Care Home: The Polegate Nursing Home

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What the care home does well The Polegate offers residents a homely and comfortable place to live. Staff involved in the inspection said that they work well together and aim to offer residents the support they need and want. Residents and visitors were equally positive saying the staff are very caring and the food is very good. What has improved since the last inspection? A number of requirements were made following the last inspection and only one of these had been fully met, that the residents personal needs are met with dignity that respects their privacy. Although there is evidence that some residents and relatives are involved in reviews of the care provided; a range of risk assessments are in place and an activity programme is being developed based on the residents preferences. What the care home could do better: Concerns were raised, and have been included in this report, with regard to the homes Statment of Purpose, the admission procedures, care plans, staff training and staffing levels. A number of requirements have been made. Key inspection report Care homes for older people Name: Address: The Polegate Nursing Home The Polegate Nursing Home Blackpath Road Polegate Eastbourne East Sussex BN26 5AP     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: Kathy Flynn     Date: 2 8 0 1 2 0 1 0 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 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Polegate Nursing Home The Polegate Nursing Home Blackpath Road Polegate Eastbourne East Sussex BN26 5AP 01323-485888 01323484011 meyersja@bupa.com www.bupacarehomes.co.uk BUPA Care Homes Ltd care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 44 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Polegate Nursing Home was purpose built in May 1996 and accommodates up to forty-four service users with continuing care needs under the Health Authoritys eligibility criteria. The home is registered to provide care for service users falling in to the category of older people and those with a physical disability. The home was purpose built to provide single bedrooms with ensuite facilities to heavily dependent service users with a need for continuity of care from hospital. The residents accommodation is on two floors; each of these floors is provided with a large lounge. Care Homes for Older People Page 4 of 26 Over 65 44 0 Brief description of the care home The lower floor has a dining room, which caters for all residents, and most group activities are held in this room. All areas of the home are assessable to service users, the corridors are wide enough to accommodate self-propelled / electric wheelchairs and the lifts are spacious. The rooms are spacious to allow room for hoists and other specialist equipment whilst maintaining a homely and comfortable environment. The decor of the home is pleasant, simple and well maintained and the furniture is of a good quality. There is a garden area with a patio that is accessible to service users in wheelchairs. There are suitable toilet, bathing and washing facilities provided to meet the needs of the service users, all with equipment designed for less abled persons. There are car-parking facilities to the rear of the property for approximately 25 cars. The home is in the centre of Polegate village, close to the shops, railway station and major bus routes. Copies of inspection reports and the homes Statement of Purpose are made available on request. The current fees can be obtained from the home, and these do not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Care Homes for Older People Page 5 of 26 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection was carried on the 22nd January and included a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 38 residents at the home during the inspection. 8 residents were involved in the inspection and two visitors to the home were happy to discuss the support provided. The deputy manager, nurses, care staff, cook on duty discussed the care and support they provide at the home. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at The Polegate will be referred to as residents. Care Homes for Older People Page 6 of 26 The Annual Quality Assurance Assessment (AQAA) was forwarded to the Commission since the inspection and would have been included in the report, but there is very little information about how the service is being developed. Advice should be sought to ensure that the AQAA reflects how the home will endeavour to meet the needs of its residents. Care Homes for Older People Page 7 of 26 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 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the services offered at the home is available in the Statement of Purpose, however it is not up to date and may not enable prospective residents to decide if the home can meet their needs. Evidence: The Statement of Purpose provides information about the support and services provided at The Polegate, and is available for prospective residents and their relatives. However it does not clearly identify the range of needs the home intends to meet, and should be updated to ensure people can use the Statement of Purpose as a guide to deciding if the home can meet their needs. Pre admission assessments are completed for all prospective residents to ensure that the home can meet their needs, with the involvement of the prospective residents and their representatives. A number of people admitted to the home have a dementia type Care Homes for Older People Page 10 of 26 Evidence: illness and there is no clear evidence that the home can meet all their needs, in particular their social and psychological needs. The home should ensure that they can offer appropriate support and care before they offer a place at the home. The residents spoken with at The Polegate said they or their relatives had chosen the home, some had visited the home to see if it would be appropriate, and all said their rooms were very nice and found the home comfortable. