Care Home: The Depperhaugh

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What the care home does well The interaction between staff and people that lived at the home and visitors was observed to be caring, friendly and professional. During the afternoon of the inspection provided people with a fun and happy environment, where they could participate in activities if they chose to. People`s bedrooms were personalised which reflected their choice and individuality. The bedrooms were clean and there were no unpleasant odours in bedrooms. The service user survey asked what the service did well and comments included `difficult situations and medical needs`, `takes care of vulnerable people and very good with patients`, `all the residents look clean and well dressed. My (relative`s) clothes always look well coordinated as though someone has made the effort. I always fell welcome and I feel that the management would listen to any problems. They make a big effort to make you feel part of all aspects of care` and `the home demonstrates kindness and understanding`. What has improved since the last inspection? A plan of refurbishment was underway at the time of the inspection, areas that had been improved included the communal areas that had been redecorated, recarpeted and new furniture was in place. Some areas of improvement remained, such as the home`s laundry and bathrooms, however, they were identified and planned to be undertaken. Commodes were cleaned appropriately to ensure that risks of cross infection were minimised. People were safeguarded by the home`s recruitment procedures, the appropriate checks were undertaken on staff that worked at the home. The training that staff were provided with and the recording of staff training had been improved, which showed that staff were provided with training that they needed to meet people`s needs. There were shortfalls identified in the training provision, however, they were identified and planned by the home`s manager. What the care home could do better: The care plans had been reviewed, however, they needed further development to ensure that they are more person centred, which the home`s manager agreed that they would address. It was recommended that consideration be given to ensuring that the home provide facilities which ensure that it is accessible to people with dementia, for example to enable them to recognise their bedroom, bathrooms and the dining room. It is recommended that checks be made on the administration processes of medication to ensure that medication is administered in line with people`s individual care plans. Key inspection report Care homes for older people Name: Address: The Depperhaugh The Depperhaugh Hoxne Eye Suffolk IP21 5BX     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: Julie Small     Date: 0 2 1 2 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 35 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 35 Information about the care home Name of care home: Address: The Depperhaugh The Depperhaugh Hoxne Eye Suffolk IP21 5BX 01379384236 01379384815 depperhaugh.admin@kingsleyhealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Althea Healthcare Properties care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Old Age, not falling within any other category - Code OP Date of last inspection Brief description of the care home The Depperhaugh is a large Gothic style country house built in the 1860s. The Depperhaugh is situated in a rural setting, two miles from the village of Stradbroke, three miles from the town of Eye and seven miles from the town of Diss. It stands in pleasant landscaped gardens. The Depperhaugh can be accessed from the road through a long driveway and offers ample car parking at the front of the home. The Depperhaugh was first registered as a residential home for older people in 1987, Care Homes for Older People Page 4 of 35 2 4 0 2 2 0 0 9 30 0 Over 65 0 30 Brief description of the care home then in 1995 it was registered as a nursing home for older people with severe mental infirmity. The home was purchased by Althea Healthcare Properties Ltd, which is part of Kingsley Care Homes, June 2008. The Depperhaugh is registered to accommodate up to thirty people. At the time of this key inspection the homes manager advised that the fees are £502 to £900 per week dependant on the accomodation and care required. Care Homes for Older People Page 5 of 35 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 unannounced inspection took place Wednesday 2nd December 2009 from 09:10 to 16:45. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present during the inspection. The manager and the staff that were spoken with provided the requested information promptly and in an open manner. During the inspection the care records of three people were tracked, which included their care plans and medication records. Three staff recruitment records, staff training records and health and safety records were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and two people that lived at the home, three staff members and two visitors were spoken with. Care Homes for Older People Page 6 of 35 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and was returned to us within the required timescale. Staff, health professional and service user surveys were sent to the home. Five staff, five service user and two health professional surveys were returned to us. Care Homes for Older People Page 7 of 35 What the care home does well: 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 Care Homes for Older People Page 8 of 35 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 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. People who use this service can expect to be provided with the information that they need about the home, to be provided with a needs assessment prior to moving in and to have their assessed needs met. Evidence: Four service user surveys said that