Care Home: The Cyder Barn

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What the care home does well This is currently a small home with a “family feel”. There is a stable staff team. Additional staff are currently being recruited due to the on going building works and planned increases in the numbers of beds. The manager has been working at the home for a number of years. The AQAA was fully completed and detailed the progress of the service over the past year and the plans for the next twelve months. What has improved since the last inspection? One requirement was made at the last inspection. This requirement related to the storage of medication. This requirement has been met. In addition four recommendations were made. People living at the home now have a choice of main meal at lunch time. This was not seen on the last inspection visit. At the last inspection it was recommended that a programme of redecoration be undertaken. Since the last inspection major building works are being completed to enlarge the home. Following the building of the extension a total refurbishment of the existing building is being planned. This will include new kitchens, laundry and redecoration of existing communal space. The car parking facilities which will be inadequate when the home is expended will also be enlarged. Prior to the inspection visit a new courtyard garden has been completed. This area is fully enclosed and accessible to all who live at the home. The courtyard has been completed to a high standard. Information available to people thinking of moving into the home is good. Since the last inspection the number of staff who have or who are undertaking an NVQ has increased. The home now has over 50% of staff with this award.The Cyder BarnDS0000071260.V377851.R01.S.docVersion 5.2 What the care home could do better: It was identified at this inspection that work is required on the care planning process to ensure that the plans provide adequate guidance to the staff working at the home on the care needs of the individual living at the home. This is particularly relevant to people who are at risk or who have lost weight and for those who are at risk of developing pressure damage. Staff need to ensure that advise given by other healthcare professionals is reflected in the plan of care and that they act on the advise given. Small improvements are required in the recording of medication. This should include the signing that prescribed creams have been applied and checks for any new medication prescribed. People moving into residential care now have higher support needs than they historically did. The home needs to ensure that they have all the necessary equipment to meet these higher needs including equipment used in moving and handling, pressure mats to reduce the risk of falls and scales that can be used on a hoist. Due the increased support needs of people living in residential care and the planned extension of the home the management team need to keep the staffing numbers under review. This will ensure that they continue to meet the needs of people living at the home. Due to a change in management style and the current building works people living at the home and staff feel a loss of control and do not feel that they can influence how the home is run. The management need to ensure that they take action to improve communication to all parties. Some staff training is outstanding. Key inspection report CARE HOMES FOR OLDER PEOPLE The Cyder Barn West Pennard Glastonbury Somerset BA6 8NH Lead Inspector Justine Button Key Unannounced Inspection 17th September 2009 09:00 DS0000071260.V377851.R01.S.do c Version 5.3 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. The Cyder Barn DS0000071260.V377851.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 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cyder Barn Address West Pennard Glastonbury Somerset BA6 8NH 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) 01458 834945 The New Cyder Barn Ltd Mrs Donna Marie Nutt Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Cyder Barn DS0000071260.V377851.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 either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 25. 27th August 2008 Date of last inspection Brief Description of the Service: The Cyder Barn is registered to provide care for up to 25 people, over the age of 65, who require assistance with personal care. Nursing care is not provided. It is situated on the main road in the village of West Pennard. The home is an older style property set in extensive grounds. The building retains many of its original features which gives it a domestic and homely feel. Personal accommodation is spread over two floors with a stair lift between. The home was purchased in February 2008 by a company called The New Cyder Barn Ltd. The registered manager is Ms Donna Nutt. Fees at the home range from £410 - £500 per week. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Cyder Barn has been a care home for some years but was sold at the beginning of 2008. This is the second inspection since the new owners took over the home. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of this inspection visit was to inspect relevant key standards. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. This inspection was carried out over a one-day period. During this time we were able to meet with people living and working at the home, observe care practices, tour the building and view records. Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA.) This gave information about the service offered and the improvements that are planned in the coming year. Prior to the inspection 5 people living at the home and 4 members of staff completed questionnaires. Prior to the inspection concerns had been raised with us regarding the care and support afforded to people living at the home. These concerns were considered under the Somerset Vulnerable adults policy in conjunction with Somerset County Council who have the lead role in investigating and reporting on any concerns made under this policy. It should be noted that the home is currently undergoing some major building work. This will increase the number of bedrooms. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.2 Page 6 What the service does well: This is currently a small home with a “family feel”. There is a stable staff team. Additional staff are currently being recruited due to the on going building works and planned increases in the numbers of beds. The manager has been working at the home for a number of years. The AQAA was fully completed and detailed the progress of the service over the past year and the plans for the next twelve months. What has improved since the last inspection? One requirement was made at the last inspection. This requirement related to the storage of medication. This requirement has been met. In addition four recommendations were made. People living at the home now have a choice of main meal at lunch time. This was not seen on the last inspection visit. At the last inspection it was recommended that a programme of redecoration be undertaken. Since the last inspection major building works are being completed to enlarge the home. Following the building of the extension a total refurbishment of the existing building is being planned. This will include new kitchens, laundry and redecoration of existing communal space. The car parking facilities which will be inadequate when the home is expended will also be enlarged. Prior to the inspection visit a new courtyard garden has been completed. This area is fully enclosed and accessible to all who live at the home. The courtyard has been completed to a high standard. Information available to people thinking of moving into the home is good. Since the last inspection the number of staff who have or who are undertaking an NVQ has increased. The home now has over 50 of staff with this award. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.2 Page 7 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. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.2 Page 8 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 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 9 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): 1, 2, 3, 4, 5. Standard 6 is not applicable. 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. There is information available to assist people to make a choice before they come to the home. People have a comprehensive assessment before they come to the home to ensure the home can meet their needs. People have a copy of the contract or terms and conditions of their stay EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 10 Information is available for people to help them make choices about coming to the home. Some people spoken to during the visit to the home had not had an opportunity to visit the home prior to coming to live there because they had been unwell. Two people talked about the role of their relatives in selecting a home. The manager always conducts an assessment visit prior to someone coming to live in the home. Completed comprehensive assessments were seen in peoples files. The manager discussed the importance of always completing an assessment even when there was a sense of urgency because a hospital discharge was needed. Records were also seen that showed that people were reassessed by health professionals as their needs changed and in some cases more appropriate care settings were found. All but one person stated that they had received a copy of the terms and conditions. This document includes details of the fees payable. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 11 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, 10. 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. Staff need to ensure that care plans are consistently developed in all areas and for all individuals living at the home. The home needs to ensure that they are meeting the peoples health care needs in all areas. Improvements in the management of medication have been seen, however, some minor developments are still needed to ensure that this is delivered in line with best practice. EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 12 All people spoken to during the inspection said that they were well cared for. There was further evidence in the Residents Questionnaires sent out by the home that people found the care to be good or excellent. Each person has a care plan that is reviewed regularly. There is evidence that people and their families are involved in setting up the plan in some cases. Three plans were seen and reviewed in detail. As previously stated concerns had been raised to us with regard to the care and support afforded to one person living at the home. These concerns related to the prevention/development of pressure ulcers. Pressure ulcers are also known as pressure sores, or bed sores. They occur when the skin and underlying tissue becomes damaged. People who are unable to move some or all of their body due to illness, paralysis or advanced age are more at risk of develop pressure ulcers. There are two main goals when caring for people who are at risk of developing pressure ulcers. These are: to attempt to prevent the development of pressure ulcers by using special dressings and equipment, and by regularly supporting a person to change and to treat existing pressure sores by cleaning them using appropriate dressing for the wound and improving nutrition. It was clear from the concerns raised with us that one individual had developed pressure ulcers and that these had been identified by a visiting healthcare professional. On viewing the care records for this individual it was apparent that the individual was of slight build and had a reduced appetite. Due to this the person was at risk of loosing weight. As previously stated nutritional input is important in the prevention and healing of pressure damage. The care plans for this aspect