Care Home: The Rosary Nursing Home

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What the care home does well We received positive feedback from people who live in the home about the kindness of staff. People wrote " I can only say I am thankful to the home for the care I get." "They look after you well." Other people wrote "All staff are friendly and caring." "They allow me to be independent and do my own thing." A relative wrote " The staff at the rosary look after my mother extremely well they seem very caring towards her. The food looks good and the comfort is lovely." Another relative wrote " I am happy my husband is being so well looked after and the staff do everything they can for us. The food is excellent and he enjoys the musical entertainment." People we spoke to during the inspection said they were well looked after. People we saw looked clean and comfortable. We received positive comments from staff who returned surveys to us and from those we spoke to during the inspection. The home is very clean. The domestic staff work well to maintain the home to a high standard. Surveys confirmed that the home is always fresh and clean. Menus are nutritious and there is evidence that choices are offered and promoted. We saw good practise in the Snowdrop unit where people are offered choice at the table. The home and Sanctuary Care have responded promptly and effectively to the issues raised at the last inspection. The company has made additional resources available to the home and additional staff have been appointed. The company has also supported the home through the Quality Assurance team enabling assessment and training to take place in the home. The home environment is now completed and furnished to a high standard. What has improved since the last inspection? The building of Snowdrop House and the substantial refurbishment of Primrose House inevitably caused some disruption to the people who live in the home and the staff caring for them. Four months on from the last inspection the home has "settled down" again and managers and staff have focused on the systems and procedures that required review and action. The home produced a detailed action plan in response to the last inspection. The home has clearly identified three operational units, two in Primrose House and currently one in Snowdrop. Each is the responsibility of a Senior Nurse/Head of Unit. Staff are now allocated to each suite with a team of Named Nurses to oversee and supervise practise.We spoke with one nurse who told us that the staff were settling into this way of working staff liked having their designated floors this arrangement had made things better for people who live in the home. People who lived in the home told us that knew who was going to be on duty and looked forward to seeing their staff. Carers got to know people needs really well. The deputy is now available two days a week to support and supervise staff. A dependency tool has been developed and introduced to which identifies the staffing levels required to meet the needs of the people who live in the home. All people currently living in the home have been assessed using the tool to assess existing staffing levels in the home. Additional nursing and care staff have been recruited. Additional hours have been given to the units. All care plans of people living in the home have been audited by nurses allocated to particular people (Named Nurses). They have reviewed the care plans and addressed any identified shortfalls. The deputy manager and senior registered nurses are auditing care plans and undertake weekly audits. Staff have received further training in the completion and use of care plans The Handover format has been changed. Registered nurses give handover directly to all staff on duty to ensure consistency Registered nurses are responsible for checking fluid balance charts and nutritional intake charts and passing on relevant information to the next shift. We saw evidence of good record keeping. Wound management training has been undertaken for all registered nurses with the Tissue Viability Nurse. We saw wound care records in care plans were appropriate and conformed to best practise. A camera and printer is available at all times to monitor wounds according to policy. The home has reviewed and improved the way in which people at risk of pressure damage are assessed and cared for. We saw clear care plans and evidence that people have their position moved regularly. There is a weekly completion of an audit of pressure damage by registered nurses. The nurses pass this information to senior managers for review. We saw records of the pressure damage audits and evidence of prevention in the home. Senior nurses have twelve hours a week supernumerary time to maintain administration and records and review wound care The home is planning to identify a wound care champion to undertake additional training with the tissue viability nurse All care plans reviewed contained evidence of appropriate assessment and review. The home has reviewed and improved the way in which it assesses and manages those people who are losing weight. We saw that the policies and procedures resulted in food and fluids being recorded. The senior nurses understood their responsibility for checking charts. Communication with the kitchen has improved with the use of the residents dietary notification form which registered nurses will complete for all people who live in the home on admission and when unplanned weight loss occurs. The new dining room in Primrose has been completed. As a result of this there is an additional space that can be used for activities. The main sitting room in Primrose has been completed with pictures and curtains resulting in a very comfortable area. A full time activities leader has been appointed. There are activities programmes