Care Home: Tatchbury Manor Nursing Home

What the care home does well The home is clean, comfortable and homely and is surrounded by a pleasant well maintained grounds that service users can enjoy in a safe environment. Each service user has person centred care plans that are comprehensive and cover all aspects of their needs. The daily notes describe the actions taken by staff to provide for the service user`s needs as set out in the plans and generally described how the person has spent their day. Staff are respectful and kind and were observed to be sensitive to those who were more mentally fragile. Service users told us on surveys that. `The staff give me choices and I feel part of a family, I am happy here`. `My privacy is respected and the manager has become my friend`. `The home involves the families and is open and friendly. There are lots of activities`. `I am more than satisfied with all aspects of the care and facilities provided for my wife`s needs`. `My comments have always been listened to and when required have been attended to`. Those service users who were able to communicate with us told us that they think the home provides them with the care they need. The home has a busy activities programme that is provided by three activities organisers who try to plan the programmes of activities around past recreational preferences to try to stimulate residents and meet their social needs. The home provides an appropriate and varied training programme for all levels of staff. Over 50% of staff have achieved a National Vocational Qualification level 2 & 3 and other staff are undertaking level 4. Staff spoken to and surveys returned to CQC from staff told us that they consider their training needs are met. Staff spoken to and staff surveys told us that staff are satisfied with their employment and comments said. `The home provides equal opportunities for all staff. We deliver person centred care`. `We have different training to improve our skills and provide recreational activities to stimulate service users`. `The manager has an open door policy and is supportive`. `We work in a stress free environment and the home gives us good support`. `I am happy to work here. We have enough staff and do appropriate training courses`. The service users` health care needs are met by a range of health professionals who visit the home. All visits are recorded in care plans. Surveys received from those professionals visiting the home were very complimentary about the care that is given to the service users. Comments made said. `Tatchbury Manor looks after patients with severe mental health issues, dementia and behavioural problems.They know how to keep people safe, stimulated appropriately and staff are always knowledgeable about any of the residents when I contact them. I am confident they will contact the mental health team for advice if needed`. `The home meets the needs of the client group very well and seeks appropriate advice from other agencies when needed. The home maintains good standards of care. It is a very good service. The home is run well by a good manager`. `Tatchbury Manor`s manager has excellent skills for caring for elderly with mental health needs and has excellent teaching skills and will, as an advocate for the service users, challenge doctors on choice of treatment. `The quality of care in this nursing home has improved beyond measure in recent years under its current nurse management. Excellent leadership`. All service users are nutritionally assessed and care plans are in place to manage any identified risks. Meals are well balanced and a choice is available. Observation indicated that service users enjoy the food and they told us it was good. The manager has a quality assurance system in place and she monitors all aspects of the service. What has improved since the last inspection? There were no issues of concern identified at the last inspection of the home. The home has increased staffing levels at busy times of the day and shift patterns have been altered to meet the needs of the service users. The home has an ongoing redecoration programme and a number of bedrooms and the corridor areas of the home have been redecorated and new carpets put down. What the care home could do better: The bathrooms are in need of refurbishment. Protocols should be written into care plans to guide staff when PRN medication should be administered. Personal toiletries should be maintained in the person to whom they belong, room or kept in a locked environment in the bathroom area. A bolt or lock should be fitted to the sluice room door on the first floor to ensure service users do not have access to this area. Key inspection report Care homes for older people Name: Address: Tatchbury Manor Nursing Home Tatchbury Lane Netley Marsh Southampton Hampshire SO40 2HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Tatchbury Manor Nursing Home Tatchbury Lane Netley Marsh Southampton Hampshire SO40 2HA 02380812352 02380814779 tatchmanor@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sewah Singh Adkar care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service uses to be accommodated is 38 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home Tatchbury Manor Nursing Home is situated close to the village of Netley Marsh in the New Forest. The old wing of the building is of historic interest being over 1000 years old. The building has been extended and renovated over the years and now provides accommodation for 38 residents with dementia. The home stands in extensive grounds and the rear garden has a large pergola and patio area. Separate buildings in the grounds house the laundry and a staff training room. Information on the range of fees charged can be obtained by enquiring at the home. The fees do not include the cost of hairdressing, chiropody and other personal items. 