of the individuals needs were not robust. Regular weights had not been completed (the home stated that this was due to difficulty in the individual accessing the scales) nor had a full nutritional assessment been completed by staff. Care plan had been developed however the plan was ambiguous stating only that “staff should encourage meals”. Although supplements had been prescribed by the GP the plan did not reflect this. The plan did not state what actions the staff should take if and when meals were not eaten. The plan did not consider increasing the calorific value of the foods offered nor increasing the frequency of such things as snacks. When people develop wounds or pressure damage a diet high in protein is recommended to help to aid healing. This was not considered in the plan. As previously stated a regular change of position is required to help prevent pressure damage or to aid healing for ulcers that have already developed. The community nursing service had provided the home with specialist pressure relieving equipment however only the night care plan detailed the frequency that the individual should be supported by staff to change position. The home had sought the advise from an occupational therapist (OT) with regard to this persons reduced mobility and the increased risk of falls. The OT had visited the individual at the home and given advise with regard to equipment that could be used to aid mobility and reduce the falls risk. It could not be confirmed if The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 13 this equipment had been purchased by the home. The advise given by the OT was not reflected in the care plans. On viewing the homes training matrix it could not be confirmed if staff have received training on recognising the signs that pressure damage is occurring. This is recommended. As a result of the concerns raised the local social services have also conducted reviews of some people currently living at the home. These reviews confirmed the finding of our inspection with shortfalls noted in care planning process particularly around weight loss and the prevention of pressure damage. As a result of the concerns raised a meeting was arranged under the safeguarding adult’s policy with the management of the home. This meeting was chaired by social services who have the lead role in safeguarding investigations/meetings. The concerns around care planning, weight loss and pressure damage were shared with the management. The management of The Cyder Barn explained that a new care planning system was being implemented at the home and that this would address the shortfalls identified. The records viewed confirmed that there are regular visits from health professionals, doctors and nurses to the home. There is support available from community Psychiatric Nurses when needed. There is evidence that people can access specialist care when needed. In care plans there are clear records of visits from doctors, nurses, chiropodists and opticians. People can make their own arrangements and continue to visit their own choice of professional services with family or home support. Issues with regard to the management of medication were raised to us as part of the safeguarding concerns. Medication records were viewed during the inspection visit. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). The senior staff member on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had been marked with an expiry date however the MAR chart not been signed to confirm that the creams had been applied as per the Prescription. This is recommended. The pre-printed MAR charts are delivered by the pharmacy on a monthly basis. There may be occasions during the month that these have to be amended say for example when a GP visits and changes the dose required or introduces a new medication. When this occurs staff have to hand write the new drug onto the medication record. It is good practice that when this occurs the hand written entry is checked by another person to ensure it is accurate. This reduces the risk of drug errors. For at least one person living at the home a GP had visited and prescribed a new medication. Staff had written the new prescription on the MAR however this had not been checked by a second The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 14 person. It is recommended that staff ensure that this is checked by a second staff member. This will reduce the risk of medication errors. Since the last key inspection a new drug fridge has been purchased. This will ensure that medication requiring refrigeration is kept at the correct temperature. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 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, 14,15 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. Activities are well advertised. There is a range of social events Comment cards indicated that not all people found the availability of activities adequate Families were seen to be welcomed and to be part of the home life. The menu is varied. The food on the day of the inspection was of a good standard. EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 16 The care plans viewed during the inspection detailed the preferences of service users. People living at the home or their Relatives & friends provide information relating to their loved one’s social history, previous hobbies/interests, preferences, likes and dislikes if the individual is not able to provide this information. Those staff observed on the day of the inspection appeared to have a good knowledge of the people living at the home and what they did and did not like. Those people living at the home who expressed a view told that their wishes were respected and that they could choose what time to get up or go to bed. People confirmed that they can choose where and how to spend their day. Any restrictions would be identified in risk assessments. As previously mentioned, staff interacted with service users in a kind and respectful manner. The