in place for both Snowdrop and Primrose. In Snowdrop there is evidence that staff are understanding the needs of people with dementia. There are things for people to look at and touch. People are offered a choice of meals at the table instead of displaying menus that may not be understood. What the care home could do better: At this inspection we saw systems and ways of working that are new. The home assured us that improvements can be maintained. Most people are satisfied with the food. A few people were not happy with the presentation of some meals. The home has invested in additional staff and is monitoring staffing levels. A small but significant number of surveys from people who live in the home and from relatives and staff said that the home still needed more staff. Key inspection report Care homes for older people Name: Address: The Rosary Nursing Home Mayfield Drive Durleigh Bridgwater Somerset TA6 7JQ     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: Shelagh Laver     Date: 2 0 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 30 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 30 Information about the care home Name of care home: Address: The Rosary Nursing Home Mayfield Drive Durleigh Bridgwater Somerset TA6 7JQ 01278431164 01278446739 ltaly(rosarycarehome)@sanctuaryhousing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Care Ltd care home 103 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 103. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (Code OP) - maximum of 63 places Dementia (Code DE) maximum of 40 places Date of last inspection Brief description of the care home The Rosary Nursing Home is located on the outskirts of Bridgwater. It is owned by Sanctuary Care Ltd. It was purpose built in 1994 as a Nursing Home. The home was initially registered as a Care Home with Nursing , to accommodate up to a total of 63 persons. There were sixty-one single bedrooms and one double bedroom. One bed provides regular respite care. All, except three bedrooms, have an en suite facility, Care Homes for Older People Page 4 of 30 Over 65 0 63 40 0 2 8 0 9 2 0 0 9 Brief description of the care home which includes a wash hand basin and toilet, two of these rooms have a shared facility and one a bathroom is adjacent to the bedroom. The home is fully equippped to provide nursing care and is now known as Primrose House. In 2009 a new 40 bed building Snowdrop House was completed. This service has been designed and built to the highest standards and provides care for people with dementia. There are spacious en-suite rooms, attractive communal areas and an enclosed garden. There are a full range of health and safety measures and the whole home is fully adapted to meet the needs of the people who live there. There is a high standard of decoration and furnishing throughout the home. All bedrooms are fitted with telephone sockets. There are Registered Nurses on duty at all times. The current fee range is £630.00 to £720.00 This does not include toiletries, chiropody and newspapers Care Homes for Older People Page 5 of 30 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: We last inspected the home on the 24th and 28th September 2009. Before we visited the home on this occasion we had received the Annual Quality Assurance Assessment . This was completed by the manager and gives us information about the achievements and challenges experienced by the home in the previous year. the AQAA had been completed in depth and gave us a great deal of information about the home. Following this inspection of September 2009 we found that there were key areas of the provision that needed urgent action and attention. We received a comprehensive action plan from the home and at this Key Inspection we were able to see the extent to which the plans had been implemented. Two inspectors visited the home for one day. We were able to meet with the manager Lyn Taylor and some of the nursing and care staff. We were also able to meet the Care Homes for Older People Page 6 of 30 Regional Manager Keren Wilkinson and members of the company Quality Assurance team. We made a tour of both Primrose House which was the existing Rosary Nursing Home for 63 people and of Snowdrop House which is the newly completed building for the care of people with dementia. We talked to people who lived in the home, their relatives as they were visiting and to staff that we met in the home. We asked for surveys to be sent to people who lived in the home and to staff. We received feedback from some of the health professionals who go into the home and were told that they were satisfied with care observed. We looked at documentation relating to the care of people in the home. We looked at records of newly appointed and established staff. We found at this inspection that the home had taken steps to implement the action plan that we had received following the last inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The building of Snowdrop House and the substantial refurbishment of Primrose House inevitably caused some disruption to the people who live in the home and the staff caring for them. Four months on from the last inspection the home has settled down again and managers and staff have focused on the systems and procedures that required review and action. The home produced a detailed action plan in response to the last inspection. The home has clearly identified three operational units, two in Primrose House and currently one in Snowdrop. Each is the responsibility of a Senior Nurse/Head of Unit. Staff are now allocated to each suite with a team of Named Nurses to oversee and supervise practise. Care Homes for Older People Page 8 of 30 We spoke with one nurse who told us that the staff were settling into this way of working staff liked having their designated floors this arrangement