they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them and one said that they did not. One survey, which was completed by a relative on the persons behalf stated I was able to view the home and ask questions on behalf on my (relative). The AQAA stated that they offer prospective residents and their families the homes Statement of Purpose, Service User Guide. This is supplemented by the homes brochure giving general information and the most recent copy of the newsletter or the annual quality report. The AQAA said that improvements made in the last twelve months were updated the Statement of Purpose and Service User Guide. Produced a home brochure to supplement the other documents. Care Homes for Older People Page 11 of 35 Evidence: The Statement of Purpose was viewed and included information such as about Althea Healthcare, the homes accommodation, fees, the services and facilities that were provided to people, staffing arrangements and training, details of the qualifications and experience of the homes responsible individual and manager, which had been updated to show the current management arrangements of the home. The Service Users Guide was viewed and included information such as the services that were provided at the home, contracts, terms and conditions, payment of fees, accommodation in the home, staffing and the document advised that the previous inspection report was available at the front desk of the home. Both the Service Users Guide and Statement of Purpose included the complaints procedure, which had been updated to provided the current contact arrangements for CQC (Care Quality Commission). The care records of three people were viewed and each held a needs assessment, which had been undertaken before they moved into the home. The needs assessments detailed the support that people required on a daily basis and there were care plans which identified how the assessed needs were to be met. There were also local authority needs assessments in place for people who were local authority customers. Two health professional surveys said that the homes assessment arrangements usually ensured that accurate information was gathered and the right service was planned for people. The AQAA stated we use assessment tools and documents that give us information around potential residents needs. This include assessments around general health issues, mobility, breathing and circulation, continence, eating and drinking and any other domains of daily living including personal interests and hobbies. We also gain information from the placing authority, GP and family to understand specific medical social and psychological matters. This usually takes the form of discharge information or summaries from GPs. Medical letters that confirm the type of dementia a person is gained were ever possible and any other medical problems. The AQAA also stated that in the last twelve months they had introduced a new pre admission assessment tool. Care Homes for Older People Page 12 of 35 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. People who use this service can expect that their assessed needs and how they are met be set out in an individual care plan, to have their health care needs met, to be treated with respect and to be safeguarded by the homes medication procedures. Evidence: The care records of three people were viewed and each held a life story and a care plan, which identified how their assessed needs were to be met, in areas such as communication, mobility and personal care. The manager told us that the care plans had recently been updated and reviewed. We spoke with them about the need to include more person centred information, which detailed, for example areas of personal care that people could attend to themselves, where the care plans stated that people should be provided with enough food and drink, the care plans should clearly detail what was enough, how the behaviour of people with diabetes may change indicating high and low blood sugar levels and where there were issues with peoples behaviours the care plans should identify the specific behaviours that people displayed. The manager agreed that they were working toward ensuring that peoples care plans were more person centred and they would include the specific details of Care Homes for Older People Page 13 of 35 Evidence: their care. Regulation 26 visit reports that were viewed also identified the need for ensuring that care plans were more person centred, which showed that the issue had been identified. The AQAA stated develop and keep updated the care plan and assessments for each resident. Ensure there is a balance between peoples physical, emotional and social needs. Make sure that changes are noted and any interventions are timely and in the interests of residents and use life story books to better understand individuals to understand where they are now while respecting their achievements earlier in life. Peoples care records included progress sheets which related to each area of their care plan, which showed that the care plans were reviewed on a monthly basis to address the changing needs and preferences of people. Risk assessments were in place, which identified how the assessed risks were to be minimised in their daily lives in areas such as mobility, bed rails, skin viability, continence, falls and nutrition. Records of monthly falls auditing were viewed which showed that the homes manager routinely assessed and reviewed peoples risks of falls and the falls that had occurred. The manager told us that the bedrooms provided an updated alarm system which identified if people wandered during the night. The older system had been updated following an incident of a person leaving their bedroom and found in another persons bedroom. A complaint had been sent to us regarding the issue and a safeguarding alert was made. The incident was investigated by the Suffolk Outcomes and Quality Monitoring Team. Two visitors to the home were spoken with and they told us