochure. Risk assessment documentation is more tailored to peoples’ needs. This also helps staff to plan actions to minimise the risks. The amount of staff that has gained a national vocational qualification in care, (NVQ) has increased. This shows a commitment to a trained workforce. What the care home could do better: Recording of medicines needs to improve so that there is a clear audit trail as to why it has been omitted and how much medicine is in the home. There could be a better range of activities for people to participate in. Some people were happy but others said they would like to complete more. People were able to make choices about aspects of their lives but staff could improve on this by ensuring even little decisions are made by residents. The complaints procedure is clear but it should contain information about how people can complain to the local authority, as they are responsible for funding the placements of a lot of residents. The manager was aware that some refresher training had slipped due to the flooding of the local authority training centre. She had produced an action plan to deal with this. It needs to be adhered to, so training gets up to date. The training plan could also include conditions that affect older people so staff members have the opportunity to cover a range of topics. The home had an annual quality assurance plan but it had lapsed as a result of management changes. This needs to be re-started. Staff members do receive formal supervision and the new manager has developed a better system. Care staff members need to have a minimum of six supervision sessions a year. This will enable them to discuss things at regular interval and also ensure their practice is monitored. The manager needs to apply for registration with the Commission as soon as possible. This will provide the home with stability and direction.Sutton Village Care HomeDS0000071540.V377295.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Sutton Village Care Home 30 Church Street Sutton Hull East Yorkshire HU7 4TA Lead Inspector Beverly Hill Key Unannounced Inspection 20th August 2009 09:00 DS0000071540.V377295.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 2 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 Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton Village Care Home Address 30 Church Street Sutton Hull East Yorkshire HU7 4TA 01482 707085 01482 712668 suttoncarehome@suttoncarehome@karoo.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Mark McWilliam Manager post vacant Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE. The maximum number of service users who can be accommodated is: 23. 22nd August 2008 2. Date of last inspection Brief Description of the Service: Sutton Village Care Home is a large detached house standing in its own grounds in the village of Sutton. It is close to local facilities including shops, a post office and churches, and there is easy access to local public bus services. The home is registered to provide care and support to twenty-three older people, some of whom may have needs associated with dementia. Accommodation is on two floors serviced by a through floor lift and stairs. There are three shared and seventeen single bedrooms, three of which are ensuite. The home has a large lounge and a separate dining room set out with individual tables. There is a further small seating area for two to three chairs in the dining room. The home has an assisted bathroom on the ground floor and two bathrooms, one of which is assisted, and a shower room on the first floor. There are sufficient toilets close by to bedrooms and communal areas. The gardens are secluded, well maintained and provide seating for residents. There is a private car park, which provides ample parking space. The current scale of charge is £358 per week for people funded by the local authority, with top up fee of £5 for a shared bedroom and £20 for a single bedroom. The fee is £420 per week for privately paying residents. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and taxis for personal use. Information about the home is included in the statement of purpose and service user guide, which are located in the home and distributed to potential residents. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection completed on 22nd August 2008, including information gathered during a site visit to the home, which took approximately eight and a half hours hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sutton Village Care Home. We also had discussions with the proprietor, the new manager (in post for only six weeks), care staff members and visitors. Information was also obtained from surveys received from six people that live at the home, two relatives, four staff members and a health professional, employed by the home to provide reminiscence therapy. Comments from the discussions and surveys have been used throughout the report. We looked at the information provided to prospective residents or their representatives to check that people had full information on which to base a decision about the home. We also 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, activities provided, nutrition, complaints management, 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 checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, 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, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed 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 Village Care Home, the staff team and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us on the day. