Care Home: The Paddocks

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What the care home does well People thinking of moving into the home were given useful information to help them to make a decision about whether it was the right place for them. The manager carried out an assessment with new people to make sure that their needs were fully understood and could be met at The Paddocks. The residents who completed surveys, and those we spoke to, were satisfied with the care and support they received. One resident said, "Staff are extremely kind and they do everything I want them to do." When necessary people were referred to other professionals, such as the GP and district nurse. A resident said he found it very helpful that staff organised his hospital appointments. Residents who completed surveys told us that staff were always, or usually, available when they needed them and a resident said that staff usually answered buzzers quite quickly. Several people made very positive comments about the staff team. They said staff were polite and respected their privacy. Residents we spoke to made positive comments about the home. One said, "It`s very good; I`m happy here, I think most people are." Another resident told us that there was no regimentation and they were able to have control over their own life. Staff described how they helped people with dementia to make choices and decisions about their care. Residents we spoke to on Nightingale and Kingfisher wings told us that there were enough activities going on to prevent them from getting bored. There were regular activities for people on Sandpiper unit but these did not always match with individual`s interests and abilities. Most of the residents who completed surveys, and those we spoke to, said they usually liked the meals. Residents were encouraged to bring in ornaments and other small items to personalise their bedrooms. This helped to make them more homely and familiar. Residents told us they were happy with their rooms, one said, "It is very cosy." Residents were also satisfied with the cleanliness of the home. Those who returned surveys indicated that it was always clean and fresh. There was a good programme of staff training. Staff who completed surveys all indicated that they received training that was relevant to their role and helped them to understand and meet the needs of the residents. Over half the staff held a nationally recognised qualification in health and social care. The home had a stable management team. The registered manager was qualified and experienced and there were lines of accountability on each of the wings. There were systems for monitoring the quality of the service provided and residents and their families had opportunities to make their views of the service known. Suggestions for change were acted upon. A resident told us that the home was, "Well organised." What has improved since the last inspection? After the last inspection we made a requirement that the assessments carried out with people prior to their admission must be more detailed. This requirement had been met. The examples we saw during our visit gave staff a good picture of the person`s needs and of their abilities, likes and dislikes. This helped to ensure that staff had a clear picture of what care they needed to provide. It also helped to reduce the risk of failed placements. Overall there had been improvements in care records since our last inspection. The people that we case tracked had assessments to identify risks to their health and safety and had care plans to address their personal and health care needs. Care plans, especially on Sandpiper wing, were more detailed and person centred. They told staff how to provide care that matched residents` wishes and supported them to maintain their independence. Background checks on new staff were more thorough, which helped to ensure that they were fit to work in a care setting and provided protection for residents. However, we made a recommendation that references that were not from previous employers, should be requested from more objective sources. What the care home could do better: Despite the improvements in care records, noted above, there was room for further improvements. Care plans on Nightingale and Kingfisher wings were not always detailed enough and they must give staff clearer directions to ensure that residents receive the care they need. There must be some improvements in the way some medicines are stored. This is to protect residents` safety. There are plans for major refurbishment of Kingfisher wing, which will improve the comfort of residents on that wing. Some other areas also needed attention to bring them up to the good standard of the rest of the environment. To minimise the risk of errors and to provide safeguards for residents and staff, records of money handed over by residents, for safekeeping, must be reviewed. The procedure must include systems for checking transactions and regular audits. In order to safeguard residents` health and safety, the manager must assess whether there are any potential risks caused by the lack of window restrictors on Sandpiper wing and by caustic denture cleaner being kept in some bedrooms in Nightingale wing. We also made a recommendation that the hot water temperatures in bathrooms should be monitored to ensure that the thermostatic controls remain in good working order. Key inspection report Care homes for older people Name: Address: The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP     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: Jane Craig     Date: 0 9 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 34 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 34 Information about the care home Name of care home: Address: The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP 01760723416 01760722420 lincolncare1@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lincoln Care Homes Limited care home 100 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 that can be accomodated is: 100 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 primay needs on admission to the home are within the following categories: Older people, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Paddocks provides personal or nursing care for up to 100 older people. It is situated in a residential area and is within walking distance of the town centre of Swaffham. There are three separate wings, one of which is a dementia care wing and one is allocated to accommodate people who have nursing needs. In addition to the three wings there is a separate block which houses the administrative offices and laundry. The home is set in pleasant gardens, with a secure area for people with dementia. There is car parking at the rear of the home. Medical and nursing services are provided via the local G.P. service. Information about the Home, including the Care Homes for Older People Page 4 of 34 1 1 0 3 2 0 0 9 100 0 Over 65 0 100 Brief description of the care home scale of fees, is available from the registered manager. Care Homes for Older People Page 5 of 34 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 last key inspection on this service was completed on 11th March 2009. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out over two days, on the 8th and 9th December 2009, by one regulatory inspector. At the time of the visit there was a total of 84 people resident in the home. We met with some of them and where possible asked about their views of The Paddocks. We spent time observing daily routines in the home and how staff interacted with residents. Four residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager and the responsible individual. This is the person who has been nominated by the company who owns The Paddocks, to take Care Homes for Older People Page 6 of 34 responsibility for the service. We also spoke with visitors to the home and members of the staff team. We looked around the three wings and viewed a number of documents and records. As part of the inspection process we sent out surveys to a random selection of people living and working at the home to gain their views about various aspects of the service. Most residents who returned the questionnaires had been assisted to complete them by members of staff. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? After the last inspection we made a requirement that the assessments carried out with people prior to their admission must be more detailed. This requirement had been met. The examples we saw during our visit gave staff a good picture of the persons needs and of their abilities, likes and dislikes. This helped to ensure that staff had a clear picture of what care they needed to provide. It also helped to reduce the risk of failed Care Homes for Older People Page 8 of 34 placements. Overall there had been improvements in care records since our last inspection. The people that we case tracked had assessments to identify risks to their health and safety and had care plans to address their personal and health care needs. Care plans, especially on Sandpiper wing, were more detailed and person centred. They told staff how to provide care that matched residents wishes and supported them to maintain their independence. Background checks on new staff were more thorough, which helped to ensure that they were fit to work in a care setting and provided protection for residents. However, we made a recommendation that references that were not from previous employers, should be requested from more objective sources. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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. The admission process ensures peoples needs are understood before they are offered a place at the home. Evidence: The information packs given to people thinking of moving into the home were clear and meaningful. The pack for people moving to Nightingale and Kingfisher wings had been updated to reflect that the home now provides nursing care. The pack for people moving to Sandpiper was specific to people who were in need of dementia care services. The manager also showed us a book of photographs, which she took out to show people who were thinking of moving into the home. She said she talked the person through the pictures of the home, staff and activities. This helped to give people a sense of familiarity when they were admitted and was especially beneficial to people who were not able to read the information packs or to visit the home before moving in. The annual quality assurance assessment (AQAA) told us that there are plans to develop a website for the home, which will further assist this group of people. Care Homes for Older People Page 11 of 34 Evidence: Residents who returned surveys indicated that they received enough information to help them decide that the home was right for them. One commented that everything was explained to them. The AQAA indicated that everyone had a contract or service agreement, which helped to ensure that residents were clear about their rights and the responsibilities of the service. Anyone thinking of moving into the home was assessed by the manager or senior staff. This was to ensure that people were not admitted unless their needs were fully understood and could be met at the home. These assessments were supported by information from the social worker, or health care professionals, involved in the persons care. Following a requirement after our last inspection, the pre-admission assessments had been expanded to include information relevant to people with dementia care needs. The examples of pre-admission assessments we saw provided sufficient information to enable staff to provide support to the new resident. Care Homes for Older People Page 12 of 34 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. Care met the assessed needs of people using the service. Evidence: We looked at four sets of care records as part of the case tracking process and others to check on specific issues. Everyone had an assessment on admission, which built on information gained from the pre-admission visit. This assessment helped staff to identify areas for further assessment and draw up care plans. The standard of information on care plans varied between the three wings. For example, those we saw on Sandpiper wing were more person centred. Directions