home has recently employed an activities organiser. The completed AQAA stated that this is planned over the next 12 months. The activities records were viewed as part of the inspection. These demonstrated that there is a range of activities on offer. Activities included quiz, flexerscises poetry, hairdressing library, shop and one outing to the umbrella group. Holy Communion and birthday celebrations, knitting and bingo were also seen to be on the activities timetable. People spoken to during the inspection and in the surveys received commented that they would like the opportunity to have more outside trips. People spoken to during the inspection stated they felt that they no longer had the opportunity to influence how the home was run and that this had lead to a sense that they did not have as much control over their lives as they had previously. Thus is discussed in more detail under standard 32. Due to the current building works the gardens have not been accessible during the summer. People living at the home stated that the previous gardens were in excellent condition and are accessible to all. People stated that they had missed enjoying the garden and the ability to wander freely enjoying the outside space. A courtyard garden has recently been completed which will now allow some access to the outside. People stated that whilst they appreciated that the courtyard had been completed to a good standard they continued to miss the rural views and a lawn. The home welcomes visitors at any reasonable time in accordance with the wishes/preferences of the person living at the home. Visitors spoken to during the inspection were extremely complimentary about the care and support afforded to people living at the home. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 17 All meals are prepared and cooked on the premises. The home has a rolling menu. This appeared wholesome and varied. The main meal is served at lunchtime with a lighter cooked meal at tea time. This was evident at the time of the inspection. We were informed that snacks and drinks are available. Special diets are catered for. These were seen to be attractively presented. Sweets were available for those requiring a diabetic diet. Staff were observed assisting service users in a manner which was relaxed, unhurried and respectful. The meal on the day of the inspection consisted of roast chicken or vegetarian sausage roll. Vegetables including mashed and roast potatoes, leeks, swede and the accompanying gravy were served in dishes to each table. This enabled people to help themselves and maintain a sense of independence. It also allows people to chose what and how much of the meal they would like. The majority of people who expressed a view were positive regarding the meals available and stated that there was always plenty to eat. Some people however stated that they felt that the standard of food was not as good as it once was. Two people stated that the food could be warmer when it is served. Three choices of main meal are now available daily one of which is vegetarian.The tables were set with tablecloths, napkins and appropriate condiments. A range of cold drinks was available through the meal. Menus are on display in the dining room. A choice of sweets and puddings were available following the main meal. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 18 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, 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. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the home’s policies and procedures. Some staff have not received recent training in the prevention and recognition of abuse. EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 19 Feedback forms to people living at the home asked do you know who to speak to if you are not happy? Comments from relatives included “A wonderful home no complaints”. The Home has a complaints procedure that is clearly written and contains the contact details for CQC. All the complaints are dealt with in line with the homes policy and procedure. One complaint has been received by the home. A range complimentary letters were also held on the file. As discussed one safeguarding referral has been made. This has been addressed by the multidisciplinary team including CQC and Social Services. The management at the team at the home have been fully involved and have addressed the concerns made. The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. Abuse training is included in the new staff induction programme. The training matrix was viewed as part of the inspection process and this showed that not all staff had recived abuse training, although this is covered by staff who have completed an NVQ and during induction. The completed AQAA stated that the manager has been proactive in welcoming complaints and suggestions about the service, using these positively and learning from them. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 20 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, 22, 23, 24, 25, 26 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. The home is currently undergoing an extension and associated building works. This has impacted on the existing environment. The existing building will be refurbished in the near future. People have their own possessions in their room. The home was clean and tidy. EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 21 The home is currently undergoing an extension. This will increase the number of registered beds by ten, from 25 to 35. On the day of the inspection the extension was seen to nearing completion. All of the new bedrooms will be single with en-suite facilities. All of the new bedrooms will meet the current National Minimum standards for space. To accommodate the increased numbers of people living at the home a large conservatory has been added to the existing lounge/dining area. This has made this area spacious and airy. It was noted however that due to the glass roof of the conservatory this