Care Home: The Retreat, Plymouth

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What the care home does well The Retreat is a clean, warm and comfortable home where people feel welcomed by staff who are said to be caring, polite, kind, helpful and friendly. People who live in the home feel safe, respected, well cared for and happy. They said they have no complaints and one person said "It`s like a five star hotel here, couldn`t wish for a better place". The home is well maintained, with a large and spacious garden that people use whenever the weather is pleasant enough to walk and sit outside. People are enabled to maintain contact with family and friends, exercising as much choice and control over their lives as possible. People living in the home are actively encouraged to participate in choosing the menu, therefore they enjoy the meals because they have chosen what they want. People can eat their meals at whatever time they like and wherever they like within the home. People`s laundry is washed and ironed to a good standard and is returned quickly. There is a range of activities available for people to participate in if they wish to, including frequent trips out to local places of interest. Staff enjoy working in the home, which is reflected in the low turnover of staff, and this contributes greatly to the provision of continuous and consistent care. Staff feel very well supported by the manager and they have various training opportunities available to them. All the staff have the skills and knowledge to provide good quality care to the people who live there and approximaely half of them have achieved formal qualifications in health and social care. Staff files were very well organised and information was easy to find. What has improved since the last inspection? Medication practices have improved in that there was a sufficient supply of prescribed medicines in the home and the records were clear, up to date and accurately completed. Staff have regular one to one meetings with their line manager and staff meetings are also held. Staff have found out the best way to communicate with people with sensory impairments and have put their findings into practice, for example, using a notepad and pen to write things down. Many bedrooms and communal rooms have been redecorated. Bathrooms and bedrooms have disposable hand towels and soap dispensers to reduce the risk of any infection being spread around the home. Two more single bedrooms have been created, both with en suite wet rooms (level access showers) and toilets, which gives people more choice about which bedroom to live in. What the care home could do better: Whilst each person in the home did have a plan of care saying how their needs should be met, these could be improved by being more person-centred to include more information about, for example, their previous lifestyles and histories. Staff were well aware of people`s changing needs because they were documented in each person`s daily records. However it would also be useful to update people`s care and support plans immediately when their needs change. All the staff in the home were expected to attend training about safeguardingvulnerable adults from harm but they should also attend the training provided by the Local Authority. This is to make sure that all staff are aware of the local procedures to follow should an incident of abuse or neglect be suspected or occur. It would also be useful if a system was put into place to provide an overall view of which staff have completed training in fire safety awareness. This is to make sure that no staff are inadvertently missed out and that all staff receive regular updates. Whilst there were no serious health and safety concerns identified during thiis inspection, there were some potential risk areas that need to be addressed. These included keeping the laundry door shut because it is a fire door and locking all hazardous substances away to make sure that the people living in the home do not imbibe them by mistake. Also the Registered Manager should check to make sure that any remedial action needed after the electrical systems were tested in October 2006 has been completed and that the electrical wiring in the home is safe. The environment was maintained extremely well and was very comfortable but could be improved by the addition of coverings over windows that look into bathrooms and the fitting of appropriate locks to all bathroom and toilet doors. This is to ensure that people`s privacy is protected at all times. The home has a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the services and facilities in the home. Also, the results of surveys from people who live in the home should be published and made available to anyone who would like a copy. This is so that interested individuals and agencies can see that the home is being run in the best interests of the people who live there. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Retreat, Plymouth Belle Vue Road Hooe Plymouth Devon PL9 9NR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Antonia Reynolds     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Retreat, Plymouth Belle Vue Road Hooe Plymouth Devon PL9 9NR 01752204044 01752313074 enquiries@retreatcare.com 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) : Sunshine Care Limited care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 20 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Retreat has been a care home for many years and provides personal care and accommodation for a maximum of twenty people, usually over the age of 65. It is privately owned by Sunshine Care Limited. The home does not offer care to people diagnosed with dementia or those whose physical mobility is significantly impaired. The home consists of a large period house set in its own grounds on the outskirts of the village of Hooe near Plymouth. It is fairly close to local shops and to bus services