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 6 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. What the service does well: The home always ensured that peoples needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons needs. People had care plans that were detailed and gave staff information about how to care for them. Staff promoted peoples independence provided care in ways that respected privacy and dignity. The staff members knew the residents and their families well and were observed speaking to people in a friendly and respectful way. One person said, ‘they are never nasty and speak in a nice way – full marks for that’. People liked the meals provided and said they had enough to eat and drink and there was variety and choices, ‘it is all home cooked’. Sutton Village Care Home provides a pleasant and homely environment for people. It was spotlessly clean, tidy and well presented. Domestic staff obviously work hard to maintain the standards. People were happy with their home and commented on the cleanliness, its always clean and tidy and the cleanliness is very good. The home managed peoples personal allowance appropriately and maintained records of income and expenditure. The home has been awarded parts 1 and 2 of the local authority Quality Development Scheme and was graded, ‘A’ by environmental health officers when they assessed the food safety management systems in the home. The home was a safe place to live, as equipment was serviced and checks completed on the environment. Staff had also received training in how to safeguard people from abuse. What has improved since the last inspection? There have been significant improvements in the environment, as the entrance has been opened up, new carpets fitted throughout all corridors and communal areas, several bedrooms and the lounge redecorated and new equipment purchased. The proprietors have shown an ongoing commitment to improving the environment for residents and have further plans to lighten one of corridors and provide a managers office. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 7 Care plans have been re-styled and although this process has only just started improvements can already be seen. They are much more detailed and personalised. The administration of medicines has improved, although there was still an issue with recording. See below. The information provided to people when they make initial enquiries has improved. The manager stated she is looking at improving this further and is planning to introduce a brochure. Risk assessment documentation is more tailored to peoples’ needs. This also helps staff to plan actions to minimise the risks. The amount of staff that has gained a national vocational qualification in care, (NVQ) has increased. This shows a commitment to a trained workforce. What they could do better: Recording of medicines needs to improve so that there is a clear audit trail as to why it has been omitted and how much medicine is in the home. There could be a better range of activities for people to participate in. Some people were happy but others said they would like to complete more. People were able to make choices about aspects of their lives but staff could improve on this by ensuring even little decisions are made by residents. The complaints procedure is clear but it should contain information about how people can complain to the local authority, as they are responsible for funding the placements of a lot of residents. The manager was aware that some refresher training had slipped due to the flooding of the local authority training centre. She had produced an action plan to deal with this. It needs to be adhered to, so training gets up to date. The training plan could also include conditions that affect older people so staff members have the opportunity to cover a range of topics. The home had an annual quality assurance plan but it had lapsed as a result of management changes. This needs to be re-started. Staff members do receive formal supervision and the new manager has developed a better system. Care staff members need to have a minimum of six supervision sessions a year. This will enable them to discuss things at regular interval and also ensure their practice is monitored. The manager needs to apply for registration with the Commission as soon as possible. This will provide the home with stability and direction. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 8 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. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs assessed prior to admission to the home. This ensured that staff members were aware of peoples’ needs and that they could be met in the home. EVIDENCE: We looked at three care files during the visit and it was clear that people had their needs assessed prior to admission into the home. Two of the care files had copies of the local authority assessments and care plans. There was no record of the assessment in the third file. However in each case the manager or deputy had completed the homes’ assessment documentation. The assessment process consisted of information gathering at the enquiry stage, which is then followed up with an assessment visit to the persons’ Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 11 current place of residence or hospital. This enables the assessor to check whether the home is suitable to meet the needs of the person and to pass on information to them about the home. Once the decision is made for admission, the manager formally writes to the person or their representative stating that the home is able to meet the assessed needs. During the first few days of admission, further assessment documentation is completed as staff get to know the resident. This is a tick box form with scope for comments about independent living skills. The system works well and enables the staff to gather information to formulate plans of care. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their health and personal care needs planned for and met in ways that promoted privacy, dignity and independence. The recording of medication needs to improve to ensure staff members have clear instruction about administration. This will help to prevent mistakes and ensure people have their medication as prescribed. EVIDENCE: The care files contained a wealth of information, including assessments, risk analysis, personal profiles and life histories, for use when formulating plans of care. Generally care plans contained assessed needs and gave staff information on how to meet them. The manager had, in her first few weeks in post, decided to restyle the care plans and she showed us the ones she had been working on. They were much more detailed and included lots of information about preferences, likes and dislikes and personalised information Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 13 about how to promote privacy and dignity. They were cross-referenced with risk assessments and new, and existing care staff, would have all the information they need to care for the person. The new care plans also detailed the residents’ strengths, thereby prompting staff to maintain their independence. Staff evaluated the care plans and produced a monthly summary of events that have affected the person. When cross-referenced with the health monitoring form for one resident, it showed that due to a concern with nutritional intake, a GP had visited and referral made to a dietician. When fully completed the care plans need to be signed by residents or their representatives to show that they have read and agreed them. Reviews took place on an annual basis with the resident, their family, care staff members and local authority personnel, if funded by care management. Risk assessments were completed for a range of issues such as moving and handling, nutrition, falls and fragile skin. Risk assessments were generally updated when changes occurred, although there was an absence of an update in one of the files we examined. Daily recording reflected the care provided and staff completed a separate form when residents accessed health professionals for advice, support or treatment. Staff members need to take care to ensure documentation is dated when completed, as several dates were missing from risk assessments and care plan sections. People spoken with told us that care staff looked after them well and respected their privacy and dignity, ‘they look after me – they are good lasses’ and ‘the staff knock on doors before entering’. We received six surveys from residents, some of which were completed with the help of relatives, and all stated they received the care and support they required either, ‘always’ or ‘usually’. All six stated they received medical attention when needed, ‘always’. There was evidence that residents’ health care needs were met. The files examined indicated that people saw opticians, dentists, GP’s, district nurses, a physiotherapist, chiropodists, dieticians, and attended out patients appointments with consultants. Emergency care practitioners attended when residents had accidents in the home and staff members were concerned they may have injured themselves. Medication was stored appropriately, usually signed on receipt into the home and stock controlled well, which meant that people received their medication on time and as prescribed. However there were some recording issues that need to be addressed. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 14 When medication is omitted for any reason, staff members need to use codes in a consistent way. Staff had used the code, ‘O’ but had not defined what the reason for the omission was. Some medication was delivered in original containers and sometimes, midcycle. Staff did not always sign this medication as received into the home and they need to carry forward amounts from the previous medication administration record (MAR) onto the current MAR. This enables a more efficient way of auditing stock. When administering Fentanyl patches for pain control, staff double-signed the controlled drugs book but there was only one signature on the MAR. It is good practice for both staff to sign the MAR as well. One staff member had signed the MAR for a dose of inhaler medication for the evening of the site visit. This time had not yet arrived so staff must take care when signing the MAR to avoid mistakes and confusion. The MAR for one resident indicated lots of refusals for one of their medicines in the evening, coded, ‘R’. There was no explanation for this and no evidence that staff had contacted the GP to let them know. The GP may wish to alter the time of the medication to ensure the person received it. Some medication had been stopped after a discussion with the GP. This was dated but any hand written instruction should be signed by two people. One resident is prescribed a medicine that needs to be taken a half to one hour before food and another after food. The MAR indicated they were both given at 8am. The manager assured us that these special instructions were adhered to but the MAR needs to reflect this. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the 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 the provision of activities and social stimulation could result in people becoming bored. EVIDENCE: There was evidence of some activities and social stimulation provided but it was clear that the home had not got it quite right for everyone yet. People participated in reminiscence therapy on a fortnightly basis, facilitated by an occupational therapist and there were several in-house activities such as games, quizzes, listening to music and watching DVD’s. Some people went to the local shops and seasonal events were organised. One resident enjoys playing the piano and local clergy visit two people for spiritual support. People told us there used to be more to do and sometimes they can get bored. Comments were, ‘we don’t do any craft work now’, ‘we used to have more chats but there is no time now’ and ‘they do try and involve me with activities’. This was reflected in surveys as two people stated there were sufficient