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system provides staff with information about the needs of the people living at the home. Policies and procedures are in place for medication to protect residents. Evidence: The Polegate is part of the BUPA group of homes and uses the Quest assessment and care planning system. Five care plans were viewed and found to contain information about the medical, nursing and care needs of the people living there, including risk assessments for Waterlow, moving and handling, falls and nutrition; a map of their life with details of their interests; a health and safety assessment of the residents own rooms, and there was evidence that some of the care plans are reviewed, with the involvement of the residents and/or their representatives. However the care plans did not clearly identify how the home meets the needs of people with a dementia type illness. Staff involved in the inspection were unable to provide clear examples of how they enable them to be as independent as they can be Care Homes for Older People Page 12 of 26 Evidence: and make choices, therefore there was no evidence that the home can meet their specific individual needs. The expectation is that the home only admits people whose needs they can meet, and action should be taken to ensure the staff working in the home have the skills and understanding to meet the needs of all the residents. A number of residents were transferred using wheelchairs, and it was noted that several did not have foot plates on when residents were moved from the dining room back to their rooms after lunch, this is not a safe practice and a requirement has been made. Staff said that one of the residents uses her feet to push herself around in her wheelchair, therefore footplates are inappropriate, however there was no risk assessment in the care plan to ensure her safety. A requirement was made at the last inspection for the inclusion in care plans for all relevant risk assessments. A daily record is also kept in the care plan and completed by the nurses, and it was noted that very little information is recorded, comments like had comfortable day, due medication given, pad and position changed regularly, and skin still intact do not reflect how the needs of the residents are met. Daily records, when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review, and to record that they are following the assessment of needs. Residents are registered with GPs and there are links to allied health professionals including dieticians, the speech and language team, opticians and chiropodists. Although it was difficult to see how the home can meet the health needs of people with learning difficulties and dementia. Policies and procedures are in place for the ordering, storage and administration of medication, and the medicine administration record charts viewed were completed appropriately. Staff were noted to treat residents with respect when asking them what they wanted to do, and providing personal care. Residents involved in the inspection said that the staff look after us very well, and they are happy with the care they receive. Care Homes for Older People Page 13 of 26 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. A range of activities are provided for residents who are able to participate in them, the food at the home is good, choices are offered at each meal and special dietary needs are met. Evidence: There is a programme of activities arranged for the people living in the home, and these include games and quizzes, as well as specific celebrations and external entertainers. The activity coordinator works two days as a carer and 22 hours organising and providing activities. She clearly enjoys the work and has planned a range of group activities for the next few months including a ferret race and a Hawk coming to the home for the weekend following the inspection. This is in addition to the activities listed in the BUPA activity book which include celebrations for Burns Day, St Georges and St Patricks day. During the inspection a group of residents played scrabble in the morning in the lounge and in the afternoon an entertainer provided a sing along session, with balloon Care Homes for Older People Page 14 of 26 Evidence: sculptures and a small rabbit for residents to stroke. However the shaft lift has not been working since November 2009, and this has had a direct affect on the homes ability to provide activities for residents on both floors of the home. Although the activity coordinators hours have increased during this time there were 38 people living in the home, and the care staff and nurses said they were very busy and did not have a lot of time to spend with the residents. It was noted that residents not taking part in the activiites were placed in the lounge in front of the TV, although it was not clear if they wanted to sit there, with one of the residents being given the call bell in case the staff were needed. Residents should not be expected to take responsibility for other residents needs, and if there are insufficient staff to offer appropriate support the staffing levels should be reviewed. See standard 27. Residents involved in the inspection said that they can join in activities if they want to, some of them are very good and their relatives join in as well, although some choose to spend their time in their own rooms watching TV. Although it was difficult to assess how the home provides activities for residents with a dementia type illness, the activity coordinator has identified their particular needs, and spends some time with them on a one to one basis or they join the group acitivities. Additional work is needed to ensure that all their needs are met. Visitors are welcome at any time and there are links with the local churches, with the PARCHE group, United Reform Church and Priests providing services and communion regularly. The food at the home is good, choices are offered and the cook said that they can really have anything they want. Specific dietary requirements are met, including staff assisting residents with their meals. Those involved in the inspection said that the food is tasty, and we can have what we want even if it is not on the menu. Visitors were equally positive saying that the meals are excellent, and they are able to join the residents for meals if they wish. Care Homes for Older People Page 15 of 26 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. Policies and procedures are in place to enable people to raise any concerns they may have, and training in adult protection is provided for staff to protect residents. Evidence: The homes complaints procedure is available to residents and visitors in the Statement of Purpose and is also on display in the entrance area. Residents involved in the inspection said that they would talk to the staff or the nurses if they had any concerns, or they would ask their relatives, although they also said that they didnt have any concerns. The home has an ongoing training programme that includes protecting vulnerable adults. Staff involved in the inspection said they have attended the training and were able to demonstrate an awareness of abuse and what action to take if they have any concerns. Care Homes for Older People Page 16 of 26 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. The Polegate provides a homely environment for those living there. Infection control