into central Plymouth and the railway station. The home has a minibus for the use of the people who live there. The home has eighteen single bedrooms and one double room, which are located on all three floors. Eleven of the bedrooms have en suite toilets and Care Homes for Older People Page 4 of 32 Brief description of the care home two of them also have en suite wet rooms (level access showers). There are stair lifts to the 1st and 2nd floors although there are a few steps to some bedrooms. The lounge and dining rooms are on the ground floor. The gardens are well designed and spacious with seating for people to use when they go outside. Parking space is available inside the grounds. In May 2009 the fee levels ranged from approximately 345 pounds to 475 pounds per week depending on peoples needs and the room they occupy. Information about the home and copies of inspection reports can be obtained from the Registered Manager, Paul Constantine. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: This inspection consisted of an unannounced visit to the home by one inspector between 9.30am and 5.15pm on Monday, 18th May 2009. The inspector was accompanied by an Expert by Experience. We last inspected this service on the 29th May 2007. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission. An Annual Quality Assurance Assessment (AQAA) was completed by the home prior to the inspection. The AQAA is a selfassessment that focusses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. Care Homes for Older People Page 6 of 32 Ten people living in the home were spoken with during the visit and four surveys were returned from them. Two visitors were spoken with and three surveys were received from relatives. Three staff members were spoken with and six surveys were received from staff. One survey was received from a healthcare professional. The Registered Manager was available for consultation and discussion during the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Whilst each person in the home did have a plan of care saying how their needs should be met, these could be improved by being more person-centred to include more information about, for example, their previous lifestyles and histories. Staff were well aware of peoples changing needs because they were documented in each persons daily records. However it would also be useful to update peoples care and support plans immediately when their needs change. All the staff in the home were expected to attend training about safeguarding Care Homes for Older People Page 8 of 32 vulnerable adults from harm but they should also attend the training provided by the Local Authority. This is to make sure that all staff are aware of the local procedures to follow should an incident of abuse or neglect be suspected or occur. It would also be useful if a system was put into place to provide an overall view of which staff have completed training in fire safety awareness. This is to make sure that no staff are inadvertently missed out and that all staff receive regular updates. Whilst there were no serious health and safety concerns identified during thiis inspection, there were some potential risk areas that need to be addressed. These included keeping the laundry door shut because it is a fire door and locking all hazardous substances away to make sure that the people living in the home do not imbibe them by mistake. Also the Registered Manager should check to make sure that any remedial action needed after the electrical systems were tested in October 2006 has been completed and that the electrical wiring in the home is safe. The environment was maintained extremely well and was very comfortable but could be improved by the addition of coverings over windows that look into bathrooms and the fitting of appropriate locks to all bathroom and toilet doors. This is to ensure that peoples privacy is protected at all times. The home has a quality assurance system in place that asks for feedback from the people who live in the home and relatives or representatives. This system would be more comprehensive if it included an annual internal audit of the services and facilities in the home. Also, the results of surveys from people who live in the home should be published and made available to anyone who would like a copy. This is so that interested individuals and agencies can see that the home is being run in the best interests of the people who live there. 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 set out 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission processes are in place to ensure that peoples needs are properly identified and planned for before they move into the home. Evidence: Information in surveys from people who live in the home confirmed that they were given information about the home, and had opportunities to visit, before they moved in. The Registered Manager said that, before people come to live in the home, a thorough initial assessment of their physical, psychological and social care needs is carried out to decide whether the home can meet them. The files of three people who had recently been admitted to the home were inspected and these contained preadmission assessments of their needs. However the information on one file was very brief but the Registered Manager said this was an anomaly, as it was completed by a staff member who does not usually do them, and he would ensure this did not happen again. Surveys from staff members confirmed that they have enough information Care Homes for Older People Page 11 of 32 Evidence: about peoples needs to provide the care required. The admission process includes visits to the home to meet the other people who live there and staff, so that people have a chance to assess the quality, facilities and suitability of the home. The Retreat does not provide intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are treated with respect and personal support is offered in a way that makes people feel safe, well cared for and promotes their privacy and dignity. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: Those people able to comment, as well as surveys from people who live in the home and their relatives, confirmed that the staff provide personal care in a respectful way that preserves peoples privacy and dignity at all times. Everyone spoken with praised the attention they receive from the staff. Staff were observed knocking on bedroom doors before entering and people said that the staff always make sure bedroom, bathroom and toilet doors are closed when they need assistance with personal care. Discussions with people living in the home, as well as the manager, confirmed that people can have their own telephone in their bedrooms, at their own expense, if they wish to. However the home has a telephone system with portable handsets and people can use this to make and receive private telephone calls. Comments included: I am Care Homes for Older People Page 13 of 32 Evidence: being well looked after and could not ask for more; we are so well looked after here; the staff look after my mothers care and all her needs and its like a five star hotel here, couldnt wish for a better place. People who were able to comment, feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, district nurses, dentists, chiropodists, opticians and hospital consultants. Surveys from people who live in the home, as well as from relatives, showed that the care people receive from the staff team is excellent. Equipment to promote peoples health and well being was provided including equipment for promoting pressure area care and to prevent skin breakdown. Surveys from staff said that they look after people very well and their job is to promote physical and emotional well being for all clients and they are always aware of peoples individual needs. Information in a survey from a healthcare professional said that the staff respond quickly to the health care needs of the service users. The files of three people who lived in the home were inspected and these contained individual care plans with information on care needs and how staff at the home would meet those needs. Peoples files contained the names and addresses of their relatives and representatives so that staff knew who to contact should they need to. Each file contained recently reviewed and updated risk assessments relating to falls, skin/pressure area care, moving and handling and nutrition. However the care planning documentation was not always being updated as soon as someones needs changed although this information was recorded in daily records so staff were aware of the changes. Also care plans contained limited information about peoples social and personal histories, previous lifestyles, interests and routines, information about how their finances were managed or future wishes and aspirations. However the manager said that this was being addressed and they have also asked relatives to participate in gathering this information together. Medication was stored securely and most of it was administered from blister packs prepared by a local pharmacist. Records relating to the administration of medication were up-to-date and there was an accurate audit trail of medication in and out of the home. The medication administration records are checked by the senior staff member on duty after each medicine round to make sure that all medicines have been given as prescribed and the records have been completed properly. The manager confirmed that staff who were responsible for administering medication have received training from the local pharmacist ensuring they are competent and confident to administer medication in a safe way. Some people managed their own medicines and this practice had been assessed for each person to make sure this was safe. The local pharmacist visits the home regularly to check medication practices and stocks of medicines were Care Homes for Older People Page 14 of 32 Evidence: not being kept unnecessarily. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines in the home are relaxed and relatives and friends can be confident that they are welcomed. Social activities are arranged including the opportunity for frequent trips outside the home. The dietary needs of the people who live in the home are very well catered for with a balanced and varied selection of food that reflects their tastes and choices. Evidence: Discussions with the people who live in the home and staff, as well as information on noticeboards, showed that a wide range of activities is available. This included trips out twice a week in a minibus to local vantage points or places of interest where lunch is usually available for both the people who live in the home and staff. Some trips are planned in advance but others are very much ad hoc depending on the weather. On the Friday before this inspection, five people had gone out to the cafe at Jennycliff for a pasty lunch. People spoke about these outings with pleasure and liked the fact that there were at least two opportunities every week to go on trips out. The manager said that the staff organise fund raising events such as fetes and raffles and the money raised is used to pay for trips out, including meals and drinks. Activities include entertainers, singers, craft work and prize bingo which people said was very popular. Care Homes for Older People Page 16 of 32 Evidence: One person attended the nearby Age Concern Day Centre on a weekly basis travelling in a taxi. All the people in the home enjoyed a pre-Christmas lunch at the same centre. Last summer a Garden Fete was held to fund trips out and new games. A group from a local chapel visit regularly for a religious service and we were told by staff that about twelve people attend this. The manager also confirmed that people would be enabled to attend a local church or other place of worship if they