Care Home: The Royal Star & Garter Home

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What the care home does well The Royal Star and Garter offers impressive accommodation that is of a high standard, spacious and attractively decorated and furnished. Residents` private space is roomy, to the same decorative and furnished standard and those bedrooms looked at were comfortable and had been personalised by the occupant. The home is divided into four wings, two on each floor, but only three have been in use since the home opened. One of the wings (Roundel) on the ground floor is designated to care for people with dementia and advice was sought from a well regarded source (Stirling University) before the wing was set up. The home has a Statement of Purpose and a Service User Guide to provide people with information about the home but following the resignation of the previous manager and change of address and name of the Commission, some of this information was out of date. The Service User Guide is also written in a manner that addresses existing residents whereas it should also be addressed to intended or prospective residents in order to help them decide about moving into the home or not. Pre-admission assessments had been carried out in sufficient detail for the home to be able to make a decision about whether they were able to meet the person`s needs or not. people had been offered a chance to visit the home in order to help them to decide about moving in and to be familiar with the surroundings before doing so. Care plans were in place in all the care files we looked at and there was evidence that each resident had been involved in drawing these up and had been signed by them. Residents on going health needs are met by visiting GP, Optician, Dietician, Speech and Language Therapist and Chiropodist and by on site physiotherapists and a podiatrist. Records made by or on behalf of these professionals were seen in the care files looked at. Observations and discussion with residents told us that residents are cared for in a respectful manner. Their property is also treated respectfully with clothing looking smart and looked after. There is an electronic tag labelling system in the home to ensure that residents` clothes are returned to the right person. Records looked at showed that care needs are flexible to meet the individual needs of each person living at the home. There is a wide range of activities both inside and outside the home for residents to join in if they wish. The home has its own vehicle for outings and was being used on our first visit to take several residents and staff to a Buckingham Palace garden party. There is a large well equipped activity room with a very large screen television for showing films etc. The Roundel wing organises appropriate activities for the people on this wing. Catering services are provided by personnel from a catering contractor but who know the home and the residents very well. Meals are served in a large, pleasant and sunny dining room which is attractively furnished and which opens out onto a spacious patio. The mealtime observed was a pleasant social event. Residents spoken with and those that responded to the surveys mostly said that they enjoyed the meals provided at the home. One person said, "The food is good and I enjoy it." There is ample choice of meals and beverages throughout the day. One person left most of the meal given to her but staff promptly offered an alternative and the chosen sandwich was brought straight away. Ther are systems in place to maintain infection control, including appropriate hand washing facilities, protective clothing for staff`s use when required and a suitably well equipped laundry. All records, observations and discussion indicated that there are sufficient staff in the home to meet the needs of the people living there and to maintain good standards of cleanliness and hygiene. The importance of training is accepted. All staff have undertaken the induction training that is in line with Skills for Care and 64% of the care staff have National Vocational Qualification Level 2 or 3 in Care. All mandatory training related to health and safety is up to date and some training related to specialist needs has also been undertaken by most staff. This training should give them the knowledge and skills to meet the needs of residents in a safe and effective way. Recruitment procedure and practice is robust and safeguards residents from the employment of inappropriate people. There were no health and safety concerns identified during our visits. What has improved since the last inspection? There was reference to the range of fees which would be pertinent to exisiting staff, although not to prospective residents. Pre-admission assessments informed staff of the needs of that person in order that an effective care plan could be devised. A newsletter had been written and circulated that included photographs of key staff in order that people living, working and visiting at the home were aware of who they were and briefly what they did. Care plans had improved and were based on the assessment carried out by staff and other agencies. These were readily accessible to all staff. They had been reviewed monthly and as circumstances changed. Appropriate risk assessments were in place in order to minimise risks. The medicine management has improved to a good standard. Management and staff have implemented good systems to ensure this has happened and that residents` health and well being is safegurded. All staff have received training related to safeguarding of adults to give them the knowledge to be able to identify abuse and what to do if the suspect or witness it. The home has copies of the Local Authority`s and the organisation`s safeguarding guidelines, which are accessible to staff. Staff are also familiar with the Whistle Blowing policy. The resident`s signature or that of two members of staff were used for each transaction of money looked after by the home. All notifications about incidents in the home are sent to us appropriately and