for staff generally helped to promote residents wellbeing by maintaining their independence and taking into account their preferences and wishes. There were some clear plans for residents with complex behaviour. This helped to ensure that staff supported people in a consistent way. The plans we looked at on the other wings were less individualised and directions for staff were less specific, which could result in people not receiving consistent care in the way they preferred. Care Homes for Older People Page 13 of 34 Evidence: There was a list of dates to show when care plans had been reviewed and whether they had been amended. The format of the care plans did not require staff to write notes to summarise the care given, or to evaluate whether the care had been effective. Staff on Nightingale and Kingfisher wings had used the care plans to record this information, which had resulted in some plans giving confusing and conflicting directions. It was not possible to tell, at a glance, what information was still relevant. Residents and relatives were invited to participate in a full care plan review every three months. The head of Sandpiper wing said this had already been beneficial as relatives were often able to provide staff with extra information about the residents likes and dislikes or give further insight into their lives before admission. The AQAA indicated that staff carried out nutritional screening with every resident and monitored those who were thought to be at risk of malnutrition. We saw nutritional assessments for the people we case tracked and monthly weight checks were being undertaken. Each person we case tracked also had assessments for moving and handling and risk of developing pressure sores. Where a risk had been identified plans were in place but they were not always sufficient to control the risk. For example, the risk assessment for one resident showed they were at very high risk of developing pressure sores but their plan was out of date and it did not indicate what strategies staff should use to minimise the risk, for example, pressure relieving equipment. Despite the lack of records, there was evidence that residents had special mattresses and cushions to prevent pressure sores developing and district nurses visited the home to provide advice and treatment. One of the senior staff was a member of the local falls prevention team. They were collecting information about falls to identify any patterns or trends and to enable staff to draw up strategies that focused on the reasons for the falls. For example, bed and seat sensors were available for people who did not always wait for staff to help them to get up. However, these records were only completed after a resident had fallen. Not everyone had an initial risk assessment to highlight whether they may be at risk of falls, which meant that support with regard to falls tended to be reactive rather than proactive. A number of residents had assessments which indicated that they needed bedrails. In most cases these were fitted by the maintenance staff but there were no checklists to show that rails that were being fitted were suitable for the bed and mattress. Once in place, the rails were checked by domestic staff each day but there were no records to show whether faulty equipment had been identified and reported. Despite some shortfalls in health care records, there was evidence that residents Care Homes for Older People Page 14 of 34 Evidence: ongoing health care needs were monitored. Staff who returned surveys said they were given up to date information about the care each resident needed. There were verbal handovers at every shift change and staff we spoke to were able to describe the support residents needed. A member of staff told us that the care plans were not always as detailed as the verbal instructions they were given. Records showed that staff made prompt referrals to outside professionals where necessary. A health professional told us that staff on Sandpiper wing were good at incorporating advice they had been given into everyday practice. Three of the residents who returned surveys indicated that they always received the care and support they needed and two said they usually did. One commented that staff made them comfortable and another wrote that staff helped them when they needed it. The residents we spoke to during our visit said they were happy with the care and attention they received. One resident said, The staff are extremely kind and they do everything I want them to do. Another told us that staff kept on top of the arrangements for hospital appointments, which helped him. Residents also commented that staff were polite and respected their privacy. One resident said that staff always knocked on their door, even if they had only left the room a few minutes ago. When we asked one resident about whether staff promoted their privacy and dignity, they said, Yes, they treat us like human beings. A visitor told us that staff helped their relative to maintain their appearance, which had always been important to them. However, on the day of our visit there were a high number of female residents on Sandpiper wing who were not wearing stockings or tights. Several staff told us that this was because the residents had chosen not to but we were also told that sometimes people did not wear them because they did not have them. We looked at the systems for storing, recording and administering medication in the three wings. All staff who handled medication had received relevant training. We observed two members of staff carrying out medicine rounds and found their practice to be safe and hygienic. Tablets and liquid medication were stored safely. There were plans to improve the storage facilities on Kingfisher wing, which currently are too small. There was excess stock of some creams on Nightingale wing. Residents in Nightingale and Kingfisher wings kept prescribed creams and lotions in their bedrooms. There were no appropriate lockable storage facilities, which could place residents at risk. A small number of residents on Sandpiper wing were receiving their medication covertly. Those we looked at had assessments to show