38 Over 65 0 Care Homes for Older People Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit to Tatchbury Manor Nursing Home, which was unannounced, took place on 21st October 2009 and was attended by one inspector who was assisted throughout the visit by the registered manager Mrs. Helen Woodman. For the purpose of this report the inspector is referred to throughout as we or us collectively, being a representative of CQC. The visit to Tatchbury Manor formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The focus of this visit was to support the information gathered prior to the visit. The judgements made in this report were made from information gathered prior to the visit and information from the previous inspection report, correspondence and any contacts relating to the service were also taken into consideration. The Annual Quality Assurance Assessment (AQAA) which was submitted to CQC by the manager, did not Care Homes for Older People Page 5 of 32 give us a great deal of detailed information and therefore our evidence and judgements have been made from the evidence gathered during this visit and from talking to service users and staff and observations throughout the day. We also looked around the premises. There were a number of service users unable to be involved with the visit but those who were able were generally complimentary about their home and the care they receive. Surveys had been distributed by CQC to service users, staff and visiting professionals. Four service users returned their surveys and were generally very happy with the care and services they receive in the home. Four visiting professionals returned surveys and were highly complimentary about the manager and the care given in the home. Five staff surveys were returned to CQC and also from speaking to staff indicated that staff feel well supported and consider they receive appropriate training that relates to their role and enhances their understanding of the service users needs. There were thirty seven (37) residents living in the home at the time of this visit, all of which, but one, came from the same ethnic background. Care Homes for Older People Page 6 of 32 What the care home does well: The home is clean, comfortable and homely and is surrounded by a pleasant well maintained grounds that service users can enjoy in a safe environment. Each service user has person centred care plans that are comprehensive and cover all aspects of their needs. The daily notes describe the actions taken by staff to provide for the service users needs as set out in the plans and generally described how the person has spent their day. Staff are respectful and kind and were observed to be sensitive to those who were more mentally fragile. Service users told us on surveys that. The staff give me choices and I feel part of a family, I am happy here. My privacy is respected and the manager has become my friend. The home involves the families and is open and friendly. There are lots of activities. I am more than satisfied with all aspects of the care and facilities provided for my wifes needs. My comments have always been listened to and when required have been attended to. Those service users who were able to communicate with us told us that they think the home provides them with the care they need. The home has a busy activities programme that is provided by three activities organisers who try to plan the programmes of activities around past recreational preferences to try to stimulate residents and meet their social needs. The home provides an appropriate and varied training programme for all levels of staff. Over 50 of staff have achieved a National Vocational Qualification level 2 & 3 and other staff are undertaking level 4. Staff spoken to and surveys returned to CQC from staff told us that they consider their training needs are met. Staff spoken to and staff surveys told us that staff are satisfied with their employment and comments said. The home provides equal opportunities for all staff. We deliver person centred care. We have different training to improve our skills and provide recreational activities to stimulate service users. The manager has an open door policy and is supportive. We work in a stress free environment and the home gives us good support. I am happy to work here. We have enough staff and do appropriate training courses. The service users health care needs are met by a range of health professionals who visit the home. All visits are recorded in care plans. Surveys received from those professionals visiting the home were very complimentary about the care that is given to the service users. Comments made said. Tatchbury Manor looks after patients with severe mental health issues, dementia and behavioural problems.They know how to keep people safe, stimulated appropriately and staff are always knowledgeable about any of the residents when I contact them. I am confident they will contact the mental health team for advice if needed. The home meets the needs of the client group very well and seeks appropriate advice from other agencies when needed. The home maintains good standards of care. It is a very good Care Homes for Older People Page 7 of 32 service. The home is run well by a good manager. Tatchbury Manors manager has excellent skills for caring for elderly with mental health needs and has excellent teaching skills and will, as an advocate for the service users, challenge doctors on choice of treatment. The quality of care in this nursing home has improved beyond measure in recent years under its current nurse management. Excellent leadership. All service users are nutritionally assessed and care plans are in place to manage any identified risks. Meals are well balanced and a choice is available. Observation indicated that service users enjoy the food and they told us it was good. The manager has a quality assurance system in place and she monitors all aspects of the service. What has improved since the last inspection? What they could do better: 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 8 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 9 