promptly. The organisation had contracted a Health and Safety consultant to undertake an inspection and audit of the premises and they were awaiting the report. The home had received a fire service inspection and all reccomendations made by them had been addressed. What the care home could do better: The Service User Guide should be updated to include information about the current manager and the changes in our contact details. The organisation should audit how residents feel about outings in a vehicle which boldly shows that they live in a care home. Whilst the vehicle is new the charity may wish to consider a more discreet naming of vehicles in the future if feedback justifies this. It was noted that a few bedroom windows open onto public pathways. The home should be able to demonstrate that the occupants of these rooms are satisfied with their room bring on full view or whether they would prefer window dressing that would prevent people looking in and protect their privacy. Some money for some residents is kept by the home for safe keeping. Whilst discussion with staff and observation of records showed that the home and the organisation was mindful of safeguarding residents` financial interests this would be improved by having individual receipts for all spending and individual records for all transactions. Key inspection report Care homes for older people Name: Address: The Royal Star & Garter Home Tudor Coppice Monkspath Hall Road Solihull West Midlands B91 3DE     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: Lesley Beadsworth     Date: 3 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: The Royal Star & Garter Home Tudor Coppice Monkspath Hall Road Solihull West Midlands B91 3DE 01217116330 01217116329 solihullenquries@starandgarter.org www.starandgarter.org The Royal Star and Garter Home Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 60. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 60 Dementia (DE) 60 Physical Disability (PD) 60 Date of last inspection Brief description of the care home The Star and Garter is a new purpose built nursing home, provided by the Royal Star and Garter Charity. It is located in a pleasant cul de sac off one of the main routes to Solihull town centre approximately a mile away. Residents accomodation consists of Care Homes for Older People Page 4 of 33 60 0 60 Over 65 0 60 0 Brief description of the care home four living areas (wings) over two floors with all residents areas accessible by two passenger lifts which are located in the centre of the building. All bedrooms are spacious and of single occupancy; each has an ensuite facility. Communal spaces include lounges in each wing and a dining room on the ground floor. The reception area has a cafe/licensed bar, a piano area and a comfortable sitting area. The home provides twenty-four hour nursing care for up to sixty people and is registered to cater for older people, people with dementia and/or people with physical disability. There is a designated wing to cater for those people with dementia. There are a range of aids and adaptions designed to assist in the management of residents with restricted mobility. The home can be contacted for up to date information about the fees. There are additional charges for hairdressing, chiropody, dental care and optical care where appropriate, dry cleaning, insurance for personal belongings, service and repair of personal equipment, taxis and escorts as appropriate, personal telephone, internet and satellite connection and service charges, toiletries and over the counter medication, Visitors meals and snacks. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to The Royal Star and Garter. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA) which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Five surveys were completed and returned to us by people living at the home. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Care Homes for Older People Page 6 of 33 Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The main inspection was carried out by two inspectors and the visit took place over two visits, between 10:15 and 17:15 on the first visit and 16:15 to 20:15 on the second visit. Our pharmacy inspector carried out the inspection of medication on a different day and this lasted three hours. Care Homes for Older People Page 7 of 33 What the care home does well: The Royal Star and Garter offers impressive accommodation that is of a high standard, spacious and attractively decorated and furnished. Residents private space is roomy, to the same decorative and furnished standard and those bedrooms looked at were comfortable and had been personalised by the occupant. The home is divided into four wings, two on each floor, but only three have been in use since the home opened. One of the wings (Roundel) on the ground floor is designated to care for people with dementia and advice was sought from a well regarded source (Stirling University) before the wing was set up. The home has a Statement of Purpose and a Service User Guide to provide people with information about the home but following the resignation of the previous manager and change of address and name of the Commission, some of this information was out of date. The Service User Guide is also written in a manner that addresses existing residents whereas it should also be addressed to intended or prospective residents in order to help them decide about moving into the home or not. Pre-admission assessments had been carried out in sufficient detail for the home to be able to make a decision about whether they were able to meet the persons needs or not. people had been offered a chance to visit the home in order to help them to decide about moving in and to be familiar with the surroundings before doing so. Care plans were in place in all the care files we looked at and there was evidence that each resident had been involved in drawing these up and had been signed by them. Residents on going health needs are met by visiting GP, Optician, Dietician, Speech and Language Therapist and Chiropodist and by