that they lacked capacity to Care Homes for Older People Page 15 of 34 Evidence: make a decision about whether or not to take their medication. They had appropriate risk assessments and care plans in place. However, one person was not receiving their medication on a regular basis because they refused the food containing the disguised medicine. The medication plan had not been evaluated to show it was not working. Staff told us they had tried other methods but these were not recorded, which meant that other staff would not be able to follow the new guidance. There were complete records of medicines received, disposed of and of any stocks of medicines carried over from the previous month. These records contributed to the audit trail and helped to ensure that prescribed medication was always available. We checked a small sample of medicines and found that the stock matched the records. This was a good indication that residents were receiving their medication as it was prescribed. However, there were a few gaps on medication administration record (MAR) charts, which were generally errors in recording rather than administration. This had been highlighted by regular medication audits and the manager told us that it was addressed with the individual staff responsible. There were some handwritten entries on MAR charts, these were not signed or witnessed to reduce the risk of transcribing errors. Some people were prescribed medicines to be given in a variable dose. Staff recorded how much had been administered, which helped to ensure that residents did not receive too much and also the effects of the medication could be evaluated. Some residents were prescribed painkillers to be given when required. There were no care plans or guidance to alert staff when these should be given but staff told us that all the residents in question could tell staff whether they needed their medication or not. There were no residents who were prescribed sedatives to be given at the discretion of staff. Controlled drugs were stored safely. In all but one case they were administered and recorded appropriately. An analgesic patch had been administered late. This had not been reported to the manager as a drug error and it had not been picked up by the medication audit because it had happened on the first day of the new medication cycle. The manager investigated the incident during our visit and was putting systems into place to ensure it could not happen again. Care Homes for Older People Page 16 of 34 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 were supported to make choices and retain control over their daily lives. Evidence: Some of the care records we looked at included a summary of the residents life history. Staff said this information was used to help them to plan care and to understand important events in peoples lives. The AQAA indicated that all residents had social plans. Some of those we saw included a good description of previous interests and how the resident currently spent their day but there was no evidence that staff facilitated group or one to one activities that specifically matched residents interests or abilities. For example, one plan that we looked at indicated that the resident used to enjoy physical activities and now spent their day walking around the unit. We discussed with the manager how the care plans could be used to support residents to find new interests, which fully utilised their abilities. The home employed an Activities Co-ordinator to work on Nightingale and Kingfisher wings. Residents we spoke with said they had entertainment, games and music. One told us, There is enough to keep us from getting bored. Another said they were looking forward to the Christmas party. Staff working on Sandpiper facilitated activities for residents accommodated on that wing because they were more Care Homes for Older People Page 17 of 34 Evidence: knowledgeable about the residents preferences and abilities. There was a daily roster to ensure that the nominated member of staff was given the time to organise an activity in the morning and afternoon. On the day of our visit the morning activity was a short ball game, which a small group of residents enjoyed. The AQAA indicated that some staff had attended a course to help them with activities and the manager told us that they looking at nominating a core of staff to be responsible for activities on Sandpiper. Residents social and cultural needs were recorded but there was a lack of direction on one plan to support someone with dementia to continue to follow their religion, even though their assessment indicated that this had been important to them in the past. However, on speaking with staff it was evident that they respected the needs and wishes of people with different religions. A resident told us that they regularly attended a religious service in the home. People said they had choices about all sorts of things. One said, I still have control over my life and make my own decisions. Staff told us that a lot of residents on Sandpiper wing were not able to understand verbal descriptions so they used visual cues to assist them to make choices. For example, there were menu cards, which helped people to make a choice about the meals on offer. Another member of staff said they held out different sets of clothing to assist the resident to make a choice about what to wear. There was open visiting, which helped residents to maintain contact with their relatives and friends. A visitor told us that this was convenient as they had to rely on other people for transport. Some residents went out with family members but there were few opportunities for other residents to go out. The AQAA told us that the service plan to purchase a mini bus in the next year, which will enable more people to access community facilities. Residents we spoke to were generally satisfied with their daily lives in the home and felt that it matched their expectations. One told us, Its not home but its OK. Another said, Im happy here and I think most people are. Everyone we spoke with were happy with the meals. The four week rotating menu showed that residents were offered a varied diet and this was