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. Service users needs are identified before they move into the home to ensure that all their needs can be met by the home. Evidence: A sample of four (4) service user files was viewed. These demonstrated comprehensive needs assessments had been undertaken prior to the person moving into the home. The manager told us that she or a senior member of staff will undertake the pre-admission assessments and this is usually done in a hospital environment or another care home. Three of the four service users files viewed had come to the home from hospital. There was evidence that relatives had been involved with the assessment process. Where the admission of a person to the home had been made through care Care Homes for Older People Page 10 of 32 Evidence: management arrangement i.e. with the support of the adults services department of a local authority, the home does not always receive copies of the assessments of the needs of the person referred, which is completed by the care manager, and the home sometimes have to request these. Some service users who are admitted to the home under the continuing care criteria are assessed by health professionals and the home to agree funding. The AQAA tells us that potential service users and their families are invited to visit the home and are given information about the home before they make a decision to move in. Service users are encouraged to bring with them personal items to aid their orientation. The manager told us that when relatives do visit the home prior to any decisions being made about a persons admission, it is at this time that the home will give them a copy of the statement of purpose and the service user guide to enable people to make an informed decision. One service user spoken to at the time of this visit said that he was happy with his admission to the home, he had read information about the home and had agreed readily to come to the home to live. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has systems in place to ensure the personal and healthcare needs of people living in the home are met and their medication is managed safely. Staff working practices ensure that service users privacy and dignity is promoted. Evidence: The sample of four service users care plans was viewed by us. The assessment tool was person centred and identified peoples needs and risks. The assessment covered all aspects of a persons being and there were risk assessments for aggression, falls, wandering, moving and handling, tissue viability. The manager told us she receives a monthly report on any pressure sores or wounds that service users may develop and she monitors their progress through this report and is able to access more expert advice if they are not healing as expected. Nutritional assessments are undertaken on all service users and their weight is monitored monthly or weekly if a risk has been identified. The records of this were evidenced in the care plans. Care Homes for Older People Page 12 of 32 Evidence: Each service user has a psychological assessment for moods, behaviours, memory, social interaction and their general patterns of daily living. For those who use bedrails, there was a risk assessment in place for their use and a signed agreement for their use, but the manager told us that bedrails are not used on many of the residents beds, as to use them with some service users would present a higher risk. Records indicated that care plans are evaluated every month and daily notes referred to the actions taken by staff to provide the needs set out in those plans and generally described how the person has spent their day. There was evidence from documents examined and also discussion with relatives that individuals and or their representatives were consulted about the contents of the care plans. The records examined indicated that a range of health care professionals visit the home and that arrangements are made for treatment for people when it was necessary. The home has one GP practice that serves the home and the GP visits the home routinely every week. At the time of this visit the GP was visiting the home to see service users who needed review or were not well. He commented in the survey returned to CQC that the home was excellent at assessing service users and ongoing monitoring. The leadership in the home is excellent and there is ongoing staff training. On observation there was obvious good communication and professional relationships between staff and the GP. The homes registered manager also described relationships with local psychiatric services team for older people as very good and said the home was very supported by this team. Comments on surveys returned from this team said the home looks after service users with severe mental health issues, dementia, behavioural problems. They know how to keep people safe, stimulated appropriately and they are always knowledgeable about any of the residents when we contact them. I am confident they will contact the team for advice is needed. Individuals health is monitored regularly e.g. weight, blood pressure and temperature. This monitoring is recorded in the care plans each month. The home now employs a physiotherapist who assesses the service users moving, handling and their level of ability to mobilise, he will then write care plans to describe how the person must be moved, handled and mobilised. The physiotherapist was spoken with and he told us he is enjoying his job and it extends further than just physiotherapy and that he is involved with all aspects of the service users care. The manager told us and care plans evidenced that the chiropodist visits the home six Care Homes for Older People Page 13 of 32 Evidence: weekly. The optician also visits annually and the manager said the dental service is improving and service users can visit an NHS dentist in the local town. At the time of this visit one service user was attending hospital for day surgery and a carer had escorted him and stayed