had made things better for people who live in the home. People who lived in the home told us that knew who was going to be on duty and looked forward to seeing their staff. Carers got to know people needs really well. The deputy is now available two days a week to support and supervise staff. A dependency tool has been developed and introduced to which identifies the staffing levels required to meet the needs of the people who live in the home. All people currently living in the home have been assessed using the tool to assess existing staffing levels in the home. Additional nursing and care staff have been recruited. Additional hours have been given to the units. All care plans of people living in the home have been audited by nurses allocated to particular people (Named Nurses). They have reviewed the care plans and addressed any identified shortfalls. The deputy manager and senior registered nurses are auditing care plans and undertake weekly audits. Staff have received further training in the completion and use of care plans The Handover format has been changed. Registered nurses give handover directly to all staff on duty to ensure consistency Registered nurses are responsible for checking fluid balance charts and nutritional intake charts and passing on relevant information to the next shift. We saw evidence of good record keeping. Wound management training has been undertaken for all registered nurses with the Tissue Viability Nurse. We saw wound care records in care plans were appropriate and conformed to best practise. A camera and printer is available at all times to monitor wounds according to policy. The home has reviewed and improved the way in which people at risk of pressure damage are assessed and cared for. We saw clear care plans and evidence that people have their position moved regularly. There is a weekly completion of an audit of pressure damage by registered nurses. The nurses pass this information to senior managers for review. We saw records of the pressure damage audits and evidence of prevention in the home. Senior nurses have twelve hours a week supernumerary time to maintain administration and records and review wound care The home is planning to identify a wound care champion to undertake additional training with the tissue viability nurse All care plans reviewed contained evidence of appropriate assessment and review. The home has reviewed and improved the way in which it assesses and manages those Care Homes for Older People Page 9 of 30 people who are losing weight. We saw that the policies and procedures resulted in food and fluids being recorded. The senior nurses understood their responsibility for checking charts. Communication with the kitchen has improved with the use of the residents dietary notification form which registered nurses will complete for all people who live in the home on admission and when unplanned weight loss occurs. The new dining room in Primrose has been completed. As a result of this there is an additional space that can be used for activities. The main sitting room in Primrose has been completed with pictures and curtains resulting in a very comfortable area. A full time activities leader has been appointed. There are activities programmes in place for both Snowdrop and Primrose. In Snowdrop there is evidence that staff are understanding the needs of people with dementia. There are things for people to look at and touch. People are offered a choice of meals at the table instead of displaying menus that may not be understood. 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 10 of 30 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 11 of 30 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. There is a range of information available to people before they come to the home. The home has a system of pre-admission assessment in place that includes visits from trained nurses. Evidence: We saw a range of information available for people who wished to come and live at The Rosary. Brochures have been up-dated to reflect the range of services now offered by the home. The home has an established record of completing pre-admission assessments before people come to the home. People are visited by trained staff at home or in hospital and information from the Standard Assessment Process (SAP) and hospital discharge information is used to begin completing the care plans. Care Homes for Older People Page 12 of 30 Evidence: As part of the assessment process before coming to the home all new residents are now assessed using a dependency tool introduced since the last inspection. This identifies the staffing levels required to meet peoples needs. All the care plans that we sampled contained completed pre-admission assessments. We saw assessments completed by the nurse in charge of Snowdrop unit that were appropriate and used a range of information. We saw that assessments included information about the person being assessed and the aspects of care that were important to them. On admission a range of base line information and observations are made as part of the basis for the care plan. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were very satisfied with the care they received in the home. There is evidence that nursing and personal care have been improved and that systems have been introduced to maintain this improvement. The assessment, planning and monitoring of key aspects of nursing and care were seen to be in place. Evidence: We asked people in our surveys if they received the care and support they needed. We received 14 surveys. People said that they always or usually received the care and support they needed. They said that were listened to by staff. All people who returned a card said that the home made sure they had the medical care they needed. Since the last inspection all the care plans of people living in the home have been audited by the company Quality team. Nurses have reviewed the care plans and addressed any identified shortfalls. The home tells us that the deputy manager and senior registered nurses will monitor care plans and undertake weekly audits. We saw that some audits had occurred when we looked at plans. Care Homes for Older People Page 14 of 30 Evidence: Additional training has been delivered on the use and completion of the care plans to all staff. We saw evidence of appropriate wound management and recording in two care plans we reviewed at this inspection. There were clear records of the wounds and care plans that identified the type and frequency of dressing required. All registered nurses have received additional wound management training with the tissue viability nurse and an up-date on using the Wound Formulary which gives clear practise guidance. The home is planning to identify a wound care champion to undertake additional training with the tissue viability nurse A camera and printer is available at all times to monitor wounds according to policy. There is a weekly audit of people with pressure damage in the home undertaken by registered nurses. This information is reviewed by the senior management. Senior nurses have twelve hours a week supernumerary time to maintain administration and records and review wound care. Residents who are identified as having a low weight (using the indicator of a BMI of 20 or less) have their food and fluids recorded. There is now a clearer structure for the monitoring of this aspect of care. The senior nurses have the overall responsibility for identifying people with weight loss and completing a dietary form. The nurse in charge of the shift will ensure that charts are completed after each meal. Nurses spoken to were clear about their responsibility for this. People who have a weight loss recorded when they are weighed monthly are then weighed weekly. A referral will be made to a doctor who may make a referral to the dietitian. We could see from the records of people we case tracked during the inspection that this was happening. Care plans had clear actions documented and the involvement of the catering team was noted. We saw in care plans that the monthly nutritional risk assessment had been completed. We saw for example that one person was steadily gaining weight having been prescribed supplements and a high protein and calorie diet. All people are assessed for the risk of pressure damage using the Waterlow score. We saw that Waterlow scores had been completed in all the plans we saw and an appropriate care plan had been written. We were able to see turn charts in peoples rooms that had been completed according to the care plan. Care Homes for Older People Page 15 of 30 Evidence: Weekly reports on Waterlow scores will be followed up by senior nurses. People who have a score of 10 and above are monitored by a movement chart. Care staff spoken to understood the importance of checking all peoples skin when they get up and go to bed. We were told that some people come into the home with pressure damage and that there is evidence in the monthly audits that some of these people had their damaged skin healed in the home. We saw assessments for falls to be completed and care plans written when indicated. We saw that Named Nurses are responsible for reviewing and updating care plans. The care plans we saw were up to date and showed that people and their families had been involved. A monthly compliance audit samples a minimum of five care plans and reviews them in depth. We case tracked one person and saw completed fluid and turn charts. We spoke to a member of staff who gave a good account of the persons care needs. she was able to explain about the help required with feeding and tendency to pressure damage so turns are important . We saw that the care plan mirrored what the carer had told us. The carer knew a lot about the person she was caring for including her personal history and what was important to her. This lady appeared well presented and had recently been to the hairdressers. The carer understood the importance of promoting continence and maintaining dignity. On Snowdrop we saw examples of ways in which peoples needs can be met in creative and person centred ways. Professional visits are recorded in peoples care plans. We saw that people had visits from their doctor and district nurses. We saw that some people received visits from physiotherapists, speech therapists and the dietitian when needed. We saw in files that people visited consultants and received specialist support when appropriate. We saw that records of contacts with families were kept informing them of changes or developments in peoples needs or care. We reviewed the medication storage and administration on one floor and saw it was safe. Care Homes for Older People Page 16 of 30 Evidence: Care Homes for Older People Page 17 of 30 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 make choices about how they spend their days. There is an activities and social events programme. Investment has made by the home to develop it further. People can chose from a nutritious and varied menu. Evidence: We saw evidence in both buildings that people were able to make choices about how they spend their days We saw that people were able to access communal facilities or remain in their rooms. We spoke to one person who received daily visits from her husband and who went to the lounge if there was anything exciting going on. We spoke with the newly appointed full time activities leader. The activity programme has been developed and extended. There are now programmes for both Primrose and Snowdrop. We were told about the need to keep programmes on Snowdrop flexible and to be able to change them according to peoples wishes. The importance of