that their relatives needs were met and they said that they could not speak highly enough of the home. Comments made in the service user surveys included takes care of vulnerable people and are very good with patients and the home demonstrates kindness and understanding. The staff survey asked if they were provided with up to date information about the needs of people and if the ways that they passed on information about people between staff worked well, three answered always, one answered usually and one answered sometimes. One survey commented we provide a high standard of safe, individualised, holistic and evidence based patient focussed and effective nursing care to the patient, their relatives and the multi disciplinary team. A staff member that was spoken with had a clear understanding about the individual support that people Care Homes for Older People Page 14 of 35 Evidence: required and preferred. They told us that they knew about the details in peoples care plans and that they were updated regularly with peoples changing needs and preferences. The health professional survey asked if peoples social and health care needs were properly monitored, reviewed and met and that the home sought advice and acted upon it to meet peoples social and health care needs and improve their well being, one answered always and one answered usually. Comments about what the service did well included implementation of personal care plans, individual care and provides good EMI care. One said that the service could improve by could have better nursing skills e.g. cathetorisation, pressure sore care. Training records that were viewed showed that there had been training provided in both these subjects. Peoples care records that were viewed included information of how their health needs were met and where people had been provided with health care support from services such as doctor, community nurse and chiropodist. The AQAA stated involve GPs and their specialist professionals when there is a change that affects residents wellbeing e.g. falls nurse/ dieticians/ CPNs/consultants were needed. The homes medication procedures were viewed and details how people were safeguarded by the safe handling, storage and administration of medication. The manager told us that they had recently made a change in the pharmacy who provided medication to the home. They said that they had requested a pharmacy review, which was undertaken November 2009. We viewed the records of the pharmacy review and the monthly medication audits undertaken at the home, which showed that issues were routinely identified and addressed. The AQAA stated medication supplier has changed to another MDS system that makes the administration and ordering of medicines easier to achieve on a consistent basis. New medication trolleys are in place which meets current requirements. Nurses have received training in using the new system and medication audits are undertaken and recorded to look at performance. The health professional survey asked if peoples medication was managed correctly, one answered always and one answered usually. Medication was stored in MDS (monitored dosage system) blister packs and original packaging in a secured trolley in a secure medication room. Original packaging held the date of opening. A secured refrigerator was also in the medication room, for the storage of medication which required refrigeration. Records of refrigerator and Care Homes for Older People Page 15 of 35 Evidence: medication room temperatures were viewed. The MAR (medication administration record) charts for five people were viewed and it was noted that all medication was accounted for and codes were used where people had refused to take their medication. Controlled medication was stored in an appropriate controlled drugs cabinet. A controlled drugs book was viewed, which maintained two staff signatures when the medication had been administered and a running total. The records and the stored controlled medication were looked at and were found to be accurate. Peoples care plans that were viewed identified the support that people required with the administration of their medication and the medication that they were prescribed. Part of the lunchtime medication round was observed and it was noted that the nurse that was responsible for administering the medication removed the medication from the MDS blister packs directly into a clean pot, which was then provided to people to take. We saw the nurse administering medication to two people by taking their eating utensil from their hand, scooping food from their plate and putting the medication onto the utensil and put it into their mouth. We asked them if this was the usual procedure for administering medication to the two people. They told us that they often spit their medication out so this was how they gave them their medication. We asked if we could find this in their care plans, which they said that we could. The staff member said that they had been provided with medication training, which was confirmed in the training matrix which was viewed. We viewed the care plans of the two people, which stated that staff should check that people have swallowed their medication as they could spit it out and that their medication was to be administered by using a spoon, there was no reference to the administration of medication by masking it with food. We spoke with the manager who told us that they provided medication spoons for people that needed to use them and that they had not observed the practice that we had observed, which was not appropriate. They told that they had spoken with the staff member involved to ensure that medication was administered in the methods that had been agreed in their care plans. During the inspection we noted that people looked clean and well groomed. Two relatives of a person that were spoken with told us that their relative was always clean and tidy and that the staff always treated their