with him throughout the day. The home had written policies and procedures concerned with the management and administration of medication. A recent copy of the British National Formulary (BNF) was available for reference and guidance. We talked to the trained nurse who co ordinates the ordering, receiving and general management of service users medication. He showed us that medication is stored in a locked and secure medicine trolley, in a locked room and where a medical refrigerator was also housed. There was a controlled drug prescribed for a person in the home at the time of this visit and there was a suitable cupboard for storage and a register to record activity. The balance of tablets being stored matched that recorded in the register. All medication was dispensed from original containers and the only staff in the home that gave out and were responsible for the management of medication on a day-today basis were registered nurses. Good practice noted during this visit included the recording the temperature of the refrigerator used for storing some medication. Sample copies of the signatures of the Registered General Nurses that dispensed medication were recorded in the front of the medication administration records (MAR). The medication administration record (MAR) charts were viewed and these had been recorded appropriately and codes to indicate reasons for non-administration. We discussed with the registered nurse about a written protocol for service users who are prescribed medication on an as needed (PRN) basis only and how staff would know when this should be given. The manager said that staff would know how behaviours demonstrated the need for some of these medications. There were behaviour care plans written but no specific guidance on when PRN medication should be administered. The trained nurse was observed giving out medication and they were sensitive doing so and their practice was appropriate and safe. Records concerned with the receipt,administration and disposal of medication were examined and they were accurate and up to date. Care Homes for Older People Page 14 of 32 Evidence: There were no service users choosing to self-medicate at the time of this visit. A small number of service users were being administered medication covertly. There was a policy in place and this was being followed. The GP was involved with the decision making to undertake this practice and had signed his agreement to this to be in the best interests of the service users. The manager told us that she has, with the support of the GP, greatly reduced the use of particularly sedative medication for as many people as possible because of some of the undesirable side effects e.g. drowsiness during the day and the subsequent risk of falls. The visiting GP confirmed this when we spoke to him. The privacy of people living in the home is promoted and most people are accommodated in single bedrooms. Screens were seen to be provided in shared bedrooms and staff were observed knocking on bedroom doors and waiting to be given permission to enter before going in. Individuals and relatives spoken to described the staff as being respectful and polite. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from relaxed routines that enabled them to exercise some choice about their preferred lifestyle. They are able to participate in a range of social and leisure activities and maintain contact with families and friends. The home provides a healthy, varied and nutritious diet and records choices, preferences and needs of individuals. Evidence: The home employs three part time activities co-ordinators which amount to 48 hours per week and therefore activities take place every day of the week, with carers undertaking activities at week-ends. The co-ordinators assess the ability of individuals to take part in organised activities e.g. independently or with assistance, physical activities or whether they wished to do so. This is documented in the care plans and then activities are arranged according to the abilities, needs and the preferences of individuals. Two of the activities co-ordinators were spoken with at the time of this visit. They told us they try to capture as much family and social history as they can about the service user to enable them to better understand what they may be interested in and what might stimulate them with reminders from the past. Care Homes for Older People Page 16 of 32 Evidence: The home has material and resources that could be used to enable people living there to pursue leisure interests and promote group and individual activities e.g. playing cards, skittles, bingo, table and board games art and craft material. The co ordinator told us that a group of service users enjoy playing the floor games. We were told that some of the other things organised for the service users are visiting entertainers, trips out to the various parts of the surrounding countryside, a dog that visits the home for pet therapy, a visiting library service and visits by clergy of different denominations. One service user goes to a luncheon club every week in the community. Records of the activities that take place were viewed and this recorded and evidenced that many activities take place throughout the week but the records did not say the level of participation and the outcome for the service users. This was discussed with the co-ordinator who told us that they record in the daily notes how the service user has spent the day and this includes any activities they have taken part in. It was observed that photographs were on display of the various events that take place in the home at festive times of the year or special dates in the year. These evidenced that family and friends are invited to the events, one relative saying I am always made most welcome and enjoy visiting the home and am always invited to have a meal with my wife. Another comment on a returned survey said The home always involves the family and are open and friendly with lots of