activities, ‘always’, three people said this was, ‘usually’ and one person said, Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 16 ‘sometimes’. When asked what improvements could be made two people stated, ‘more activities’. The home could consider the employment of an activity coordinator who would be able to focus their attention just to providing stimulation. Other people were happy with the home as it is, ‘it’s a good home to be in, I’ve been very happy here’ and ‘I like to keep to my own room and do my own thing – it’s a very nice home’. One resident told us they still accessed a social club in the community with another resident and really enjoyed the entertainment there. Relatives told us the home organised celebrations for Christmas, Easter and Halloween and arranged occasional outings. The manager was aware that there were shortfalls in the provision of activities and had plans to address them. People spoken with enjoyed the meals provided. Menus were varied and alternatives were offered. Catering staff provided special diets as required. In surveys people said they liked the meals either, ‘always’ or ‘usually’ and comments were, ‘they feed me well’, ‘its all home cooked’ and ‘oh the food is fine’. One person did say that their meal was a little on the cool side on the day of the visit. We also noted that the dining tables had table cloths but these were removed when the tables were set and glasses of juice were placed at the side of each setting prior to people sitting down. Removal of the table cloths made the tables look bare and was unnecessary. Not asking people what they wanted to drink removed some of their decision-making. Staff should ensure people have as much choice to make their own decisions as possible. Routines such as rising and retiring were flexible and visitors were welcomed at any time. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People felt able to complain and were protected from abuse by staff training and adherence to policies and procedures. EVIDENCE: The Home had a complaints policy and procedure that was on display on the notice board in the lounge. It was written in large print and contained information about how to contact the Commission should people be unhappy with the outcome of any complaints investigation completed by the home. It should also have information about how to contact the local authority complaints department. There were complaints forms for people to raise issues and staff members spoken with were aware of what to do should anyone raise any concerns with them. The manager maintained a log of complaints and records indicated there had been two since the last inspection. These had been investigated and resolved but how they were actioned could be clearer. People spoken with stated they felt able to complain, ‘I would tell the girls’ and ‘I would go to Mark, the owner’. Five out of the six surveys from residents stated they knew how to make a complaint and who to speak to if they were Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 18 unhappy about something. In meetings residents and their relatives were asked if they had any concerns or complaints. The Commission had not received any complaints since the last inspection. Most staff members had completed training in how to safeguard vulnerable adults from abuse. The home had policies and procedures in place and staff members spoken with were aware of what to do if they suspected abuse had occurred. The manager and deputy manager were aware of the multi-agency policies and procedures for safeguarding adults and also their role regarding referral and investigating procedures. Since the last inspection there had been one safeguarding of adults investigation when the hospital were concerned about bruising found on a resident. However the investigation found there was an explanation for this and no further action was required. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean, comfortable and homely environment, which meets their individual needs. EVIDENCE: The homes refurbishment plan was on target and there had been some significant improvements since the last inspection. The dark entrance has been opened up to provide a light and airy reception area. The wood panelling so loved by residents and their families has been preserved throughout the home. New carpets have been fitted throughout the corridors, both upstairs and downstairs and in the lounge. New curtains and chairs have been fitted in the reception area and lounge. Several areas of the home have been redecorated making it look clean, homely and bright. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 20 Equipment has been purchased for the laundry, kitchen and garden. The proprietor also told us about plans to renovate a section of the space outside the kitchen to make an office for the manager and to install a wide set of doors in the downstairs corridor to bring in more light. Communal areas consist of a large lounge that is light and airy and a dining room with a small seating area at one end overlooking the garden. There are also two quiet seating areas, one in the foyer and another on the landing. Accommodation was on two floors serviced by a through floor lift and consisted of three shared and seventeen single bedrooms, three of which were en-suite. One of these en-suites was a full bathroom with a bath suitable for more able people. The bedrooms were of a good size and the high ceilings in most gave a feeling of space. Bedrooms were personalised to varying degrees dependent on the taste and choice of the occupant and the three shared rooms had privacy screens. People spoken with liked their bedrooms and the home in general. Comments were, ‘they make it possible to personalise rooms’, ‘the home is very clean’, ‘the home is always very clean and fresh’ and ‘I have my own room and like to do as I like’. Surveys from residents confirmed