wished to go. Staff said that they assist people with sensory impairments to join in all the activities if they wish to participate. Discussions with people living in the home, as well as the manager, confirmed that there is a choice of two main meals at lunchtime with a wider variety being available at teatime. The manager said that, every Saturday, a staff member talks to all the people who live in the home and asks them to choose what they would like on the menu for the week commencing the following Tuesday. Everyone has an opportunity to participate and people discuss and come to agreements about what they would like to eat. Once the menu has been agreed staff at the home make sure that all the ingredients are available. Each morning the staff remind people what is on the menu that day and ask them what they would like for lunch and tea. Alternatives are available if the menu choice is not to someones liking. People were generally complimentary about the food saying, I get on very well with the food, More than enough to eat, Good variety, Ive eaten things here Ive never had at home and enjoyed them, Food wonderful, and Lovely food. The main meal on the day of the inspection was a choice of chicken curry or ham, chips and peas. People seemed to enjoy the food with the exception of the peas most of which were left. People could also have a sandwich or salad of their choice if they preferred this. Dessert was ice cream with an option of cream from an aerosol can. There was fresh fruit available on every table in the dining room and people living in the home could help themselves to what they wanted. No one required assistance with eating on the day of the visit. Special diets, such as diabetic, were catered for, vegetarian options were available, and dietary needs were documented in peoples personal files. The manager and deputy manager were clear that, if a person needed a soft diet or their food liquidised, the individual items would be placed separately on the plate and it was evident that they understood the need for food to look appealing to people and for them to be able to differentiate between the food items on the plate. Family and friends were observed visiting the home and it was evident that they were actively welcomed into the home and may visit whenever they liked. People who lived in the home said that visitors were always offered hot drinks and biscuits and could stay for a meal if they wished to. A staff member commented that the home is very relaxed and sociable. A healthcare professional commented that The Retreat has a very homely feel to it and is a pleasure to visit. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that any complaints or concerns will be listened to and acted upon by the home. Evidence: The homes written complaints procedure was displayed in the hallway as well as a copy being given to each person who lives in the home. Surveys from people who lived in the home and their relatives confirmed that they know how, and to whom, to make a complaint should they need to. People living in the home, who were able to comment, said they would talk to the staff on duty if they had any concerns, and this was observed during the inspection. One person, in a survey, said If we are worried about anything they will sort it out quickly. All the surveys we received from the people in the home and their relatives confirmed that they have no complaints about the home. The home keeps a complaints file where all concerns and complaints are recorded as well as the details of any investigation and actions required. The Commission for Social Care Inspection received information from an anonymous source in September 2008 raising concerns about the home. This was sent to the Registered Manager who investigated the concerns thoroughly and put an action plan in place to ensure the issues did not arise again, thereby demonstrating a positive attitude to addressing any concerns and complaints. The home has a visitors book to record dates, times and names of all visitors to the home. Care Homes for Older People Page 19 of 32 Evidence: There was a policy and procedure in the home for staff to follow regarding the protection of vulnerable adults. Staff training records showed that all staff were expected to complete in-house training related to the safeguarding of vulnerable adults although they had not all attended the training provided by the Local Authority. This training is useful to ensure that all staff are aware of the local procedures to follow should an incident of abuse or neglect be suspected or alleged. Discussions with the manager and staff team confirmed that they were knowledgeable about the local processes in place to safeguard vulnerable people. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. High standards of comfort, cleanliness and safety are provided for people living in the home who also have unrestricted access to extensive, attractive and well maintained gardens. Evidence: We looked all round the home and found it was warm, comfortable, clean and free from offensive odours. The shared rooms consist of two connected lounge rooms, which have a variety of seating for people to use, and a dining room, as well as a large hallway. The home is surrounded by well maintained and extensive gardens that people walk around and sit in when the weather is fine. A staff member commented that we encourage people to take advantage of the beautiful gardens and seating. The bedrooms are located on each floor and several of them have en suite toilets, whilst two also have level access showers. There are stair lifts to assist people with mobility difficulties. However there are also steps to some of the bedrooms so the manager has to ensure that people who use those rooms can manage a few stairs with staff support if necessary. Bedrooms were well decorated and contained many personal possessions. The manager confirmed that most people have keys to