on site physiotherapists and a podiatrist. Records made by or on behalf of these professionals were seen in the care files looked at. Observations and discussion with residents told us that residents are cared for in a respectful manner. Their property is also treated respectfully with clothing looking smart and looked after. There is an electronic tag labelling system in the home to ensure that residents clothes are returned to the right person. Records looked at showed that care needs are flexible to meet the individual needs of each person living at the home. There is a wide range of activities both inside and outside the home for residents to join in if they wish. The home has its own vehicle for outings and was being used on our first visit to take several residents and staff to a Buckingham Palace garden party. There is a large well equipped activity room with a very large screen television for showing films etc. The Roundel wing organises appropriate activities for the people on this wing. Catering services are provided by personnel from a catering contractor but who know the home and the residents very well. Meals are served in a large, pleasant and sunny dining room which is attractively furnished and which opens out onto a spacious patio. Care Homes for Older People Page 8 of 33 The mealtime observed was a pleasant social event. Residents spoken with and those that responded to the surveys mostly said that they enjoyed the meals provided at the home. One person said, The food is good and I enjoy it. There is ample choice of meals and beverages throughout the day. One person left most of the meal given to her but staff promptly offered an alternative and the chosen sandwich was brought straight away. Ther are systems in place to maintain infection control, including appropriate hand washing facilities, protective clothing for staffs use when required and a suitably well equipped laundry. All records, observations and discussion indicated that there are sufficient staff in the home to meet the needs of the people living there and to maintain good standards of cleanliness and hygiene. The importance of training is accepted. All staff have undertaken the induction training that is in line with Skills for Care and 64 of the care staff have National Vocational Qualification Level 2 or 3 in Care. All mandatory training related to health and safety is up to date and some training related to specialist needs has also been undertaken by most staff. This training should give them the knowledge and skills to meet the needs of residents in a safe and effective way. Recruitment procedure and practice is robust and safeguards residents from the employment of inappropriate people. There were no health and safety concerns identified during our visits. What has improved since the last inspection? There was reference to the range of fees which would be pertinent to exisiting staff, although not to prospective residents. Pre-admission assessments informed staff of the needs of that person in order that an effective care plan could be devised. A newsletter had been written and circulated that included photographs of key staff in order that people living, working and visiting at the home were aware of who they were and briefly what they did. Care plans had improved and were based on the assessment carried out by staff and other agencies. These were readily accessible to all staff. They had been reviewed monthly and as circumstances changed. Appropriate risk assessments were in place in order to minimise risks. The medicine management has improved to a good standard. Management and staff have implemented good systems to ensure this has happened and that residents health and well being is safegurded. All staff have received training related to safeguarding of adults to give them the knowledge to be able to identify abuse and what to do if the suspect or witness it. The home has copies of the Local Authoritys and the organisations safeguarding Care Homes for Older People Page 9 of 33 guidelines, which are accessible to staff. Staff are also familiar with the Whistle Blowing policy. The residents signature or that of two members of staff were used for each transaction of money looked after by the home. All notifications about incidents in the home are sent to us appropriately and promptly. The organisation had contracted a Health and Safety consultant to undertake an inspection and audit of the premises and they were awaiting the report. The home had received a fire service inspection and all reccomendations made by them had been addressed. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to information about the home so that they can make an informed choice about whether or not to move in. Pre admission assessments take place before people move into the home so that they can be confident their individual needs will be met there. Evidence: The home has a statement of purpose and service user guide which are made available to the people who live there. These documents contain important information about the services and facilities provided in the home. Four out of five people answered Yes in the surveys when asked if they had received enough information to make the decision whether to move into the home or not. However the service user guide, entitled Residents Guide is directed only to existing residents of the home but should also be written for intended residents. For example, the introduction is a welcome to the home and states that the person has already decided to become part Care Homes for Older People Page 12 of 33 Evidence: of The Royal Star and Garter community. Whilst there is a reference to fees in the service user guide that says, You will have been provided with information regarding your fees before moving into the home. This does not help those people only thinking of moving into the home. The organisation should be directing the information in the Guide to prospective residents, as well as to people already living in the home, to assist them in making a decision about moving in or not. The service user