confirmed by residents. One told us, We get good food with a good variety and choice. Another person said, We always get a choice. The main meal was served at lunchtime and on the day of our visit it looked appetising. Residents said they enjoyed it. We observed the meal being served on Sandpiper. Staff ensured that residents received the assistance they Care Homes for Older People Page 18 of 34 Evidence: needed. Care Homes for Older People Page 19 of 34 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 using the service were protected by the complaints and safeguarding processes in the home. Evidence: The complaints procedure was included in the service users guide and given out to everyone. There were also copies on display in various areas of the home. The procedure indicated how people should make a complaint and how it would be handled. Everyone who completed a survey said they had someone to speak to if they were unhappy and the majority knew how to make a formal complaint. Residents we spoke to said they would feel comfortable talking to staff if there was anything wrong. One said that their relative had raised a minor concern and this had been dealt with immediately by staff. Another said, If there is a complaint they try to do something about it, they dont dismiss it. There had been no formal complaints since the last inspection. Staff received safeguarding training on induction and during their NVQ. As from next year all staff will attend annual refresher courses to ensure they are always up to date with best practice. The safeguarding policy for the service gave information about the types and indicators of abuse. It directed staff to report suspected or alleged abuse, or harm immediately to the manager. Staff we spoke with said that they would automatically do this and the manager was clear about her role in reporting on to social service or the police. However, the policy did not provide a clear procedure for Care Homes for Older People Page 20 of 34 Evidence: other senior staff about how to make a safeguarding referral, or the role of social services as the lead agency. There had been no safeguarding referrals made in the past year. The service carried out a brief mental capacity assessment with residents. The assessment gave an indication of the residents ability to make decisions about different aspects of their daily life, for example, finances, personal care and emergency aid. The assessment also informed staff of the help people may need to make a decision or who can be contacted to make a best interests decision for the individual. We discussed with the manager that the document needed to make clear that capacity can fluctuate and the resident needed to be assessed whenever a new issue arose. She agreed to review it to ensure that staff did not make assumptions. Some of the files we looked also included a document to show whether the person had made any advance directives with regard to care. None of those we saw had been completed. The manager and senior staff had received training about the Mental Capacity Act and related legislation. The plan was to roll the training out to the rest of the staff in the new year, which will help to ensure that residents rights continue to be promoted. Care Homes for Older People Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most areas of the home were well maintained, clean and comfortable but some areas of the home might pose risks to residents safety. Evidence: The home is split into three wings. Sandpiper, which accommodated people with dementia, was further split and had bedrooms and communal rooms on the upper and lower floors. Residents on the lower floor had direct access to a secure garden, which included some nice features such as a pergola and a summer house. Residents on the upper floor were reliant on staff to escort them to the garden. Nightingale and Kingfisher wings accommodated people who needed nursing or personal care. Each wing had its own communal areas, toilets and bathrooms. Most areas on Sandpiper wing were well maintained and the furnishings and decor were comfortable and homely. However, we noted that some of the bedroom windows were fogged and needed attention to ensure that residents in those rooms had a clear view out. The paintwork on some of the corridors was badly scuffed and needed upgrading. The decor and furnishings in many areas of Kingfisher wing were tired and in need of upgrading. The manager confirmed that major refurbishment was planned for the wing, which would increase the number of en-suite rooms. A new passenger lift was Care Homes for Older People Page 22 of 34 Evidence: also to be installed which would provide more space for wheelchairs. Some of the windows on Sandpiper unit did not have restricted openings. Whilst the windows were generally high enough to control the risk of people falling through them, there were no assessments to show that risks to residents safety had been assessed when the decision was taken not to fit restrictors. The AQAA told us that there were written risk assessments with regard to potentially hazardous items. However, we were unable to find any to show that there were no risks to residents health or safety from caustic denture cleaner, which was kept in some of the bedrooms on Nightingale wing. Other safety measures were in place, such as low surface temperature radiators and thermostatic controls on the hot water to reduce the risk of scalds. We discussed with the manager that water temperatures should be checked to ensure that the controls remain in good working order. There was discreet signage throughout Sandpiper wing. All bedroom doors were painted different colours and had the residents name and a meaningful picture to aid recognition. At the last inspection we identified that some bedrooms on Sandpiper were kept locked during the day to prevent other residents from going in. The head of care on Sandpiper said that that this only happened in rooms where the resident was unable to access their room independently. We were told that locks could be fitted on bedroom doors and residents, who were able, could hold their own keys. However, this was not done as a matter