the home was clean and fresh either, ‘always’ or ‘usually’. One person did tell us that because of the high ceilings, the lounge could be cool at times especially in the colder months and that once, staff had to bring blankets to cover peoples’ knees. This needs to be monitored closely and the heating turned up to reflect peoples’ needs and wishes. The home has one assisted bathroom on the ground floor and two bathrooms, one of which is assisted, and a shower room on the first floor. There are sufficient toilets to meet the needs of people close by to bedrooms and communal areas. The home was spotlessly clean and smelled very fresh. Housekeeping staff obviously work very hard to maintain standards, as it is a large house and room sizes are generous. The laundry is an adequate size for the size of the house and needs of the residents. One staff member commented in a survey that more care could be taken with residents’ clothes when washing them. The manager was aware of this and was monitoring the situation. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some gaps in refresher training means that staff may not be fully up to date in their knowledge and skills base. However, there is a high percentage of staff that have gained a national vocational qualification in care. Checks are made on staff prior to employment to ensure they are suitable to work in the home. EVIDENCE: Staffing levels had remained the same and rotas showed there were three care staff members on duty during the day, plus the manager or deputy manager and two staff at night. Staff told us this was generally enough to meet peoples’ needs and if they were particularly busy in the mornings, then the manager would help out. In surveys three staff stated there were sufficient staff, ‘usually’ and one person said this was, ‘sometimes’. There were sufficient catering, domestic and maintenance staff. The home does not employ an activity coordinator, which has impacted on the delivery of activities and social stimulation. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 22 Residents told us in surveys that staff were available either, ‘always’ or ‘usually’, but one person said this was, ‘sometimes’. There were also comments in two of the surveys suggesting that there needs to be more staff employed. This related to the provision of activities and the limited time that care staff have to sit and talk with people. Residents spoken with on the day were complimentary about the staff and described them as, ‘friendly’, ‘will do anything for you’, ‘they are never nasty and speak to you in a nice way – full marks for that’, ‘they are good to me’, ‘the girls are fine’ and ‘the night staff are very good – lovely’. The home has a training plan and the manager has started to update information about staff training to add to the plan. She was aware that mandatory training, mostly refresher courses, had fallen behind, mainly as a result of flooding to the local authority’s training centre. The training plan showed that this had been addressed and courses were booked. The deputy manager stated, ‘we are now back on track with training’. Previous training records indicated that a small number of staff had completed other training such as, dementia care, continence products, equality and diversity, pressure area care, diabetes, Parkinson’s disease, mental capacity awareness and deprivation of liberty safeguards. Staff members also need access to other training in the conditions affecting older people. For example, catheter care management, nutrition for people with dementia and how to support people after a stroke. According to information provided in the homes annual quality assurance assessment (AQAA), there are eleven care staff out of seventeen that have gained a national vocational qualification (NVQ) in care at levels 2 or 3. This equates to 65 and is a very good achievement. There are further staff members due to the start the courses in September. New staff complete skills for care induction standards and have their work signed off by senior staff. This enables the supervisor to be sure they are competent in basic care and the staff member to gain confidence in their caring abilities. The induction also includes an orientation into the homes’ way of working and specific policies and procedures. Generally the recruitment process made sure that checks were completed prior to the start of employment for new staff. Application forms were completed, references obtained and staff attended for an interview. Initial povafirst checks were made and it was noted that people were employed before the full criminal record bureau check (CRB) was returned. This should happen only in exceptional circumstances and not as a matter of routine. The manager confirmed that staff would be paired up with more experienced ones until the full CRB was returned. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the managers’ fitness to manage has not been tested yet by the Commission, we are assured that the home is well managed. It is a safe place to live and work in and provides people with opportunities to express their views about the running of the home. EVIDENCE: The manager has been in post for only six weeks, although she was familiar with the home having worked there as a carer. She has four years experience as a manager within another residential home and twenty-five years experience in the caring field. She has completed her Registered Managers’ Award and is preparing to apply for registration with the Commission. This Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 24 needs to be completed quickly so her fitness to manage can be tested. She has completed a range of training suitable for her role. She is also a moving and handling trainer and can facilitate this in-house with staff. Staff commented in discussions and in surveys that the manager was supportive and professional, ‘she