guide contained inaccurate information regarding the homes manager and about contacting the Care Quality Commission (previously CSCI). We were, however shown a newsletter that briefly introduced the new manager who is due to start work within the next few weeks. There have been new people move into the home since our last visit in February 2009. We looked at the records for three of the people to establish that their needs had been assessed before a service was offered to them. The records showed that assessments had been carried out both by Royal Star and Garter staff, in accordance with their own policies and procedures, and by other professionals such as social workers and health care workers. There was detailed information to describe peoples needs which had been used to draw up an individual plan of care. This should enable the home to determine that peoples needs can be met before a placement is offered. People had been offered opportunities to visit the home (before moving in) with their relatives, to look around and spend time talking with the staff team. Two people told us that this helped them make the decision to move into the home. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place that generally in sufficient detail to inform staff of the care required by the people living at the home.Residents have access to health care professionals and are cared for in a respectful manner. The improvement in the medication system means that it now safeguards the welfare and well being of the residents. Evidence: The home has made good progress in improving the care plans and the hard work involved is acknowledged. All care files looked at included a care plan and we inspected three of these as part of the case tracking process. The home uses a computerised recording system but care plans are also printed out and are available as a hard copy on each of the wings. Daily records are not routinely printed out but can be if required. The care plans identified the needs of the person and what care was required to meet those needs. These included the preference of gender of the person providing personal care; showing flexibility in helping the people living at the home with their preferred routines. Charts were available, where appropriate, to show a persons fluid intake, their pressure area care or their weight in order to monitor any Care Homes for Older People Page 14 of 33 Evidence: concerns in these areas. When asked in the surveys what the home did well one resident said, My personal care and caring for me. One care plan looked at contained a great deal of information and it was initially difficult to find the information we were looking for. However discussion with a member of staff showed that they were able to locate the information easily. This care plan referred to and described challenging behaviour, however it did not detail how staff should manage this behaviour. There was evidence that residents had been involved in drawing up their care plan, having been signed by them. Residents on going health care needs were being met with evidence of visits by the GP, District Nurse, optician and chiropodist and visits to out-patients appointments being identified in the care files looked at. Residents spoken with confirmed they could see a doctor if they wished and that they had visits from other health care professionals when necessary. There was also evidence of visits by a dietitian, a moving and handling coordinator and a speech and language therapist (SALT), who add to the computerised records on each wing so that staff can access their information regarding the care and treatment plans about the people they had visited. Physiotherapists are employed for thirty hours a week and discussion with one of them said that they felt the home meets the needs of the people who live there.The physiotherapist also showed us how staff access records made by them on the computer. A nurse in charge of one of the units confirmed that they had seen the most recent entry that physiotherapists had made. There are two computers on each wing and a nurse showed us the computerised daily record system and confirmed that all staff can read and input information. The records we looked at were up to date and showed us that care plans had been reviewed appropriately. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were now in place and risk assessments for moving and handling (transferring a person from one place to another) were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed, for example assessments were in place identifying risk involved with smoking for one person with physical needs, and with regard to the risk of scalding when drinking for resident with Care Homes for Older People Page 15 of 33 Evidence: dementia. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. Observations and discussion with residents and staff showed that the people living at the home were cared for in a respectful manner. Their clothing was also looked after respectfully and responsibility taken for their condition. A system of labelling clothing with a tag that electronically identifies the owner had been installed although not all clothes had been labelled in this way. We were told by staff that this was due to the limited number of tags available and they had labelled other clothes with the owners initials in indelible ink on the product label. Whilst the electronic labelling system would ensure that belongings were returned to the rightful owner some of the tags had been attached in places that were unsightly or would be uncomfortable or could create risk of sore skin. This observation was shared with the Director of Care and Service Development of the organisation who was in overseeing the home at the time of our visit. She volunteered that this would be addressed promptly by reminding staff of the correct procedure to ensure the tags are attached in a comfortable and discreet place, and that further tags would be purchased. The home benefits from it having its own vehicle which is used for outings. Those residents going to