of routine. Toilet and bathroom doors on Sandpiper unit were painted yellow. A member of staff said this had helped a number of residents to be more independent. Most of the bathrooms around the home had assisted bathing facilities. Staff had made attempts to make the bathrooms a bit homely and the AQAA acknowledged that this was an area where they were planning to improve over the next year. People living in the home were encouraged to personalise their bedrooms with furniture and ornaments, to make them more familiar and homely. Residents we spoke to said they liked their rooms. One said, I find it very cosy. At the time of our visit all areas were clean and there were no odours. Residents who completed surveys indicated that it was always fresh and clean and a resident also told us that people often remark on the cleanliness of the place. Two of the residents we spoke to said the laundry service was good. One said that sometimes clothing went missing for a short while but it always turned up. Staff had training in infection control and the AQAA said the service had an action plan Care Homes for Older People Page 23 of 34 Evidence: to deliver best practice in prevention and control of infection. There were ample hand washing facilities throughout the home. Staff wore gloves and aprons when attending to individual residents, which helped to minimise the spread of infection. Following a requirement after our last inspection there were no communal toiletries in the bathrooms, which helped to control the risk of infections being passed on. Care Homes for Older People Page 24 of 34 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. There were sufficient staff, with appropriate training, to meet the needs of people using the service. Evidence: Each wing of the home was staffed individually. Staff working with the people with dementia care needs chose to do so and residents became familiar with their staff team. The staffing rosters for each wing showed that the staffing numbers did not fall below the planned levels set by the manager. We saw evidence that extra staff were rostered at busy times of the day, for example mealtimes and periods when most people were receiving personal care. The manager told us that she had the authority to increase staffing levels on a temporary basis in order to meet increased need, for example, if a resident was ill. She told us that staff on Nightingale wing had identified that more staff were needed for an hour in the early evening and she was considering their request. Staff who completed surveys and those we spoke to said there were usually enough staff to meet the needs of the current residents. Residents who completed surveys stated staff were always, or usually, available when they needed them. A resident told us that staff usually came quite quickly if they pressed their buzzer. Another said, In general I dont have to wait too long. A resident told us that people who were unable to walk sometimes had to wait for staff attention. On the day of our visit we did not see any evidence of this and there were no periods of the day when staff call bells went unanswered. Care Homes for Older People Page 25 of 34 Evidence: We made a requirement after the last inspection, that the manager must check the personal and employment background of all staff applying for a job to ensure they were fit to work at the home. The recruitment procedure had improved. We looked at two staff files. Both had an application form which provided a full employment history and reasons for leaving previous care jobs. Neither had started work until they had a POVA first or full CRB disclosure, which showed they did not have a criminal record that could preclude them from working in a care setting. They both had two written references before starting work. However, the references for one member of staff were character references, given by friends. This meant they were not unbiased. The service had recently started to employ registered nurses. There was a system for checking that nurses registrations were still valid and to flag up when they were due to re-register. There were also systems in place to highlight when overseas staff had to renew work permits. There was a training manager in post. The registered manager told us that staff training had improved and was more organised since her appointment. There was a thorough induction training programme. New staff had a skills audit to identify the level of induction training they needed. Initial induction training took place over four days, which included two days taught sessions and two days shadowing senior staff. This helped to ensure that staff had some theoretical knowledge and understanding of care issues, as well as practical skills. The remainder of the induction programme followed the Skills for Care common induction standards. During this time the training manager liaised with senior staff to ensure that any further learning needs were identified. Wherever possible, practical training, such as moving and handling, was carried out within the first week. This helped to ensure that staff could use equipment when they started to work with residents. Following their induction, staff joined the rolling programme of training. We were not able to tell from the current training records whether all the mandatory training, for example, moving and handling and fire safety were up to date. The training manager agreed to devise a central matrix, which should help to quickly identify any gaps in training. Dementia care training was considered to be mandatory for all staff. Most had attended a course accredited by the Alzheimers Society. A member of staff told us that the dementia care course she attended had a positive impact on the way she thought about residents and how she communicated with them. Staff who completed surveys indicated that they received relevant training that helped them to understand and meet the needs of the resident. One wrote, Carers are given Care Homes for Older People Page 26 of 34 Evidence: proper training and information. Staff we spoke to also told us that, in addition to mandatory topics, there were good opportunities for training in subjects relevant to the resident group, such as care of the dying, diabetes and Parkinsons disease. Extra training needs were identified through the supervision and appraisal process. Over half of the staff were qualified to NVQ level 2 or above in health and social care. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was run by a competent manager who ensured that peoples views were listened to and acted upon. Evidence: There was a clear management structure within the home. The registered manager was supported by the responsible individual, who carried out regular visits to the home. There was a deputy manager whose role included heading up care for Kingfisher and Nightingale wings. Sandpiper wing also had a nominated manager who had several years experience in working with people with dementia and was knowledgeable about their needs. The registered manager is a qualified nurse and has several years experience in managing care services. She has a management qualification relevant to care settings and is currently doing more training in general management. Staff who completed surveys indicated that they felt supported by the manager. One wrote, The manager is always available if there is a problem. A resident told us they thought the home was well organised. Care Homes for Older People Page 28 of 34 Evidence: There were systems in place to monitor the quality of the service, which included seeking the views of people living at The Paddocks. The results of the survey for 2008 were published. We saw that the action plan, to address areas of concern and suggestions for improvements, had been carried out. At the time of our visit the results of the most recent survey were waiting to be collated. The surveys we saw included mostly positive responses and comments. However, two residents indicated that they did not feel that they were always listened to. The manager was unable to identify who they were and so could not address the comments with the individuals concerned. She planned to discuss the issue in general at the next residents meeting. Minutes of previous meetings showed that suggestions were acted upon and concerns were addressed. Staff also had opportunities to voice their opinions or make suggestions for improvements during staff meetings. The only audits of procedures at the time of our visit were medication audits, which helped to identify whether staff were complying with policies and procedures and identified any further training needs. Several residents had small amounts of money held for safekeeping. There were individual account sheets which indicated when money was deposited or withdrawn. These transactions were initialled by the member of staff but were not witnessed, which meant they were not double checked. Receipts were obtained for most items but these were kept in a central place, which meant that calculations could not be cross checked at the time. Residents accounts were audited monthly. The current systems for handling residents money did not provide complete safeguards for residents or staff. There were health and safety policies in place and the staff handbook made reference to key issues. A health and safety manager had recently been appointed. She had started meeting with representatives from each department to ensure health and safety policies were understood and being followed. The manager was due to attend a health and safety course in the new year, after which the role would become more defined and developed. There had been a fire inspection the week prior to our visit. The manager told us that there were no recommendations following the inspection. Staff received fire safety training. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQQA showed that the maintenance and servicing of other equipment and installations were up to date, which helped to protect the health and safety of people living and working in the home. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Care plans to reduce 31/03/2010 assessed risks to residents health and safety must be kept up to date and include current strategies. This is to promote residents health and safety 2 9 13 There must be appropriate, safe storage for creams and other prescribed preparations kept in residents bedrooms. This is to safeguard residents. 31/01/2010 3 19 13 The lack of window restrictors in some areas of the home and the open storage of caustic denture cleaner in bedrooms must be risk assessed. This is to protect residents health and safety. 31/01/2010 Care Homes for Older People Page 31 of 34 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 4 35 17 The records of residents money handed over for safekeeping must be reviewed. The procedure must include systems for checking transactions and regular audits. This is to minimise errors and provide safeguards for residents and staff. 31/01/2010 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 7 Care plans for covert medication should be evaluated to ensure that medication is given in the most appropriate way to ensure residents receive essential medicines. Care plans should be sufficiently detailed to ensure consistent care in the way the resident prefers. Care plan reviews should be recorded separately and amendments to care plans made clearer to ensure that staff have clear and accurate directions to work from. Handwritten entries on MAR charts should be witnessed to reduce the risk of transcribing errors. The procedure for responding to suspected or alleged incidents of abuse should be made clearer to ensure that all senior staff are aware of how and where to report to. There should be ongoing checks on temperature of the hot water in bathrooms to ensure that the thermostatic control valves remain in good working order. References for new staff should be sought from an objective and unbiased source. There should be a central training record that shows at a glance what training each member of staff has undertaken Page 32 of 34 2 3 7 7 4 5 9 18 6 19 7 8 29 30 Care Homes for Older People 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 and will highlight any gaps in mandatory training. 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