relative with respect. A comment made in a service user surveys was all the residents look clean and well dressed. My (relatives) clothes always well coordinated as though someone has made an effort. During the inspection it was noted that interaction between staff and people who lived Care Homes for Older People Page 16 of 35 Evidence: at the home and their visitors was respectful, friendly and professional. The service user survey asked if the staff treated them well, three answered always and two answered usually. Comments made in the staff surveys included we continue to value each and every individual who comes to live at the Depperhaugh Nursing Home. Two health professional surveys said that peoples privacy and privacy was always respected. Peoples privacy was respected, we observed staff ensure that toilet and bedroom doors were closed when people were supported with personal care and staff knocked on bedroom and bathroom doors before entering them. Each shared bedroom that was seen provided a privacy screen. Care Homes for Older People Page 17 of 35 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. People who use this service can expect to be provided with activities which are of interest to them, to be supported to maintain their chosen contacts and to be provided with a balanced diet. Evidence: People were provided with the opportunity to participate in activities that interested them. The homes Statement of Purpose was viewed and explained that activities that were provided in the home included reminiscence therapy, film club, painting, quizzes, bingo, indoor bowls and skittles, singing, crafts, visiting entertainers, music and movement, board games, reading and trips. The AQAA stated before admission we try to identify peoples interests, preferences and that this information is included in the plan of care to help clients to achieve their goals and fulfill their lives. After admission we use the life history book to find out more about the residents life and give us guidance in creating opportunities to have some activities related to personal interest and hobbies or spiritual needs and regular entertainment is organised and used this as family event. The AQAA said that they had improved in the last twelve months we have employed an activities coordinator, this was confirmed by the homes manager and the activities coordinator who was met. The activities coordinator was busy supporting a person to do some art work to give to their relative. They told us that Care Homes for Older People Page 18 of 35 Evidence: they were busy planning Christmas related activities for people to participate in, such as decorating the home. The activities book was viewed, which identified the group and individual activities that were provided in the home and the people who had participated in them. The activities included playing musical instruments, manicure, foot massage, exercises, making Christmas cards, Halloween party, music therapy, quizzes, scrabble and board games. The manager told us that they were planning various Christmas activities such as a party and children from the local community to sing carols at the home. The manager showed us photographs of a recent garden party and Halloween party, where people and their relatives attended. They told us that they were planning further activities in the grounds of the home when the weather improved. During the morning of the inspection the home was quiet and people were dozing in one of the homes lounges and people were watching television in another lounge. A person was enjoying their hairdresser appointment, with the visiting hairdresser, who told us that they visited the home twice a week. During the afternoon of the inspection the home came alive, we could hear lots pf laughter and singing to music from the 1940s. We went into the lounges to observe the fun, we observed five care staff members working with individual people and they rotated their time to ensure that all people were given equal attention. Three people were playing scrabble with a staff member, people were singing and dancing with staff to the music, a staff member read a newspaper with a person, people played catch ball with a staff member, a staff member knitted with a person and people and visitors chatted with staff. People were smiling and the interaction between staff and people was very good. A person showed us their photographs of their relatives which they carried with them and we spoke with a person about their memories of their life. The life story of three people were viewed and each identified their interests and hobbies, their care plans identified how they were supported to maintain their interests, such as a person was interested in bird watching and the care plan identified that they were supported to identify the birds in the homes grounds and a person enjoyed classical music, their care plan stated that they were supported to listen to their chosen music. The daily records of three people were viewed and they identified where they had made choices in their daily living, such as the activities that they chose to participate in and when they had enjoyed visits from their relatives. The service user survey asked if the staff listened and acted upon what they said, two answered always, two answered usually and one answered sometimes. Care Homes for Older People Page 19 of 35 Evidence: Two visitors were spoken with during the inspection and they told us that they were always made welcome in the home and during lunch we observed a further two visitors having a meal with their relatives. The manager was observed in a telephone call to a persons relative where they clearly provided information of their well being. Peoples care records that were viewed identified peoples chosen contacts and the support that they were provided with to maintain their contacts. The minutes from a recent relatives meeting were viewed, which the manager said that they had recently