their own bedroom doors and the staff have a master key so they can gain access in an emergency. Toilets are conveniently situated for those without en suite facilities and near the lounge and dining rooms. Bathrooms include assisted baths and contain other Care Homes for Older People Page 21 of 32 Evidence: useful equipment such as raised toilet seats and frames. Other aids and adaptations to aid mobility and independence were seen around the home such as grab rails. We noticed that the bathroom opposite the lounge room had a translucent window in the door that did not have a covering to prevent people seeing in and the window did not have a covering either. One of the toilet doors had a lock fitted that could not be opened from the outside in an emergency and a bathroom on the top floor did not have a lock on the door. Radiators have been guarded to reduce the risk of people being burnt. The manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people are not scalded, are installed on all the baths. People living in the home commented on the cleanliness and one person said The cleaner is a marvel, very thorough and such a quiet worker. Further enquiry revealed that the cleaner tries to undertake noisy duties, such as vacuuming bedrooms, when the occupier is elsewhere. Information from a healthcare professional said that the home is kept exceptionally clean and hazard free. Laundry facilities were good and arrangements for controlling the spread of infection were seen including gloves and aprons being available for staff to use. There were covered systems in place for transferring soiled and potentially infected linens between bedrooms and the laundry. Whilst no-one specifically mentioned the quality of the laundry service, people were observed dressed in clean, ironed clothes. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of caring, well trained, staff support the people who live in the home. Robust recruitment practices protect the people who live in the home from risk of harm. Evidence: Information contained in staffing rotas, as well as discussion with the manager, showed that there were usually four care staff on duty in the mornings and three care staff in the afternoons and early evening. They were supported by catering, domestic and maintenance staff. A member of the staff team was also designated to organise activities each day. At night there were two staff members on duty - one waking and one sleeping in. The Registered Manager was on call if needed. Surveys returned from four people who lived in the home and six staff members said that there were always enough staff in the home to meet the needs of the people who lived there. The people we spoke to during the visit also said that there were enough staff on duty although there were times when they were very busy. We did not see any staff spending time talking with the people who lived in the home during our visit because they were busy doing other tasks. People said that the call bell respone time varied from a couple of minutes to ten minutes but this was quicker at night. Several people mentioned that, if they were awake in the night, the staff would bring them a cup of tea. Care Homes for Older People Page 23 of 32 Evidence: People who lived in the home and their relatives, as well as information in surveys, indicated that the staff were respectful, polite and caring. A relative commented that the staff always have time for my mother. We observed that the staff behaved very professionally at all times, with good humour and sensible banter. They displayed a very caring attitude towards the people who lived in the home. Information from a healthcare professional said that the staff are always approachable and friendly. We examined the personal files of three recently recruited staff members which were very well organised and information was easy to find. These showed that the required checks and references were obtained before people started working in the home. The manager said that, occasionally, new staff may start working in the home before a full check is received from the Criminal Records Bureau but they are always supervised until a satisfactory check is received. The manager confirmed that all new staff are expected to complete a four day structured induction programme before they start working in the home. Discussions with staff members, as well as information contained in surveys, confirmed that the induction training was comprehensive and covered everything they needed to know to do their job. Staff spoken to said they worked well as a team and that The Retreat was a good place to work. In particular they praised the training available to them and the support they receive, from both peers and management, to do their job. One staff member commented that the induction training is very good and we then have updates on all our training demonstrating a management commitment to ongoing training for staff. Information in the AQAA and discussion with the manager confirmed that four of the ten staff in the home have obtained qualifications in caring for older people, namely National Vocational Qualifications (NVQ) at level 2 or above, and three people were in the process of obtaining a level 2 NVQ. In addition staff were expected to complete training in moving and handling, emergency first aid, health and safety, food hygiene, infection control and safeguarding vulnerable adults. These records also showed that staff had opportunities to participate in more specialised training such as the administration of medication, palliative care, working with people with dementia and pressure area care. The manager and deputy manager had also attended training about the Mental Capacity Act and deprivation of liberty safeguards so were up to date on recent changes in social care legislation. Surveys from six staff members confirmed that they have good training opportunities and considered that they have enough training to do their jobs well. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that it is well managed and run in the best interests of the people who live there. The health, safety and welfare of the people living in the home are promoted and protected. Evidence: The Registered Manager, Mr Constantine, has been managing The Retreat for several years and is supported by a manager and deputy manager who are responsible for most of the day-to-day running of the home. Mr Constantine holds qualifications in project management and has completed a care and management course, namely the Registered Managers Award. The management team operate an open door policy and feedback from people who lived in the home, their relatives, staff and a healthcare professional indicated that they are very supportive and always available to discuss any issues or concerns. A relative commented that The Retreat is a very friendly, welcoming place. Care Homes for Older People Page 26 of 32 Evidence: Discussion with the manager, as well as documentation and surveys from staff, showed that the staff have regular staff meetings and 1:1 supervision meetings with their line manager, at least six times a year. These also include observation of staff providing personal care to make sure they are doing it properly and in accordance with the persons wishes. Training records showed that care staff were expected to complete training in emergency first aid, food safety/hygiene, moving and handling, infection control and health and safety. Discussion with the manager, as well as documentation, confirmed that the financial affairs of the people who lived in the home were managed by themselves, their families or representatives. The home did administer spending money on behalf of some people who lived in the home and records relating to the money of three people were checked and found to be correct. The fire safety equipment records showed that checks and tests of the fire safety equipment are carried out regularly and a local contractor services the fire alarm system and fire extinguishers at least annually. Information contained in the staff training records showed that staff have received training in fire safety awareness and/or attended a fire drill. The manager said that newly appointed staff receive training in fire safety procedures on the first day of employment as part of the induction process. However there was no system in place that provided an overall view of which staff had received fire safety training and which staff needed to update it. The manager said that all the radiators were guarded to reduce the risk of people being burnt and all radiators seen during the inspection were guarded. The manager confirmed that thermostatic valves, to reduce the temperature of hot water so that people are not scalded, were installed on all the baths. The manager also confirmed that procedures were in place to reduce the risk of legionella occurring. The home had an electrical wiring certificate dated 2nd October 2006 that said the testing had been unsatisfactory. However no documentation could be found to show that remedial action had been taken. Documentation showed that all portable electrical appliances in the home had been checked for safety in January 2009. Servicing records showed that the hoists and stair lifts had been serviced recently. The home had a quality assurance system in place and questionnaires were distributed to people living in the home on a regular basis to ask them for feedback on the quality of care they received. The results were collated and any points for improvement noted and acted upon. However the process did not include an annual internal audit of the services and facilities in the home and, if this had taken place, may have identified the issues raised in this report. Care Homes for Older People Page 27 of 32 Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be updated as soon as care needs change so that staff know what to do to meet those needs in a consistent way. They should also contain more detailed information about peoples social and personal histories, their previous lifestyles, interests and routines and future wishes and aspirations, as well as arrangements about how their finances are managed and by whom. This is to provide a more person-centred approach to care planning so that staff know more about the people they are caring for. All staff should attend the safeguarding vulnerable adults training provided by the Local Authority. This is to make sure that all staff are aware of the local procedures to follow should an incident of abuse or neglect be suspected or occur. All the toilet and bathroom doors should have locks fitted that can be opened by staff from the outside in an emergency. Coverings should be provided for the door and window of the bathroom opposite the lounge room. This is to ensure that peoples privacy is protected at all times. The quality assurance system should be developed to include an annual internal audit of the services and facilities Page 30 of 32 2 18 3 21 4 21 5 33 Care Homes for Older People in the home. The results of surveys from people who live in the home should be published and made available to anyone who would like a copy. This is so that interested individuals and agencies can see that the home is being run in the best interests of the people who live there. 6 38 The Registered Manager should check to make sure that any remedial action needed after the electrical systems were tested in October 2006 has been completed and that the electrical wiring in the home is safe. A system should be put into place to provide an overall view of which staff have completed training in fire safety awareness. This is to make sure that no staff are inadvertently missed out and that all staff receive regular updates. 7 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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