Care Home: The Salisbury

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What the care home does well The service provides good information about the home and facilities. There is a detailed service users guide and statement of purpose. Inspection reports and and quality assurance surveys and outcomes are available to resident`s and their relatives and provide a good overview of the service. In addition there is a quarterly newsletter which provides the news and views about the service and is posted out to relatives who may not be local or have easy access. Four residents were spoken to on the day and all gave an individual and clear account of their care support and how their needs are met. One said everyone is `very kind and helpful and I like living here and in this area where I have lived all my life`. Another said `nothing is too much trouble and I was very ill and lonely and now i am not`. One of the relatives spoke very positively about the management and staff and the support provided to their relative. `They said that the home meets all our expectations and we don`t have to worry about anything, and if there are any issues they are sorted out straight away`. There is a good recruitment and selection process in place and staff skills and knowledge are underpinned by training and supervision in the relevant fields. Staffing levels have been sustained and NVQ training in care and housekeeping is being promoted. What has improved since the last inspection? Major refurbishment plans are in progress and the kitchen area has recently been completely upgraded to a good standard. The dining area has also been refurbished including new furniture and fittings and some carpets and curtains in resident`s rooms. The assessment and care planning process has been revised in part to improve the details relating to each person especially for those receiving respite care. The MUST nutritional assessment tool which measures nutritional and dietary needs has also been added to the care planning process. One member of staff has completed the training and is cascading the information to the staff team. Regulation 26 visits by the registered providers are now in place and record maintained. What the care home could do better: The programme of refurbishment and upgrading should be established as part of an ongoing business plan that sets out estimated timescales for the work to be carried out and completed and can be monitored effectively by the manager. A review of care files should be undertaken and a filing protocol established to ensure information is in place and up to date. Care plan records and daily reporting should be reviewed to ensure the information relating to health care support and input is specific and detailed in content and easy to use and reference. Details relating to complaints and how they are investigated needs to be comprehensive in content and give a clear account of any investigation possible outcome and action. A review of the management of the premises should be undertaken to ensure that there are facilities for storage of every day items when not in use and and audit of facilities carried out on a regular basis to ensure they are in good working order and available and accessible to residents at all times. The manager should be offered formal supervision to ensure professional development and training needs are identified and promoted. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Salisbury 20 Marine Crescent Great Yarmouth Norfolk NR30 4ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Golphin     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Salisbury 20 Marine Crescent Great Yarmouth Norfolk NR30 4ET 01493843414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Surrinder Batra,Mrs Indira Batra,Dr Suman Nagpal,Dr Sunita Nagpal Name of registered manager (if applicable) Mrs Karen Bradnum Type of registration: Number of places registered: 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: One service user with a physical disability, who is under 65 years of age and is named on the Commission`s records, may also be admitted, at any time, provided care needs have been assessed and these can be met at The Salisbury. No other person under the age of 65 years is to be admitted. Six service users over the age of 65 years, with dementia, may be accommodated provided care needs have been assessed and these can be met at the Salisbury. Twenty six (26) older people of either sex may be accommodated. Date of last inspection 0 0 1 Over 65 6 26 0 care home 26 Care Homes for Older People Page 4 of 27 Brief description of the care home The Salisbury is a residential home providing care and accommodation for up to 26 older people and is situated approximately one mile from the centre of Great Yarmouth. Accommodation is provided on two floors and there are 16 single bedrooms, four with en-suite facilities, and five shared rooms. There are two lounges and a dining room and a secure garden to the rear of the building. The fees range from £299- £450 with additional costs for personal requisites, hairdressing,chiropody and newspapers and magazines. Information about the home including inspection reports and reviews about the service are available in reception and from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: the quality rating for this service is 2 star this means that the people who use this service experience a good quality outcome. This key unannounced inspection was carried out over one day, 7 hours in total. the manager was present throughout the the inspection. The report contains information from the Annual Quality Assurance Assessment document the previous inspection report and from notifications received from the service since the last inspection which was carried out on 30th July 2007. During the course of the day we were able to undertake a brief tour of the premises and talk to residents and visitors . It was also possible to observe staff at work and supporting residents. A small sample of staff and residents records as well as maintenance and Care Homes for Older People Page 6 of 27 administrative records. Comment cards had been completed and returned to CSCI by people using the service but were not located at the CSCI office prior to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The programme of refurbishment and upgrading should be established as part of an ongoing business plan that sets out estimated timescales for the work to be carried out and completed and can be monitored effectively by the manager. A review of care files should be undertaken and a filing protocol established to ensure information is in place and up to date. Care plan records and daily reporting should be reviewed to ensure the information relating to health care support and input is specific and detailed in content and easy to use and reference. Details relating to complaints and how they are investigated needs to be comprehensive in content and give a clear account of any investigation possible outcome and action. A review of the management of the premises should be undertaken to ensure that there are facilities for storage of every day items when not in use and and audit of facilities carried out on a regular basis to ensure they are in good working order and available and accessible to residents at all times. The manager should be offered formal supervision to ensure professional development and training needs are identified and promoted. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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. Infromation about the service is available to prospective residents to enable them to make an informed choice about where to live. All prospective residents needs are assessed prior to admission to ensure they can be appropriately met. Evidence: Changes to the assessment of need format have been made and updated this year. One of the residents and a relative spoken to on the day said that the information they received about the service prior to admission was helpful and provided them with the details they needed to help them make a decision about the suitability of the home. They aere happy to say that they were pleased with their decision to accept a place and that their personal expectations of the service had been met. Care Homes for Older People Page 11 of 27 Evidence: Three care files were seen on the day and the revised assessment process discussed with the manager. The manager confirmed that the assessments for each resident have been updated as part of the improvement plan agreement arising out of the last inspection carried out in July 2007. The format provides information about each persons needs and was originally updated and brought into use for residents requesting respite care, but is now also used for those seeking a longer term placement. Two residents and one relative spoken to on the day said that when they were considering the service as a permanent home the information sought as part of the assessment process covered all their immediate needs and requirements and are satisfied with the placement and the support provided. The home does not provide separate intermediate care service, but prospective residents can be offered respite care if beneficial to their needs. this aspect of the service is also used as an introduction to longer term residential care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of the residents is established in each plan of care and is used to ensure assessed needs are met. There are clear policies and procedures in place for the safe management of medication and health related activities. Evidence: From the information there is evidence in the care plan that residents personal health care needs are met and reviewed as needed. Residents and relatives spoken to on the day said that the support they receive is personal and flexible. However the content of some of the care records including the daily reports should be more specific in recording met needs especially about those residents who may not be able to express an informed view about their own care, as well as for those residents who may be receiving end of life support. During the discussions with residents it was said that the staff are caring and helpful and one person said that since living in the home they have become much more able . Another said that the staff appreciate my personal needs and are always attentive Care Homes for Older People Page 13 of 27 Evidence: and helpful. One resident said I like it here and I told my daughter you couldnt have found me a better place. One relative spoken to during their visit said they are very happy with the care support provided and any issues or queries are dealt with quickly. The management and storage of the medication is well maintained and a trained member of staff was observed administering and recording medication in a safe manner. The medication storage and administration is checked and audited monthly and was subject to an external audit by the Great Yarmouth Primary Care Trust in 2007. The manager confirmed that they seek the advice and guidance of health care professionals and specialists with regard to aids or adaptations or tissue viability and have regular contact with the continence adviser ( nurse) and have been supported with training from local district nurses on end of life care. There is a long term plan to build a small extension to the rear of the premises and offer accommodation to older people with dementia. As part of the overall preparation for this change the manager will be reviewing the dependency levels of residents and staff numbers and skills to meet anticipated needs in 2008/09. the manager also confirmed that she will be undertaking specialist training in the management and care of people with dementia. Care Homes for Older People Page 14 of 27 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. There are processes in place that ensure residents expectations can be met and that community and family contacts are promoted. Residents are offered and receive a varied and nutritious diet. Evidence: From the information provided and from the discussions with residents and visitors and staff, the home meets the needs and expectations of people who live there. One visitor said that their relatives health had improved and is enjoying life much more now since moving to the home. One resident said that they have everything they need and people are very helpful and are always on hand. Others commented positively about the menu and meal options. On the day of the inspection the lunch time meal looked appetising and well presented. The manager stated that the care plans are in the process of being updated to include the MUST guide which is a recognised tool care staff can use to monitor residents nutritional intake and dietary needs. The manager confirmed that one member of staff will be undertaking the training and cascading the information to the remaining staff team. Another said I am very happy here and everyone is kind and respectful.Residents said there is a range of things one can do and that includes going out and shopping and Care Homes for Older People Page 15 of 27 Evidence: meals at the pub. Risk assessments form part of the care plan and the home has recently been the subject of a satisfactory inspection by the Health and Safety executive which included a review of policies and procedures. The manager confirmed that these have been updated and revised in 2008. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have access to a complaints procedure and can be sure that their concerns and complaints will be acted on and investigated. There is a procedure in place to protect residents from abuse. Evidence: From the information received there is a complaints process in place and a complaints log which is maintained by the manager. Details about concerns raised with the home need to be more detailed and give a clearer account of who is involved and carried out any investigation and also record any action taken as a direct outcome of the investigation. All investigations and complaints reviews should be signed and dated and indicate that they have been audited or reviewed to monitor any possible recurring pattern. Not all the residents seen on the day were clear about a complaints procedure but were very clear who to talk to in the event of any concerns or issues. One visitor said that they had raised couple of minor matters with the management and they had been dealt with professionally and efficiently and they had been satisfied with the outcome. Carers have attended safeguarding adults training through the Primary Care Trust in 2007 /08. Staff can also access helpline telephone numbers ( for whistle blowing) . Three staff files seen on the day contained evidence of satisfactory criminal bureau records checks (CRB). Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with safe and appropriate environment with access to equipment and aids to promote independence and mobility. There are good procedures in place for infection control and overall cleanliness. Evidence: There is a refurbishment programme in place for the premises. The kitchen area has recently been upgraded to a good standard and included replacement equipment, utensils, storage facilites and flooring. An audit of bed linens and fabrics has also been completed but replacements have not yet been purchased. Some of the linens in use are showing heavy use and are very worn. Armchairs for the sitting rooms and carpets in some of the residents rooms have also been replaced this year. The dining room has been refurbished offers a homely and pleasant setting for meals. Two of the bathrooms are regularly in use. A third bathroom is not available to residents currently as it is being used to store various items of equipment. This assisted bathroom should be accessible to residents. The home is the subject of ongoing improvement but there are living areas that would benefit from review to ensure that equipment and other miscellaneous items can be safely stored and out of sight. During the discussions about the environmental changes in progress the manager acknowledged that a formal programme with timescales for Care Homes for Older People Page 19 of 27 Evidence: building and refurbishment would assist in the monitoring of the premises. Regular tours and checks of the building and grounds would also ensure attention to detail and standards maintained. There are plans in place to extend the premises to the rear of the building and this will reduce the garden area available. Planning permission has already been granted for the extension.There is limited off street parking to the front of the premises. Care Homes for Older People Page 20 of 27 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 is a robust recruitment and selection process in place supported by relevant training to ensure staff can meet residents needs Evidence: From the information provided on the day of the inspection there were sufficient numbers of staff to meet residents needs. Residents spoken to said that staff are prompt and attentive when called. Others residents seen on the day also gave good examples of personal care and support . A small number of staff files were made available and are up to date and well maintained. The recruitment details and identity and criminal records bureau checks for staff are also in place. Of the fifteen staff in total four staff hold NVQ 2 or higher qualifications and three staff will complete NVQ 2 this year. Two service staff are also completing NVQ 2 in housekeeping this year. Staff receive formal supervision from the manager and said that the sessions help their everyday practice and they feel well supported by the processes in place. Care Homes for Older People Page 21 of 27 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 service provided maintains the best interests of residents and staff. Evidence: Staff supervision is in place and a record maintained in each persons file. From the information received regulation 26 visits are now being carried out by the registered providers and the reports completed each month with copies held in the home. There are plans to build a small extension to the rear of the premises and planning permission ihas been granted.The manager confirmed that there are regular meetings with the providers to discuss the progress and day to day management of the home. However, there is no formal record of supervision or personal development for the manager or business plan / minutes which would reflect the progress of the service and enable the manager to prioritise planned work as well as develop a more focused and structured managerial style. The manager has achieved NVQ 4 qualification this year and is also looking to do additional training in the care and management of older people with dementia. Care Homes for Older People Page 22 of 27 Care Homes for Older People Page 23 of 27 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 24 of 27 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 3 The care files including the assessment section would benefit from a management review to ensure that all relevant information is in the file and is up to date and maintained in chronological order for easy reference. It is recommended that the management review the recording and reporting protocol for the home to ensure that specific information relating to residents healthcare and well being is detailed and specific. It is recommended that the care files are reviewed to ensure that the filing protocol for the assessment information and the plan of care are consistent and in chronological order for easy reference. It is recommended that the training in the use of the MUST nutritional tool should be completed and the monitoring process used to support resident overall plan of care. It is recommended that the complaints records for the home are reviewed to ensure that they give a clear account of any investigation and outcome and are dated and signed and regularly audited to monitor any possible recurring patterns. It is recommended that regular audits of the environment Page 25 of 27 2 7 3 7 4 15 5 16 6 19 Care Homes for Older People are carried out to ensure that the home remains well maintained and equipment and everyday items are stored appropriately. 7 19 It is recommended that a detailed programme of building changes and refurbishment with timescales be drawn up to ensure that work on the premises and furnishings and fabrics are timely and any slippage in completion and implimentation is minimal. It is recommended that the first floor assisted bathroom is reviewed and restored and made accessible to residents It is recommended that the manager undertake specialist training in the care and management of people with dementia as part of the long term management plan for the service. It is recommended that a short term business plan is established to enable the manager to prioritise work commitments and help to develop a more focused and structured managerial style. 8 9 21 32 10 32 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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