introduced to ensure that relatives were kept informed about what was happening in the home. There was also a newsletter about the home posted to peoples relatives. The AQAA stated family and friends are encouraged to visit as often as they can to give the clients the sense of family involvement. During the inspection it was noted that there was jugs of soft drinks and glasses in the lounge and a water cooler in the entrance hall of the home, from which people could help themselves to drinks. People were provided with choices of hot drinks throughout the day. The menu was well balanced and nutritious, during the inspection lunch was sausages, potatoes and fresh vegetables and an alternative was chicken and stuffing. We asked the cook about the menu and if their budget affected the meals that were provided. They told us that the people had expressed that they enjoyed traditional British food and that was what they were provided with, they told us that people enjoyed sausages and they were included on the menu to meet peoples preferences. It was noted that people ate their meal and very little was left on their plates and the meal looked and smelled appetising. Two people told us that they had enjoyed their meal, one said it was nice. People who were assisted to eat their meal, were observed to be supported by staff who stayed with them for the duration of their meal and the staff talked to them about what they were eating, for example the food that was on their plate and if they were enjoying their meal. There was a large bowl of fresh fruit in the dining room, which people could help themselves to. We spoke with the cook, who told us that there were always kept informed of peoples dietary requirements. There were people with diabetes who lived in the home and there were no vegetarians or people with dietary cultural needs living in the home at the time of the inspection. They said that they provided alternatives to people if they did not want what was on the menu and peoples meal provision was changed if there were issues with eating, for example they told us that one person had not been eating well and they were provided with finger food that they could eat easily. We observed a staff member tell the cook at lunch that a person was not eating their meal and Care Homes for Older People Page 20 of 35 Evidence: several alternatives were offered to ensure that the person ate what they preferred. The cook told us that they had recently attended a training course on food for people with dementia, which they would consider in future menu planning. Peoples care plans that were viewed showed their dietary requirements, however, it was noted that one stated that the person should be provided with enough food and drink but did not indicate how much was enough and how their food and fluid intake was monitored. We pointed this out to the manager who agreed that this information would be included in the care plans where appropriate. Two visitors that were spoken with told us that their relative was well fed. Care Homes for Older People Page 21 of 35 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. People who live at the home can expect to be safeguarded from abuse and to have their complaints listened to and acted upon. Evidence: Two staff members were spoken with and they had a clear understanding of the homes safeguarding procedures and actions that they should take if they had a concern about a person that lived in the home. The training records that were viewed, which included a training matrix and training certificates of three staff members showed that the staff had been provided with safeguarding training. The AQAA told us that there had been one safeguarding alert made and stated we have a very good understanding of SOVA (safeguarding of vulnerable adults) and procedures related to this. We were informed of the safeguarding alert, which was an issue between two people who lived at the home. We received a complaint from a relative about the support and care that was provided to a person who lived at the home, as a result of this we made a safeguarding alert to the Suffolk safeguarding team. The issues were investigated by Suffolk Outcomes and Quality Monitoring Team, who visited the home and provided recommendations for the improvement of the the service. The reports for the visits were sent to us and it was noted that the home worked with the local authority to improve their service and acted upon the recommendations that they were provided with. The manager told us Care Homes for Older People Page 22 of 35 Evidence: that they had worked closely with them to improve the service. One of the issues identified was that the relatives were provided with a blank piece of paper and envelope to write their concerns to the manager when they were at the home and that the information about making complaints in the home included the contact arrangements to CSCI (Commission for Social Care Inspection), which was the previous Regulatory organisation. The complaints procedure was viewed which had been updated to provide the contact details of the current Regulatory organisation CQC (Care Quality Commission). The procedure stated that concerns should be directed to the homes manager, the organisations quality assurance and compliance director or CQC, and how complaints were acted upon. The procedure was displayed in the entrance hall to the home and was included in the homes Statement of Purpose and Service Users Guide. The service user survey asked if they knew how to make an informal complaint and a formal complaint, three answered no and two answered yes. We spoke with the manager who said that people were advised of the complaints procedure, however, they would add it to the agenda of future relative meetings. Two relatives that were spoken with told us that they were aware of the homes complaints procedure. The AQAA stated upon admission we give the residents and families a copy of the complaints