making links with other people in the home was identified by someone who lives in the home and by the activities leader. We were told that it was important to find people who could play scrabble or do crosswords and that being in a room could be very isolating. The completion of the dining room has made a space Care Homes for Older People Page 18 of 30 Evidence: available in the second sitting room where activities can take place. We saw on Snowdrop that the Holly lounge now contained plenty to interest people including boxes of things for people to pick up and look at. We observed meals being served in the newly completed dining room in Primrose. There is access to a secure courtyard are via french doors. This appeared to be a very pleasant place to eat lunch. The home operates a four week menu and we saw daily menus displayed on the tables in Primrose. In addition to the main menu there is always jacket potatoes, salads and omelets. There are a range of desserts available from hot pudding to fresh fruit. In the attractive Snowdrop dining room the atmosphere was relaxed and friendly. We saw a choice of meals offered to people at the table. Pureed meals are presented as individual portions and people foods are supported with dignity. A member of staff eats lunch with the people on Snowdrop. Whilst overall people were very satisfied with the meals we did have three comments indicating that not everyone was completely satisfied. The concerns were about the presentation of the food rather than the content. Care Homes for Older People Page 19 of 30 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 home has policies and procedures in place to protect people from abuse. The home has implemented new procedures concerning people leaving the buildings. Evidence: At the Key Inspection in September 2009 we looked at records of complaints and found that were recorded and appropriate action taken. There had been no further complaints. All people who returned surveys to us knew someone they could talk to if they were concerned. A small number of people who returned surveys said they would not know how to make a formal complaint. People and relatives spoken to during the inspection told us that the manager and nurses sorted things out. One relative told us that if there were any issues they would always ask for a meeting with the manager. There is now a procedure in place to safeguard people, in Snowdrop particularly who may leave the building. Photographs taken to identify people have been taken as a best interest decision. Risk assessments are completed for people identifying those who may leave the building unescorted. A temporary absence form is completed when people do leave the building. There is a robust recruitment system that is designed to keep people safe. Staff receive training in Safeguarding Adults and evidence was seen in staff files. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. People benefit from living in a home that is attractive, comfortable and well equipped. The home is well lit, clean tidy and smells fresh. There is a planned approach to the reduction of infection. Evidence: At this inspection the building work and refurbishment is drawing to a close. The overall environment in both the new building Snowdrop House and the existing Primrose house is smart and comfortable. The completion of the new dining room in Primrose has provided a second sitting room on the ground floor where activities can be enjoyed. In the main sitting room in Primrose the refurbishment had been completed. Curtains and pictures had been hung resulting in an attractive and comfortable room. Bedrooms seen throughout the home were attractive and comfortable most containing personal possessions. The home was very clean. There are plenty of hand washing facilities including liquid soap and paper towels. The home is taking part in an Infection Control project with the Health Authority. There is still some outside work to be completed regarding parking but overall as a Care Homes for Older People Page 21 of 30 Evidence: person who lived in the home said The home has done very well with its altering and refurbishment. It is very neat. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in the staff who care for them. Rotas show that the home is staffed efficiently in a way that benefits people who live in the home. The service has a good recruitment procedure which is followed in practice. The service recognises the importance of induction and training for staff. Evidence: People in the home were complimentary about staff. Surveys returned to us from staff indicated that overall staff were pleased to be working in the home and felt proud of the standards achieved in the home. We were able to see the staff rotas. Staff rotas are now organised into units making it clear that people work regularly for one area of the home. We spoke with one nurse who told us that the staff were settling into this way of working staff liked having their designated floors this arrangement had made things better for people who live in the home. People knew which staff were going to be on duty and looked forward to seeing their staff. Carers got to know peoples needs really well. The staffing levels in the home have improved however some people who live in the home and some staff said they should be increased further. One person wrote The home is improving. there have been times when the floors have been short staffed but Care Homes for Older People Page 23 of 30 Evidence: things are improving slowly. Another carer wrote A few more staff ...so we can spend more time with the resident. Surveys from carers indicated that most staff thought that there were usually or always enough staff. A smaller number said that there were sometimes enough staff. All staff who returned a survey said that there had been