Buckingham Palace were using it on the day of the first visit but it was noted on the second visit that this is boldly decorated with the name of the home/organisation. The organisation may wish to monitor if residents are happy about this as it can have the affect of labelling those on board. It was noticed that a few bedroom windows in Roundel wing open onto public pathways giving passers by full view of the bedrooms and anyone occupying them. We could clearly see a person in bed as we passed after one of our visits. The home should be able to demonstrate that the people using these bedrooms are aware of this and whether they would prefer to have additional window dressing that would protect their privacy whilst allowing light in. The medication was inspected by a pharmacist inspector and the report is as follows. The pharmacist inspection lasted three hours. It took place on a different day to the main inspection. The medicine management has improved to a good standard since the last inspection in February. Management and staff have implemented good systems to ensure this has happened and this is commended. Care Homes for Older People Page 16 of 33 Evidence: Five peoples medication was looked at over the three wings currently open, together with their Medicine Administration record (MAR) charts, care plans and daily records. Three nurses were spoken with. All feedback was given to the lead nurse and the director of Human Resources present in the home at the time of the inspection. Each MAR chart had a facing page recording relevant information, such as any allergies the person had together with an identifying photograph. Copies of the prescriptions were available to check the current MAR chart against. All prescriptions received are checked and then sent to the pharmacy for dispensing. These are then checked and the quantities recorded on the MAR chart to enable audits can take place to demonstrate that the medicines have been administered as prescribed. Audits indicated that the medicines had been administered as prescribed and records reflected practice. The lead nurse undertakes regular random audits to spot check that the nursing staff administer the medicines correctly. An additional the Royal Star and Garter monthly audit is also undertaken. A further auditing system was being implemented whereby the nurses checked three other peoples medication for accuracy. Together this has raised the standards to the good level seen. The care plans had also improved in relation to medication. All care plans had been regular updated but one medicine appeared to have been omitted with no information as to why. The nurse immediately recorded in the diary that the matter was to be discussed at the next doctors visit. Detailed information regarding why each medicine had been prescribed together with the common side effects was included in each care plan seen. Information was seen when an external health care professional had been called in and included the outcome of the visit. The daily notes recorded observations in deteriorating health and staff had acted appropriately. All the nurses spoken with had a good understanding of the medical conditions of the people they looked after, together with what the medicines were for. Care Homes for Older People Page 17 of 33 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 living at the home have the opportunity to be involved in appropriate activity and occupation. They have choice in their daily lives and enjoy the varied and nutritious meals provided. Evidence: The home employs a full time designated activity organiser, who is also the licensee for the bar in the home. The activity organiser was absent from the home during our visit as she had accompanied some residents to a garden party at Buckingham Palace, in the homes vehicle. During the first visit a delivery and installation of aquariums, one on each wing, was in progress. We were told that this had been the idea of the activity organiser to provide interest for the people living at the home. Residents are informed of future activities by a notice displayed on each wing and individual circulars. These included crafts, artwork, outings, entertainers and religious services. They were varied and should provide appropriate stimulation and interest. During our visit a pianist arrived to entertain the residents and the subsequent sing-along was heard throughout the home. People spoken with over lunch said that they had really enjoyed the event. One resident was being encouraged and supported in maintaining a very active social life to meet their needs and wishes, as well as Care Homes for Older People Page 18 of 33 Evidence: pursuing pastimes within the home. Residents spoken with said that there was plenty to do and one resident said, I join in when something interests me., showing that the residents can choose whether they join in or not. Four out of five of the surveys said that the home Always or Usually arranged activities that they can take part in if they want. There is a spacious and well equipped activity room where there was evidence of different projects as well as a large flat screen satellite television for communal viewing. The smaller, cosy activity room/lounge in the wing for people with dementia houses articles of memorabilia such as an early 20th century typewriter and a treadle sewing machine that can be used for recall and to stimulate conversation. There is also a good collection of activity equipment available on the wing. Evidence indicated that residents are provided with stimulating and interesting occupation. However in a survey received after the visits and in response to the question What could the home do better., one relative had written on behalf of a resident, Look after those unable to leave rooms generally to provide some mental stimulation. The home should monitor that those people who have to spend the majority of the time in their room are having sufficient opportunity to be involved in stimulating occupation. Visitors were coming and going throughout the day and it was apparent that they are made welcome at the home. If they wish to join their relative at mealtimes they can do so and vouchers can be purchased at reception. Beverages are readily available and visitors are not charged for these. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat and where and how to spend their time. Four out of five people answered Always or Usually in the surveys when asked Do staff listen to you and act upon what you say. The occupants of three (two at present) of the wings eat in the main dining room, with the other residents in Roundel (the wing for people with dementia) eating on their wing. The Residents Guide tells us that people can have their meal in their room if they are unwell, convalescing or if meals are required outside of usual dining times. The dining room can cater for 54 people in spacious and attractively furnished and furbished surroundings. Patio doors open onto a large and pleasant patio area. Staff go around home in the afternoon to ask residents what they would like the Care Homes for Older People Page 19 of 33 Evidence: following day. We joined the residents for lunch in the dining room. There was a choice of meat and potato pie or chicken curry and a vegetarian option. The food was tasty, well presented and there was ample quantity. They were served from a hot plate and hatch that opened into the dining room and brought individually to each table if the person. There were also alternatives if these choices were not liked. There was choice of drinks and desserts. One resident left the majority of their meal and staff promptly asked her what they would prefer. A jam sandwich was chosen and enjoyed. Staff were attentive and chatting with residents. Assistance was available from care staff where needed and was given in a sensitive and discreet manner. Music was being played in the background and the mealtime was a social event. One person we dined with said, you cant fault the place, the food is good and I enjoy it. Four of the five surveys returned to us said that they Always or Usually liked the meals at the home. Menus in large print were available on each table and were also displayed at the entrance of the dining room. Tables were decorated with flowers and all tableware was appropriate and attractive. The service user guide and observations told us that snacks and beverages are available in the cafe/licensed bar at mid morning and mid afternoon or on the wings for those residents unable to attend, or on request at any time. Complimentary alcoholic drinks are provided twice a week, during Sunday lunch and as a pre dinner aperitif on Wednesday evenings and are available to purchase at the bar during the times displayed. These purchases are itemised on the monthly payment statement. Catering services are provided by outside caterers. There is a stable personnel allocated to the home and the cook liaises with the activity organiser regarding food for special events and celebrations and the residents likes and dislikes. The cook was able to show us photographs of the appetising buffet made for the official opening of the home. The kitchen was visited and was well organised and in good order. Cleaning routines and food storage temperatures are maintained and records up to date. Care Homes for Older People Page 20 of 33 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 appropriate training, policies and procedures to address complaints in a way that enables people to be confident their concerns will be listened to and to safeguard residents. Evidence: The complaints procedure was available in the Service User Guide, which is given to all residents and which was seen in the bedrooms viewed. The complaints procedure refers to a suggestion box in the dining room but this was not seen. Catering staff showed us a book called Ingredients Customer Comments. This is placed on a small table in the corner of the dining room, which is not easily accessible nor an obvious place to record complaints. The book was blank. Residents spoken with said that they did not have any complaints, but that they would speak to staff if they had any concerns. This was confirmed in the surveys when all of them informed us that they knew how to make a formal complaint and that there was someone to talk to informally if they were unhappy. A record of complaints is maintained and complaints are addressed appropriately. The training record, discussion with the Director of Care and Service Development showed that all new staff undertake safeguarding training and those staff who had previously not been able to attend have now done so. This training should enable staff to identify abuse and to know what to do if they suspect or witness abuse. The Local Care Homes for Older People Page 21 of 33 Evidence: Authority and the organisations Safeguarding policies were readily available. Staff were aware of where these were kept and had each been issued with a copy of the homes policy, a signed copy of this being seen in the staff files looked at. Staff had also been informed of the Whistle Blowing policy and further training was planned to be included in the induction training for new staff, and sessions for other staff, during the following months. The homes policies and procedures related to residents money safeguard residents financial interests and policies and procedures for recruitment safeguard residents from the employment of inappropriate people. Care Homes for Older People Page 22 of 33 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. The home offers the people living there comfortable surroundings of a high standard, and which are clean, free of offensive odour, safe and well maintained. Evidence: The home is purpose built to a high standard and provides impressive accommodation over two floors. It has recently won the National Pinders Design Award. This Awards aims to promote and recognise developments in all types of care-related property. All areas of the ground and first floors can be accessed by residents by means of a passenger lift and exits to the grounds are on a level making them