procedure. The procedure is very clear and easy to follow and constantly updated. The complaints procedure is posted in the main lobby on the notice board. Five staff surveys said that they knew what to do if a person had concerns about the home. The health professional survey asked if concerns were acted upon appropriately, one answered usually and one did not answer the question. The homes compliments and complaints book was viewed. The AQAA told us that seven complaints had been received in the last twelve months. The complaints records that were viewed clearly explained the actions that had been taken as a result of the complaints and they were responded to within twenty eight days of receipt. There were several letters and cards from relatives of people that lived at the home, which complimented the home on the support and care that had been provided to their relatives. Some of which provided compliments on the refurbishment and redecoration of the home. Care Homes for Older People Page 23 of 35 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. People who live at the home can expect to be provided with a clean and comfortable place to live in. Evidence: The home was a large attractive building, which provided well maintained grounds. Communal areas included two lounges, a dining room, a conservatory and seating areas of the landing on the first floor. A lift was provided for access to the first floor and a small chair lift for a small flight of steps on the first floor, it was noted that the fabric on the seat was torn and needed replacing. At the last key inspection we had noted that there were several areas in the home which needed attention. Since the last key inspection a plan of refurbishment was being undertaken, which was also noted in the Outcomes and Quality Monitoring Team visit reports. The communal areas to the home, such as the lounges and dining room had been redecorated and provided with new curtains. The lounges and hallways had been provided with new carpets and the dining room had new flooring laid. New furniture was in the lounges, which included chairs that held chair protectors to minimise the damage to the furniture if people were incontinent. The entrance to the home was provided with a porch area, the roof had been repaired and during the inspection we observed work being undertaken on the outside of the home, which included cleaning the guttering of the house. The manager showed us a vacant Care Homes for Older People Page 24 of 35 Evidence: bedroom which was in the process of being redecorated and they told us that each time a bedroom became vacant they would be redecorated. Several cards and letters were viewed in the homes compliments and complaints books, which were from relatives of people living at the home complimenting them on the redecoration of the home. The AQAA stated rooms are big very airy, cleaned regularly. All the changes were all assessed and all the work was done without creating discomfort for clients and we have created a few spaces for clients to have private meetings with family and friends(conservatory, upstairs lounge). Two relatives that were spoken with told us that the home was a comfortable and clean environment. One of the visitors said that there were no smells in the home, which they stated was one of the areas that they noted when they had first visited the home. This was confirmed during our inspection, however, we noted an unpleasant odour in one of the lounges before lunch and reported it to the homes manager and one of the domestic staff on duty. They acted immediately and the smell was eliminated. The service user survey asked if the home was fresh and clean, two answered always, two answered usually and one answered sometimes. The AQAA stated rooms are personalised with clients personal belongs, pictures or furniture to create a more homely space for clients. Five bedrooms in the home were viewed and it was noted that each was clean, tidy and well maintained and each was personalised with peoples memorabilia and reflected their choices and individuality. Bedroom doors provided the names of the people that lived in each room. The manager was spoken with and told us that they were considering methods of labeling of doors to ensure that people with dementia could recognise their bedrooms, toilets and areas such as the dining room. They told us about memory boxes that were in place in another home that they had worked in and may consider the use of these. The majority of the bedrooms in the home provided en suite facilities, which included a hand wash basin and toilet. Each bedroom held a hand cleansing dispenser, for the use of visitors, people and staff to minimise the risks of cross infection. The communal bathrooms and toilets had not yet been refurbished and the manager told us that they had received quotes to undertake the work. They explained their plans, such as making a wet room. Each bathroom and toilet provided hand wash liquid and disposable paper towels, which minimised the risks of cross infection. The Care Homes for Older People Page 25 of 35 Evidence: laundry was also in the plans to be refurbished. The manager told us that they were planning to have a larger laundry and were considering moving it to another part of the home. The laundry was seen and was small and held one washing machine and one drying machine. At the previous inspection the previous manager had told us that the machines were sufficient to provide a laundry service to thirty people. At this inspection the manager told us that the laundry was always in use and that they were planning to increase the number of washing machines. We told the manager about the comments that we had been provided with in staff surveys regarding the laundry service in the home, which included laundry leaves a lot to be desired, really needs a separate person to sort it all out. The manager told us that there was no dedicated laundry staff at the