checks such as CRB and references taken up before they started work. They said that their induction had covered everything they wanted to know. We reviewed staff recruitment records and found them complete and well organised. We saw files of staff who had not yet started at the home and could see all their references and CRB in place. We saw that application forms were fully completed and that interviews are recorded. We saw that staff records for recently recruited staff contained evidence of a comprehensive induction followed by a period of shadowing. We could see in the files of establisheds staff that they had received recent training. Staff who returned a survey said that managers gave them enough support. At this inspection we saw the supervision matrix in place and the cascade system that would aim to supervise all staff. We met with the in-house trainer who works practically full time in the home. Her role includes co- ordinating external training, new staff inductions and delivering inhouse training. The achievement of National Vocational Qualifications in the home is supported by a local college. A training schedule has been developed for 2010 that includes pressure care and risk assessment and person centred care. Whilst this is an interesting and varied programme some thought should be given to how staff are able to access this training. It is currently offered every Wednesday afternoon and staff are released to attend. The trainer may consider offering other opportunities for staff to attend key up-dates such as health and safety. The trainer is aware of the needs of the training needs of nurses and is developing Portfolio Management for nurses. A range of training materials are used including DVDs, distance learning and formal training. Training for all staff is planned about nutritional needs including the chef when this can be sourced. We could see the training matrix that indicated when people are due for mandatory training up-dates for example manual handling. Care Homes for Older People Page 24 of 30 Evidence: The home continues to develop both staffing numbers and expertise of staff. At the inspection the manager told us they have been hoping to appoint a Senior Clinical Lead nurse in the home. Nurses have also been supported with training by the company Quality Assurance team and there are plans for further training from them throughout the year. Wound management training has been arranged for all registered nurses with the tissue viability nurse Nurses received an up-date on using the wound formulary in the wound management training. We saw the recruitment files for three nurses who had recently joined the home and two more who are to commence employment soon. We talked to one carer about the dementia care training she had received. She told us that it had been very informative and she had been able to apply it day by day. Care Homes for Older People Page 25 of 30 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 manager is established and has the required experience. The management structure of the home has been reviewed to promote a more person centred approach to care. There is a planned system of monitoring and maintenance. Evidence: The home is lead by Lyn Taylor who has an open door policy for families and staff. The management structure of the home has been formalised with the establishment of a three unit structure headed up by a Head of Unit who will be a senior nurse. There is still some adjustments to be made regarding the personnel for these posts but the concept is established and staff are getting used to working in units. The role of the manager and deputy manager has been further clarified with the deputy manager spending more time on the floor supervising staff and heading up one unit. There are plans for the manager and deputy to undertake training for National Vocational Qualifications in Management and leadership at Level 4. Care Homes for Older People Page 26 of 30 Evidence: We saw the minutes of meetings that had been held for senior staff and unit meetings. Meetings were held weekly during the initial reorganisation phase but will then be held monthly. Staff are encouraged to participate in unit meetings. Time is allocated (12hours per week) to the each unit leader to supervise staff and review documentation. The manager and home have been supported by the Sanctuary Care Quality Assurance team who have been able to give substantial time to the home. They have worked with trained nurses to audit and review care plans making them more accessible. The company has staff expertise in clinical areas, health and safety and human resources which has been accessed to support the home. The home receives Regulation 26 visits from the Regional Manager to monitor the quality in the home. The home has a structure of quality assurance in place which includes performance audits and a survey for all people who live in the home. The home has a permanent contract with Somerset Community Directorate and is subject to contract and individual reviews. The home has the Investors in People Award. There is a stem of planned maintenance that addresses health and safety requirements. At this inspection we sampled hot water checks, in-house fire alarm checks and hoist maintenance. All were satisfactory. At the Key Inspection in September we checked the system for recording and administering peoples personal finances and found it to be sound. Care Homes for Older People Page 27 of 30 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 28 of 30 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 15 The presentation of the meals should be audited to determine whether or not it could be improved. Care Homes for Older People Page 29 of 30 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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