easily accessible for people with walking aids or wheelchair users. The home is located in a pleasant cul de sac off a main route to Solihull town centre. Parking is limited to a small car park at front of the home with further spaces to the side of the building and also some parking on the roadside. The front of the home is open, pleasantly landscaped and has pathways and gazebos that create interesting walkways, including a water feature. A fenced area to one side of the home surrounds a safe area for residents living on the wing designated for people with dementia (Roundel wing). The impressive reception area is hotel-like with a coffee and licensed bar lounge Care Homes for Older People Page 23 of 33 Evidence: furnished with tables and comfortable seating to one side of the entrance and an area housing a grand piano and a comfortable sitting area on the other. An open ceiling provides plenty of light and the gallery on the first floor looking down into the reception is an attractive feature. Adjacent to the entrance is the main dining room for all but the people living in the Roundel unit. The dining room is spacious and, as is the rest of the home, is attractively decorated and furnished. There are windows that open onto a large patio. The home is divided into four units, two on the ground floor and two on the first. One unit has not yet been in use. There are bedrooms, and communal areas on each unit. The main sitting areas on two of the wings in use are open plan, providing ample space for people to move around. There are also smaller, cosier lounges. When asked why there are no televisions in the communal areas of these units we were told that this was to stimulate sociability and that the residents have a television in their bedrooms. There is also a large screen television in the spacious and well equipped activity room but this is not a cosy sitting area. The management should monitor with the people using the home that they would always choose to watch television in the isolation of their bedroom rather than in a cosy sitting room with other people. Roundel wing has an open plan area with a living/dining area with a television. There is also a smaller cosy lounge that is used as an activity area with some memorabilia items. The AQAA tells us that the home had sought advice from an appropriate source (Stirling University) before setting up this dementia wing. There is a safe and attractive garden area that can be used by the people living here. Bedrooms are of single occupancy, are large with an en suite facility and are well furnished. Those seen had been personalised with the occupants possessions and looked comfortable. All residents asked about their surroundings said that they were very happy. A tracking hoist system is available in most of the bedrooms to enable staff to assist those residents who do not weight bear to transfer from their bed safely and easily. All bedroom doors have a lock and residents are offered a key to enable them to lock their rooms when they wish. Each wing has an assisted bathroom that is in addition to the en suite facilities and includes a therapeutic spa bath. All areas of the home visited were clean and free of offensive odours. All surveys returned to us said that the home was Always fresh and clean. Care Homes for Older People Page 24 of 33 Evidence: There are systems in place for infection control including appropriate hand washing facilities and protective clothing, (disposable gloves and aprons) are readily available for when staff assisted people with their personal care. The staff rooms and laundry facilities are on the third floor. The laundry is large and well equipped and well organised in order to maintain infection control, although there is not a facility to dispose of any faeces that we were told by staff is sometimes brought in with the soiled laundry. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff available to meet the needs of the residents and to maintain standards of cleanliness and hygiene. Satisfactory recruitment practices protect residents from the employment of unsuitable people. The importance of training is recognised. Evidence: Discussion with the lead nurse, who is deputising in the absence of the manager, looking at the rotas and noting who was working in the home at the time of our visit, showed us that there is a Registered Nurse on each wing at all times; three Health Care Assistants on two of the wings and four on Roundel wing during the day and two on each wing during the night. There is currently an extra Health Care Assistant on one of the wings in order to provide extra care for a specific resident when it is needed. In addition to nursing and care staff there are ancillary staff consisting of housekeepers, the maintenance coordinator and activity coordinator employed directly by the organisation. Further to this there are catering staff, physiotherapists and a podiatrist that are contracted in. In response to the previous inspection report, and to improve peoples understanding of their role, the homes most recent newsletter (Open Letter) included photographs of key staff at the home and brief summary about them. This included the new managers photograph and brief resume of her background. Care Homes for Older People Page 26 of 33 Evidence: Several positive comments about staff were made by residents spoken with and in response to the question, What does the home do well? a person had written that staff show genuine care for the residents. All evidence indicated that there are sufficient staff employed to meet the needs of the current residents, although surveys received after our visits included the comments, Less agency staff and More staff in response to the question What could the home do better?. All staff had undertaken induction training in line with Skills for Care when starting at the home, which includes basic orientation induction of the home, mandatory health and safety related training and training in specialist needs such as dementia. Health Care Assistants, Nursing staff and some ancillary staff have