home, however, they were planning to employ a further domestic staff member to ensure that the laundry was staffed. We observed the manager interview a person for the domestic role during the inspection. There was hand wash facilities in the laundry and we advised the manager that the sink was not clean, they addressed the issue immediately and it was cleaned by a domestic staff member. A requirement in the last key inspection was procedures must be in place to ensure that commodes are appropriately cleaned. To minimise the risk of cross contamination. Since the last inspection a new sluicing machine had been purchased (November 2009), which had not yet been installed. During the inspection we observed the manager telephone the suppliers and request an installation date. They told us that the commodes were currently cleaned using sterilising tablets in the sluice room, this was confirmed by the Outcomes and Quality Monitoring team visit report. A complaint that was received had said that there were flies in the home, the manager told us that they had an issue with flies during the summer and that they had used fly bags to attempt to eliminate the issue and that windows had been treated. They said that next year they will ensure that actions are taken earlier in the year. Records of regular pest control visits were seen which showed that the home were taking actions to eliminate the problem at the time. The issue of flies had also been looked at by the Quality and Outcomes Monitoring Team, which confirmed the actions that had been taken to address the issue. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be supported by staff who are trained to meet their needs and to be protected by the homes recruitment procedures. Evidence: A requirement made at the last key inspection was Satisfactory Criminal Records Bureau and/or POVAfirst checks must be in place before a worker starts to work at the home. To ensure that workers are fit to work at the home and that vulnerable adults are safeguarded by the homes recruitment procedures and processes. At this inspection the recruitment records of three staff members were viewed and each held evidence that the appropriate checks had been undertaken, which included identification, two written references, CRB (Criminal Records Bureau) checks and POVAfirst (protection of vulnerable adults) checks. The AQAA stated all staff recruitment follows the correct procedures. All staff files are complete and all the checks (POVA and CRB) are completed before new staff commences to work. All staff received terms and conditions before commencing work. Five staff surveys said that checks such as their CRB and references were carried out before they started work. The manager told us that the home was fully staffed, with one domestic vacancy, for which they interviewed an applicant during the inspection. A staff member that was Care Homes for Older People Page 27 of 35 Evidence: spoken with told us that there were sufficient numbers of staff that worked at the home, they told us that there were five carers and one nurse during the day and two carers and one nurse during the night. This was confirmed by the staffing rota that was viewed, the numbers of staff that we observed during the inspection and the Outcomes and Quality Monitoring visit report. The staff survey asked if there were enough staff to meet peoples needs, four answered usually and one answered never. We had received a complaint which stated that there were staff shortages and that people often had breakfast in their night clothes. It was noted that when we arrived at the home at 9:10 all people that were up were dressed and there were no indications that people were not appropriately supported due to the home being short staffed. The AQAA stated the ratio of staff was determined by assessing residents needs. The AQAA told us that there were twenty one staff that worked at the home and fifteen had achieved a minimum of NVQ (National Vocational Qualification) level 2, which met the target of 50 of staff to have achieved a minimum of NVQ level 2 as identified in the National Minimum Standards relating to older people. Since the last inspection there had been improvements in the training provision, which was ongoing and the recording of training undertaken by staff. A training matrix had been developed which showed which training had been attended by individual staff members and the dates that they needed to undertake updates. The manager told us that the training matrix had identified where there were gaps in training and actions that they needed to take to ensure that all staff were provided with appropriate training. During the inspection two staff members were attending risk assessment training and they had attended health and safety training prior to this, manual handling updates were to be undertaken December 2009, food hygiene training January 2010 and there were notices on the staff notice board which showed that wound care training was booked 4th December 2009 and fire safety 7th December 2009. Dementia training to be booked as not all staff had been provided with the training. The training matrix was viewed and showed that staff were provided with training such as COSHH (control of substances hazardous to health), continence, medication, pressure areas, catheterisation, manual handling, fire safety, infection control and safeguarding. There had been recent training provided to ensure that staff who had not been provided with appropriate training, which included five staff attended safeguarding training October 2009, six nurses attended medication training on the new system October 2009, nine staff attended wound care training September 2009 and twenty one staff attended catheter care October 2009. Care Homes for Older People Page 28 of 35 Evidence: Two staff members that were spoken with told us that they were provided with the training that they needed to do their job and meet peoples needs. Five