activities. Relatives spoken to said that a lot of activities were arranged by the home and that some were social events, to which they were always invited. The visitors book evidenced that the home is visited by a number of people every day and that some relatives visit very regularly. People living in the home and visitors that were spoken to during this visit said that there were no restrictions on visiting the home. The manager has developed a monthly news letter that is sent out to all relatives of people living in the home. This gives general information about what is happening in the home. Service users choices and preferences are respected. Their likes and dislikes and how they wish to undertake their activities of daily living are recorded in the care plans. Care Homes for Older People Page 17 of 32 Evidence: The manager said that day staff helped people get up in the mornings and night staff helped people to bed in the evening. To ensure that people were not rushed in the mornings the breakfast is a running buffet from 0800 to 1045 hours. At the time of this visit service users were observed to wander into the dining room and being asked what they would like for breakfast and being given time to enjoy it with other company. Comments on service user surveys returned to CQC said they let me be private which is my wish and the manager understands me. The home gives me choice they let me smoke and feel part of a family, I am happy here. There was information in the entrance of the home about organisations that could provide impartial advice, information and guidance to people living in the home or their relatives and representatives. The menu for the day was on display in the homes dining room. The menus and records of food provided indicate that the food is nutritious and there is a wide range of meals provided with an alternative to the dish of the day if that was preferred by any individual. In addition special diets and individual preferences and needs are catered for e.g. soft and pureed meals, lactose intolerant and diabetics. Nutritional risk assessments are undertaken on all service users and a care plan is written to managed any identified risks. Information on the service users nutritional and dietary requirements is readily available to staff in the kitchen. A high proportion of the 37 service users being accommodated in the home at this visit needed assistance or supervision at mealtimes. Consequently the main meal of the day is provided at two sittings. The main meal of the day was observed and staff were seen to be sensitive, patient and respectful providing the help that individuals required. The meal being served looked well presented and nutritious and those with pureed diets had the individual components of their meal pureed and presented in separate portions. Individuals spoken to, that were able to converse meaningfully, and survey comments returned to CQC indicated that the food the home provided is good. Care Homes for Older People Page 18 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 had a clear and satisfactory complaints procedure to address the concerns of service users and relatives. Robust procedures are in place to protect service users from the risk of abuse. Evidence: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was displayed in the homes entrance hall and all people living in the home or their relatives are given a copy when they move in. The current policy needs to be reviewed to reflect the regulatory body as being the Quality Care Commission and not CSCI and to remove the address of the office that is now closed. A record of complaints made to the home is maintained and this would detail the issue and set out any agreed action to remedy the matter and its outcome. There had been no complaints recorded in the previous 12 months. One complaint has been received by CQC. The issues were discussed with the manager and there was no evidence to support the concerns. The AQAA says that the manager has an open door policy and that every one is made aware of the complaints policy. A visitor spoken to during the site visit was confident about raising any concerns with the manager or any of the senior staff working in the Care Homes for Older People Page 19 of 32 Evidence: home. The home had written procedures available concerned with safeguarding vulnerable adults. These are intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm is prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. All staff have received training on the Mental Capacity Act (MHA) and the Deprivation of Liberty Safeguards (DOLS) and this has been delivered by the manager who has received training to enable her to do this. There was evidenced in the care plans that where it was considered necessary for any form of restraint to be used or a persons civil rights to be restricted in any way, a risk assessment has taken place and permission was then obtained from relevant interested parties and the decision to take such action was properly recorded e.g. use of bed rails to prevent falls. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is comfortable, safe and well maintained. The homes procedures and staff training should ensured that residents are protected from the risk of infection. Evidence: We looked around most areas of the home. The home is a very large old building that requires continual upkeep. The AQAA had stated that the corridors on both floors had been redecorated and new carpets put down. The manager told us that in the last year there has been a lot of investment into the environment and there still remains some areas that need refurbishment. Bedrooms are decorated and new carpets are laid when rooms are vacated. The manager said that seven bedrooms had been re carpeted recently and that there is a continual programme for replacing carpets. She reported that new bedroom suites were on order to replace those that are in disrepair. There was evidence when looking around that the one empty