is absolutely fantastic’, ‘very fair and keeps things confidential’, ‘she will deal with issues and then move on – they are dealt with privately’, ‘I feel the home is moving forward – she is very organised’ and ‘the new manager and owners are working well together’. They told us that communication in the home generally worked well and that they used a daily diary and hand over sheets to pass on information. Staff also stated they had developed good relationships with family and other visitors, which was confirmed in discussions with them and in surveys received. The proprietor visits the home almost daily and residents spoken with knew his name. Staff stated they were able to approach him with issues. The new manager had started a revised staff supervision system. She wanted to hold the first session with staff and was then to delegate some supervision to the deputy manager and senior carers. The new supervision records were more detailed regarding the discussions held and directions for staff. It was noted that staff supervision had lapsed recently and records showed they had received between 2-5 sessions in the last year. Staff should receive a minimum of six sessions per year. This enables them to discuss things regularly and also enables the supervisor to monitor practice. The new system should address shortfalls. The home does have a quality assurance system that involves audits, questionnaires and team meetings. There is an annual plan with a month by month record of tasks that need completing to monitor the quality of services provided. There has been a lapse of the system due to the change in management and this needs to get back on track. We have seen improvements though in care planning and the manager was proactive in developing an action plan to check that requirements and recommendations from the last inspection have been met. She has created a positive atmosphere in a short space of time and staff told us morale was good and they were pleased with the changes that had been made. The homes’ annual quality assurance assessment (AQAA) was completed on time. This told us what the home planned to do over the next twelve months to improve the service. For example check the policies and procedures to see if they need updating, improve risk analysis, implement a more structured training programme, provide more activities inside and outside the home and continue the restyling of care plans. This self regulation is important and shows that the manager is aware of the direction the home needs to take. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 25 The home had been awarded both parts of the local authority’s quality development scheme. Generally family members supported people to manage their finances but some people still managed this independently. The home does hold in safe keeping personal allowances for a number of residents. Individual records are maintained and receipts obtained for purchases made on their behalf by staff. The personal allowance is usually held for hairdressing, chiropody and purchases at local shops. Equipment was serviced and repairs generally completed quickly. It was noted that one of the washing machines wasn’t working for all cycles. This needs to be addressed. Fire alarm checks and drills were carried out and staff received fire safety training. Catering staff had scored an ‘A’ in the local authority’s food safety management assessment. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 X X 3 X 4 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 X 3 Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations A system should be in place to record all medication received in to the home and medication carried over from the previous month. There should be a consistent use of codes when medication is omitted. This will enable staff to complete a more effective audit trail of medicines. Handwritten entries and changes to MAR charts should be signed by two staff and specific instructions, for example with food or a set period of time before food should be clearly documented. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The activity programme should be broadened to meet the needs of people in the home. This will offer more stimulation and prevent people from getting bored. People should be encouraged to make more choices, especially in the areas of activities and their dining experience. This will promote peoples wellbeing and DS0000071540.V377295.R01.S.doc Version 5.2 Page 28 2 OP9 3 4 OP12 OP14 Sutton Village Care Home 5 OP16 6 OP29 7 8 9 10 OP30 OP31 OP33 OP36 decision-making. The provider should include information in the complaints procedure about how people can complain to the local authority, if funded by them, regarding any concerns they have about the care they receive. The manager should record the exceptional circumstances when staff are employed after a povafirst check but prior to the return of the full CRB. This will assist in the safeguarding of vulnerable adults that live in the home. It is acknowledged there have been particular delays in the local area with CRB returns, which has caused staffing issues. The homes training plan should include conditions affecting older people and dementia care training should be rolled out to all care staff. The manager should apply fro registration with the Commission as soon as possible. Successful application will provide stability for the home. The annual quality assurance system of audits and questionnaires should be re-started now the new manager is in place to direct it. Staff should receive a minimum of six supervision sessions per year. This will provide them with the opportunity to discuss issues at regular intervals and enable the supervisor to monitor their practice. Sutton Village Care Home DS0000071540.V377295.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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