training is provided for staff, however not all staff were following the homes procedures which may put residents at risk. Evidence: The home was purpose built with a lounge and dining room on each floor, and all the bedrooms have ensuite facilities. Residents are encouraged to bring their own small pieces of furniture, ornaments and pictures to personlise their rooms, and many have done this. The homes shaft lift, which had been broken down since November 2009 was being repaired during the inspection, allows residents and visitors to access all parts of the home. Hoists and other aids are available for staff to use to assist residents, and training in moving and handling is provided for all staff. Those spoken with said that they have all attended and felt they are able to use them safely. Training in the control of infection is provided for staff and the training matrix shows that staff have attended. However it was noted that staff were using gloves and Care Homes for Older People Page 17 of 26 Evidence: aprons safely. A requirement was made at the last inspection with regard to the appropriate use of gloves and aprons. Care Homes for Older People Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents, and the training programme enables staff to be are aware of their responsibilities. Evidence: The deputy manager advised that two members of staff were unavailable for work and they had only managed to cover one of the shifts, added to this was the additional work required due to the lift being out of order, which in effect may have left the home with insufficient staff. The staff were noted to be very busy, residents and visitors said that staff are very caring, but also very busy, and there were no systems in place to ensure that enough staff were working in the home. A requirement was made at the last inspection with regard to staffing levels being sufficient to meet the residents needs. Robust recruitment procedures are in place, three staff files were viewed and contained the relevant information including application forms, two references and Criminal Records Bureau and Protection of Vulnerable Adult checks. Staff spoken with said that they enjoy the work they do and feel they provide the care residents need. Visitors involved in the inspection said that the staff are very nice, they look after Care Homes for Older People Page 19 of 26 Evidence: the residents very well and are always very cheerful. The home provides an ongoing training programme that includes induction training for all new staff and there are opportunities for them to work toward National Vocations Qualifications NVQs. Staff involved in the inspection have attended mandatory training including fire training, safeguarding adults, infection control and moving and handling. As already identified although staff have attended infection control training they were not following the homes policies for the correct use of gloves and aprons. Concerns were also raised regarding staff training with regard to supporting people with dementia, staff advised that it was for one hour only, and said that it was quite limited. A requirement has been made with regard to the home providing the training staff need to meet the needs of the people living in the home. Care Homes for Older People Page 20 of 26 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 management ethos encourages the involvement of residents, relatives and visitors to be involved in the care provided at the home. Health and safety systems are in place to protect residents, however additional training is required in some areas. Evidence: The manager is a registered nurse with a management qualification and has been managing The Polegate for eight years. She is responsible for the day to day management of the home although she is also supporting a sister home in Eastbourne and is therefore spending time in each home. She was not available during the inspection, but the deputy manager was available and was able to provide the information requested. There are quality assurance systems in place, with regulation 26 visits monthly, and ongoing audits of the homes facilities including the care plans, catering, housekeeping and finances. BUPA is a large organisation with considerable support available for the Care Homes for Older People Page 21 of 26 Evidence: homes in the group, the concern is if audits are carried out effectively then the requirements made at the last inspection should have been met, and any other issues would have been identified as part of the day to day management of the home. Residents, relatives and visitors are encouraged to provide feedback about the services offered at the home. The deputy manager confirmed that questionnaires are sent out yearly with feedback from these used to plan any developments or changes to the care provided. The home does not take responsiblity for the residents finances, although some of their money is kept in the homes safe, and the deputy manager confirmed that records are kept of any transactions that is available to the residents and their representatives. The deputy manager advised that the health and safety of residents, visitors and staff are protected through the checking of the facilities including the fire system, hoists, the lift and the hot water. However the training programme should be reviewed and updated to ensure that the staff have the knowledge and skills to meet the assessed needs of the people living in the home. Care Homes for Older People Page 22 of 26 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 23 of 26 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 Risk assessments are to be completed and included in the care plans for all residents who are assessed as not requiring the use of footplates. To ensure a safe system for transporting residents in wheenchairs is used to protec residents. 08/03/2010 2 26 13 That the staff follow the homes procedures for the safe use of gloves and aprons. To ensure that residents and visitors are protected from infection. 29/03/2010 3 27 18 That systems are in place to ensure that the staffing number and skill mix are appropriate. 08/03/2010 Care Homes for Older People Page 24 of 26 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 To ensure that the home meets the individual needs of the people living in the home. 4 30 18 That appropriate training is provided to ensure that the staff can meet the specific needs of the people living in the home. To ensure that the needs of all residents. including those with a dementia type illness receive appropriate support. 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 29/03/2010 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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