room was in the process of being redecorated and that a number of areas in the home had been recarpeted. Those rooms visited were pleasantly decorated and had in the main been made individual with service users own personal belongings and family photographs, some of which had been labelled by relatives to help the service user remember the person. It was observed that the bathrooms on the ground floor and first floor were in need of Care Homes for Older People Page 21 of 32 Evidence: refurbishment with walls and flooring being in a state of disrepair and the bathrooms suites needing to be replaced. The manager told us this is on the environmental improvement agenda, which she is asked to contribute to and to provide a wish list of the improvements she considers necessary to benefit the comfort of the service users. At the time of this visit new curtains were being put up by a contractor in the lounge area. The manager told us this had been the result of a relatives survey questionnaire where relatives had commented on the condition of the existing curtains. New armchairs had also been purchased recently for the lounge. It was observed that graphic signs had been fitted to all doors to help people with orientation problems to find their way around the home independently. The manager has also thought of the significance of certain colours schemes in rooms to aid residents to identify which room is which. We observed that the door on the first floor sluice room, that contained some cleaning chemicals, did not have a lock. This was discussed with the manager that a bolt or lock should be fitted to ensure the residents do not have access to this area. The laundry is a separate building close to the home and is fit for purpose. The home is surrounded by acres of grounds and there is a safe garden for service users to wander if they wish. The home employs a maintenance person four days a week to undertake general repairs. Contractors are employed to undertake the bigger jobs and decorating. Currently the home is awaiting a contractor to attend the home to secure a leak in the roof that has caused damage to a bedroom ceiling. The home has an infection control policy and staff training files evidence that staff have attended infection control training. The manager has appointed one of the trained nurses as an infection control lead to ensure all infection control precautions are in place and adhered to. It was observed that hand washing facilities are in rooms, toilets and bathrooms. Protective clothing of gloves and aprons are also available for staff to use. We did observe that a variety of toiletries were being stored on a bathroom shelf. This was discussed with the manager as a potential cross infection issue, if they were being used by more that one person. The manager told us that it was unsafe to leave these toiletries in the persons room that they belonged to. It was discussed they should Care Homes for Older People Page 22 of 32 Evidence: therefore, be labelled with the persons name and kept in a locked environment in the bathroom. The home employs a separate housekeeping staff and three people are on duty every day to clean the house. The home was clean and there was an occasional offensive odour detected but this was acknowledged by the manager, who told us that carpets are being continually cleaned or replaced and that management of continence for some residents is difficult. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment, training, deployment, level and skill mix of staff ensure that the needs of people living in the home are met and their safety is promoted. Evidence: At the time of the fieldwork visit the home was accommodating 37 residents. The care staff rota setting out the minimum number and skill mix deployed in the home was as follows 2 registered nurses and 7 or 8 care assistants from 0700 until 1900 making a total of 9 or 10 staff throughout the day. There is 1 nurse and 4 careers on duty from 1900 until 0700 making a total of 5 staff on duty. The manager told us that during the monitoring of the accidents that occur in the home, it was identified that most accidents happened between 1700 and 1800 in the evening and as a result of this emerging theme, an extra carer comes on duty daily from 1630 until 2200 to boost numbers during the busy twilight period. The manager told us that the home does not employ agency staff, which ensures continuity of care. Observations of the daily routines and the staff practices indicated that there are sufficient staff on duty to meet the service users needs. The home employs a separate housekeeping staff of three domestics, 2 laundry persons, 3 activities organisers, 2 maintenance persons, a chef, 2 kitchen assistants and an administrator. The registered manager is in the home five days a week and Care Homes for Older People Page 24 of 32 Evidence: this can include week-ends and evenings to enable her to see all staff and be in the home at different times of the day. The AQAA records and staff files evidence that the home employs a large multicultural staff group of mixed gender, which gives service user more choice of who they wish to assist them with their care. A sample of four recruitment personnel files was viewed by us. The files evidenced that the Criminal Records Bureau (CRB)and the Protection of Vulnerable Adults (POVA) had been undertaken. Two references had been received and were evidenced in the files. All staff are issued with a staff handbook which detail policies, procedures and terms and conditions of their employment at the home. The staff files evidenced a local induction programme and this is completed and runs alongside a three month induction programme based on the Skills for Care Induction standards. The home has a staff training and development programme based on individuals training needs that are identified through annual appraisals and individual supervision sessions. The staff records evidence that performance appraisals take place