area may become very hot when the sun is out. This was discussed with the manager during the inspection who stated that blinds for the windows and roof are on order and will be fitted in the near future. This lounge has been painted yellow with one wall being very bright. A number of people living at the home did not like the bright yellow colour scheme. (see standard 32). There is a link corridor from this lounge to the new bedrooms which are all on ground floor level. We have been informed that following the building of the extension the existing building will be refurbished. This will include the kitchen, laundry, remaining communal areas and some bedrooms. It was observed that the carpet in the lounge area was in need of replacement as it was frayed and stained in some places. The manager stated that this will be completed as part of the planned upgrading of the building. A new office will be located outside of the main building. The car parking arrangements will be extended. Once the refurbishments have been completed it is envisaged that this outcome area will change from adequate to good. People coming into residential care now have more healthcare needs than they previously did. This is due to the fact people are choosing and being supported to remain in their own homes for longer. The home therefore now needs to consider increasing the amount of equipment such as hoists used in moving and handling, pressure mats and scales for weighing people who cannot stand. As previously stated the home has lost part of the garden due to the building works. We were informed that once the building works have been completed that the remaining gardens will be landscaped. In addition a courtyard garden has been completed. This courtyard has raised flower beds and a water feature and is accessible to all people living at the home. The home was clean throughout. Liquid soap and hand towels are provided. Staff were observed wearing aprons and gloves where necessary. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 22 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, 29,30 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. There were sufficient staff on duty to meet people’s needs although this needs to be reviewed. Staff recruitment procedures are robust and protect people living at the home. The home has a comprehensive staff training programme although not all staff had completed this. EVIDENCE: Duty rotas covering the two weeks prior to the inspection visit were viewed. During the day there is always a senior carer on duty who co-ordinates the shift and gives guidance to less experienced staff. In addition to the senior there are 2 carers. Sometimes there is an additional care staff member who works from 09:00 until 14:00hrs. This person was not present on the day of The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 23 the inspection. Overnight there are two waking night staff. All ancillary staff hours are in addition to the care hours. The manager is available if required. Four people spoken to during the inspection and all the staff spoken to during the inspection felt that the numbers of staff on duty was not always sufficient. This was particularly so when there was not a staff member available for the 09:00 until 14:00hrs shift. Staff told us that this was also in part due to the fact that the care needs of people at the home have increased and that there had been an increase in new staff “who are still learning the ropes”. This was confirmed by people living at the home who felt that they “now have to wait longer than they did previously”. A number of new staff have been employed in preparation for the increased staffing required when the number of registered beds increases. The management in view of the comments above and the future increased numbers of beds need to ensure that a review of staffing numbers is completed. Staffing levels will be considered when the new beds are registered with us. We viewed the recruitment files of the three most recently employed members of staff. These gave evidence of a robust recruitment procedure that minimises the risks of abuse to the people living at the home. New members of staff had undergone an enhanced Criminal Records Bureau (CRB) check and written references had been obtained before the person began work in the home. All staff who completed a questionnaire answered YES to the question “Did your employer carry out checks such as CRB and references?” There is an induction programme in place, which is in line with the ‘skills for care’ core standards. Staff spoken to during the inspection said that they had received a good induction and were happy with the ongoing training opportunities. The training matrix was viewed as part of the inspection. This demonstrated that senior staff had completed medication training, 53 of staff had completed training in health and safety, 53 of staff in abuse awareness (although this is also covered in induction) 23 of staff in end of life care, 23 of staff have had first aid training, 53 of staff in infection control, 30 of staff in food hygiene (although this did include all staff who work in the kitchen) 16 of staff in dementia awareness, 66 of staff have received fire awareness training and 60 of staff have completed moving and handling training. The management need to ensure that any staff who have outstanding training receive this as soon as possible. Sixteen staff have an NVQ 2 or above with an additional 6 people working towards this qualification. Four staff who currently have an NVQ 2 are currently working towards a level 3 qualification. This is above the expected levels and should be commended. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 24 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 25 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, 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. The home is well managed taking although more emphasis should be placed on considering the views of people who use the service. Various systems are in place to maintain a safe environment. EVIDENCE: The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 26 Since the home was purchased a management company has been employed to oversee the running of the home. The owner visit the home very occasionally The registered manager of the home is Donna Nutt. She has many years experience of working with older people and is qualified to NVQ level 4 in both care and management. The manager stated that they are well supported by the management company in place. People living and working at the home described the manager as very approachable. Both people living at the home and staff have had difficulty in coming to terms with the new management style since the home was purchased in 2008. The previous home owner had a very hands on approach to the home and although a manager was employed they visited the home on a daily basis. Due to this they had a close relationship with people living at the home and staff. People living at the home stated that they made time to talk to you on a day to day basis. The current home owners have a different management style and a more remote working relationship. Due to this people living at the home and staff stated that they did not feel that the owners were as approachable. As previously stated the home owners have employed a management company to oversee the running of the home. Some people living at the home and the staff stated that the identified members of the management team visited the home at regular intervals. All parties stated that as they were getting to know people from the management company they felt that the situation was improving. During the inspection visit some people commented about the building works. All were concerned that as the numbers of people living at the home increased that the home would lose it’s “family feel”. All were concerned that this would also impact on the previously high standard of care that was delivered. The majority of people spoken to during the inspection stated that they had found the building works disruptive. All stated that they did not feel that communication to them during the building works had been good. People stated that they appreciated that on occasions the works would cause some noise disruption however all felt that if they were told when big deliveries of building materials were going to made for example at least they would be prepared. The new lounge/conservatory had been opened and decorated in two shades of yellow. Although people appeared to like the lighter shade no one liked the brighter shade. People stated that they had not been consulted on the decoration of the new areas. One person stated “this is my home. It would have been nice if we could have been asked what colours we wanted”. This was discussed with the management team at the end of the inspection and at the subsequent safeguarding meetings. The management team agreed to consider these comments and discussed ways in which they would keep people living at the home more informed of the building works and how they could be The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 27 involved in the decoration of the home. This could include more regular meetings between the management and people living at the home and regular newsletters. The home does not act as a power of attorney or financial appointee for anyone living at the home. Small amounts of personal allowance can be deposited with the home for safe keeping ensuring people have access to their personal finance. We viewed a sample of these monies. Records and receipts are maintained and these balanced with the amounts of money being looked after. There is a full time handy person employed who takes responsibility for day-to -day maintenance and maintaining a safe environment. A fire risk assessment has been completed and records show that the fire detection equipment is regularly tested in-house and serviced by outside contractors. All equipment in the home is regularly inspected to ensure that it remains safe. All accidents are recorded. The management audits these records to monitor the needs of individuals, and to establish if there are any implications for the service. The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 28 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 29 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. 1 Standard OP7 Timescale for action 15 (1) Assessments and associated care 22/11/09 plans must be developed for all aspects of individuals needs. The plan should provide clear guidance to staff on the needs of the individuals. 18 (1) (c ) The management need to ensure 22/01/10 that all staff have completed all necessary mandatory training. In addition the management need to ensure that training is provided to staff appropriate to the work they perform for example recognition of pressure damage. 12 (3) The management must ensure 22/11/09 that people living at the home feel that they have control over their lives. This should include consultation with regard to the current building works and redecoration of the environment Regulation Requirement 2 OP30 3 OP32 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 30 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 OP22 Good Practice Recommendations The management must ensure that staff have all the necessary equipment to meet the needs of people living at the home. This should include equipment used in moving and handling. Staffing levels must be kept under review in line with the needs of people living at the home The management must ensure that two people check and sign all hand transcribed entries on the Medication Administration Record The management must ensure the Medication Administration Records are signed when prescribed creams and lotions are applied 2 3 4 OP27 OP9 OP9 The Cyder Barn DS0000071260.V377851.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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