attended Dementia Awareness training. For nursing and care staff this is followed by a three day dementia course. Nurses have also undertaken training related to Parkinsons Disease. This training should give staff the knowledge and skills to work safely and effectively in the home and to meet the residents needs. Sixty four percent of the care staff had achieved the National Vocational Qualification In Care Level 2 or 3. This qualification shows that staff have undertaken training and been assessed as competent in their role. All staff files are kept at the home although at the time of the last inspection they were at the head office in Richmond following the recruitment of the large number of staff when the home opened. Three staff files were looked in order to assess the recruitment practice at the home. All files included the required records including three or four written references that had been validated. A pre employment health check had been completed by each member of staff. The POVA First checks and Criminal Records Bureau Disclosures were evidenced on the organisations computer system and no member of staff whose files we looked at had been appointed prior to these being in place. The files included notes taken at interview and the written exercise applicants had undertaken as part of their recruitment. Evidence seen indicates that the home has a robust recruitment system that safeguards residents from the employment of unsuitable people. Care Homes for Older People Page 27 of 33 Evidence: Care Homes for Older People Page 28 of 33 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. A person with the appropriate qualification and experience has been recruited to manage the home. The monitoring and auditing of the service and practices is undertaken to ensure that all services operate in the best interests of residents. Health and safety policy, training and practice safeguard residents and ensure that the home is a safe place to live and work. Evidence: The home was without a registered manager at the time of the inspection visit following the resignation of the previous manager. A new manager had been recruited, and was shortly due to take up her post. We had the opportunity to meet with her whilst she was visiting the home. The Lead Nurse was deputising in the absence of a manager and a team of senior staff from head office took it in turn to provide direct support on week days. Care Homes for Older People Page 29 of 33 Evidence: A Quality Assurance programme is in place and monthly visits are made by a representative of the registered provider. A report is produced from this visit and a copy made available for our inspection is maintained at the home. Residents meetings take place regularly and give the people living at the home the opportunity to give feedback about the home and the services they receive. The home looks after some money for some residents who either cannot, or prefer not to, handle their own cash. This money is kept jointly in a locked box in a secure location and any payments are made from a petty cash box, also kept in a secure location. Receipts are kept with the petty cash until reimbursements from residents money to the petty cash are made. Most of the residents money is held in a joint noninterest bank account. Recordings of monies spent and some receipts are not individualised; for example hairdressing receipts list all the people who have had their hair done on that day with each cost and the total; the receipt and payment for individual newspapers is also done in this way, with the home working out what each person owes. Transactions are recorded on a computer system when the reimbursements are made. Accounts are individualised on this system and each persons balance is calculated separately. Although all transactions are signed by the resident or if they are unable to do so by two members of staff, combining cash and receipts does not personalise, can cause difficulty in finding where an error is if money does not balance and until added to the system does not comply with data protection. Discussion with the person responsible and inspecting the records indicated that the home intended to act in the best interests of the people living at the home but protection of staff and residents would be improved with individual receipts and records. The Director of Care and Service Development told us in her Improvement Plan that since the last inspection the home has been visited by an external Health and Safety consultant at the request of the organisation. The consultant has undertaken an inspection and audit of the premises and grounds and the report is pending. All staff have undertaken mandatory training related to health and safety issues giving them the knowledge and skills to be able to work safely. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Incident notifications are sent to us appropriately. No health and safety concerns were noted during our visits. Care Homes for Older People Page 30 of 33 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 31 of 33 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 1 The service user guide should be reviewed so that people are offered accurate information about the services and facilities provided in the home and is also directed at intended residents. Care plans should inform staff of the care or support required to manage challenging behaviour. People occupying the bedrooms where windows open onto public walkways should be consulted about their wishes regarding privacy. The people living at the home should be asked if they would always choose to watch television in their own room or if they would prefer a television in communal sitting areas. A system for managing the faeces occasionally brought into the laundry should be implemented. The home should consider personalising the residents money and paper records and receipts held by them. 2 3 7 10 4 20 5 6 26 35 Care Homes for Older People Page 32 of 33 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). 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