staff surveys said that they were provided with training which was relevant to their role, provided enough information about health care and medication, helped them to understand and meet peoples needs and kept them up to date with new ways of working. One survey stated I am doing a dementia awareness course, it has really helped me in understanding our residents needs and well being. The Outcomes and Quality Monitoring team visit report identified that staff had not been provided with diabetes training, the manager told us that the training was booked for nursing staff 15th December 2009 and that the care staff would be provided with the training early 2010. The AQAA told us that new staff were undertaken the Skills for Care Common Induction Standards, which was confirmed by the training matrix which was viewed. The staff survey asked if their induction covered everything that they needed to know to do the job when they started, one answered mostly and four answered very well. Care Homes for Older People Page 29 of 35 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. People who use this service can expect to live in a home which is managed in their best interests and that their health, safety and welfare is promoted and protected. Evidence: Since the last key inspection there had been a change in the management arrangements of the home. The current manager had been in post for six months, they told us that they were a Registered Nurse and had achieved the RMA (registered manager award). They said that they had recently made a registered manager application to CQC. The staff training matrix was viewed and showed that the manager had achieved the above qualifications and NVQ levels 2 and 3 and attended recent training courses such as in 2009 medication, person centred care, dementia, pressure areas and fire safety and 2008 moving and handling, infection control, supervision and management training, which showed that they regularly updated their knowledge. The AQAA stated the new acting manager has the qualification (General Nurse Care Homes for Older People Page 30 of 35 Evidence: qualifications and RMA) and experience to manage the care setting. The new manager has worked for the company for more than five years and knows the organisations strategic and financial planning systems and the operational or business plan. The manager works to improve the systems in place. The manager works towards provision of increased quality of life, equality and diversity, dignity and privacy and person centred care. The manager leads and supports the staff team to achieve a high standard of knowledge and level of care. The manager makes sure the staff follow the policy and procedures and any updates made are brought to staff attention. There were records of areas of where the manager monitored the support that people were provided with such as with falls, complaints, safety of the environment and medication. The manager undertook weekly manager reports which reported on areas such as staffing levels, occupancy, pressure areas (none) and equipment used to prevent pressure areas. The manager was receptive to inspection process and provided the requested information promptly and in an open manner. They had made several improvements in the service since the last key inspection which included staff recruitment, staff training and related records, care planning and in the environment. They had introduced a newsletter and relatives meetings to ensure that relatives were provided with information about the home and with the opportunity to express their views about the home and the support that their relatives were provided with. People were further provided with the opportunity to express their views about the service in satisfaction questionnaires and in discussions during Regulation 26 visits. The results of recent satisfaction surveys were viewed and the monthly Regulation 26 visit reports were viewed, which showed that the home was routinely monitored by the homes providers. The manager told us that peoples finances were not kept in the home, they told us that their relatives or representatives were invoiced for peoples spending, such as newspapers and hairdressing. Records of invoices sent to peoples relatives were viewed. People were provided with a small safe in their bedroom where they could keep their valuables. Peoples health and safety was promoted and protected. Fire safety records that were viewed showed that checks were regularly undertaken to ensure that people were safeguarded in case of a fire. People were further safeguarded in the routine checks of water temperatures and Care Homes for Older People Page 31 of 35 Evidence: medication, for which the records were viewed. The home provided a legionella risk assessment. Certificates were viewed which showed that routine health and safety checks and services were undertaken which included gas safety, the lift, hoists and nurse call system. Staff were provided with training on health and safety related issues such as manual handling, infection control and safeguarding. The minutes from staff meetings were viewed (from June and August 2009) which advised staff of their roles and responsibilities in areas such as working in the laundry, infection control and the vaccine for swine flu. Care Homes for Older People Page 32 of 35 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 33 of 35 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 It is recommended that checks be made on the administration processes of medication to ensure that medication is administered in line with peoples individual care plans. It is recommended that consideration be made to ensuring that the environment is more accessible to people with dementia, for example to enable them to recognise rooms in the home, such as their bedroom, toilets and the dining room. 2 19 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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