annually and supervision is undertaken 6 times a year. The manager is committed to staff development and training and undertakes the training in many of the subjects herself. The manager told us that 17 of the 22 care assistants are undertaking their NVQ levels 2 & 3. A housekeeper and activities organiser are undertaking their NVQ level 2. A number of care staff are undertaking advanced levels of the NVQ whilst working at the home, with assessors attending the home to assess their competence. The training matrix was shown to us. This demonstrated that all mandatory training in health and safety and other training appertaining to the resident group, such as dementia training, safeguarding, risk assessment and medication, has been supplied and undertaken by staff to increase their knowledge and skills to enable them to meet specific needs of people living in the home. Staff spoken to at the time and surveys returned from staff told us that the home does well with providing training for staff, one saying we have different trainings to Care Homes for Older People Page 25 of 32 Evidence: improve and enhance our skills. Surveys returned from other visiting health professionals said The home does well with training and supports other homes with training. excellent ongoing training of staff. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes registered manager provides effective leadership. The home has systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home. Evidence: The homes registered manager is a registered general nurse and has had some years experience of working in and managing nursing homes. She has a relevant management qualification that indicates that she has the knowledge and skills necessary for the role. The manager also has a training background and has an educators qualification. She maintains her professional portfolio by attending various training sessions and seminars to update her clinical knowledge. Relatives and staff spoken with told us that they have confidence in the manager and that the staff are well supported by her. They told us the manager has an open door policy and is available to talk to at any time. A visiting health professional commented Care Homes for Older People Page 27 of 32 Evidence: Excellent leadership in the home and the quality of care has improved under its current nursing management. Another said The home is run well. The manager is always available for help, advice and support. The manager has now appointed a head of care and one of the registered nurses has taken on this role. The home had systems in place for monitoring the quality of the service and includes monthly audits of its systems e.g. care plans, medication system,complaints, accident analysis and health and safety check lists. The manager undertakes weekly audits on all wound care to identify improvements and deterioration of wounds. The manager told us she also undertakes a monthly bed rail risk assessment audit to ensure that risk assessments are in place appropriately and that agreement for their use has been recorded. The manager analysis the accident book monthly and will identify emerging themes of when and why accidents are occurring. Currently she is reporting her findings to one of the local GPs who is undertaking a research project on falls in the elderly. The manager reports monthly to the provider on any issues and how the home is working.The home is visited by one of the directors of the home to undertake a regulation 26 visit report. Staff meetings are separately held every month for trained staff, carers, housekeepers and night staff, at which time the staff are encouraged to discuss any issues about their roles and how the home in run. Records of these meetings are recorded by the manager and were seen by us. The manager says she holds more social events for relatives rather than formal meetings as she finds these are better attended and give friends and relatives an opportunity to discuss any issues and liaise with each other in a relaxed atmosphere. Surveys are distributed annually to service users and other stakeholders. These are analysed by the manager and improvements over the previous year are identified along with any issues and a copy of a report is sent to the provider. The manager told us that the home does not manage or store any of the service users monies. The Environmental Health Officer visited the home in February 2009 and has subsequently visited for a further inspection to check compliance. No report had been received but the recommendations made by them have been complied with. Care Homes for Older People Page 28 of 32 Evidence: Records examined indicated that the homes equipment, plant and systems were checked and serviced or implemented at appropriate intervals. i.e. passenger lift and hoists, fire safety equipment, sluice machine etc. There were contracts in place for the disposal of clinical and household waste. The fire log was viewed and evidenced a fire risk assessment with recommendations that had been made and complied with. The invoice of these repairs was seen by us. The fire alarm records evidenced that fire alarms and systems are tested at appropriate intervals. Staff said that they attended regular and compulsory fire and other health and safety training. Records demonstrate that all staff including housekeeping staff have attended all mandatory training such as fire, moving and handling, food hygiene and first aid etc. The homes registered manager is an accredited moving and handling trainer and there are hoists, and other equipment in the home to promote safe working practices. Records are kept of all accidents Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Protocols for the use of PRN medication should be recorded in service users care plans to guide staff for when they should be administered. 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. 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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