Latest Inspection
This is the latest available inspection report for this service, carried out on 22nd April 2010. CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for The Squirrels Care Centre.
What the care home does well Prospective people wishing to live at The Squirrels are assessed prior to admission so that the management and staff team are able to meet the individual`s needs. Visitors to the home are made to feel welcome and are offered refreshments. Several members of staff have been employed at the care home for some considerable time, providing stability and continuity of care to the people who live there. There is a quality assurance system in place so as to seek the views of residents and their representatives, staff and other stakeholders about the services and facilities provided at the home. People who use the service are able to raise concerns and feel confident to do this. Where safeguarding alerts are raised and initiated, there is evidence to show that the management and staff team of the home are proactive so as to ensure positive outcomes for people and that they are protected from possible harm and/or abuse. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. There is a safe and robust system in place to ensure that recruitment procedures within the home ensure people`s safety and wellbeing. People who live at the home are generally happy and content. People are happy with the care and support they receive. What has improved since the last inspection? Care plan documentation for individual people who live at the home are much improved. These were observed to be more person centred and risk assessments are in place for the majority of identified risks, including assessments for people who self medicate. Significant efforts are now in place to improve the home environment so as to ensure people have a pleasant place in which to live. All 3 statutory requirements from the last key inspection have been addressed and all but one recommendation met. What the care home could do better: All people living at the home must receive a varied social care programme that meets their needs. Each person`s care plan must clearly identify people`s social care needs past and present and how these are to be met. Key inspection report
Care homes for older people
Name: Address: The Squirrels Care Centre Warley Road Great Warley Brentwood Essex CM13 3HX 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: Michelle Love
Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home
Name of care home: Address: The Squirrels Care Centre Warley Road Great Warley Brentwood Essex CM13 3HX 01277224308 01277261353 thesquirrels@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Roda Magwizi Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Personal care to be provided to no more than fifty eight service users over 65 years. Total number of service users for whom personal care is to be provided shall not exceed 58. Date of last inspection Brief description of the care home Ashbourne Eton Ltd., which is part of Southern Cross Ltd., owns the Squirrels Care Centre. The home provides personal care and accommodation for up to fifty-eight older people. The home is a large listed building and is situated in extensive grounds in a rural location some distance from shops and public transport. The home provides transport to both staff and visitors. There are car-parking facilities at the front of the property. The home provides single and double bedrooms and all rooms have en-suite WC facilities. There are two lounges and a large separate dining room. Passenger lifts Care Homes for Older People
Page 4 of 30 Over 65 58 0 Brief description of the care home provide access to all upper floors. We were advised that the fees for accommodation range from £453.00 to £750.00 per week. Extras to the fees include hairdressing, chiropody, personal toiletries, magazines and newspapers. Information about the services provided at the home is located within the homes main reception area. Inspection reports are available from the home and from the CSCI website www.csci.org.uk Care Homes for Older People Page 5 of 30 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 10 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the manager from another Southern Cross Healthcare establishment had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to people who live at the home, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of care staff were Care Homes for Older People
Page 6 of 30 spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for people who live at the home and staff were requested to be sent to the home for distribution. At the time of writing this report we had received 7 completed staff surveys and 2 from people who live at the home. Where comments have been recorded these have been incorporated into the main body of the report. However we have been made aware by staff that staff surveys were not treated as confidential, staff were denied an individual envelope to place their survey in and surveys were read prior to these being forwarded to us. The Area Manager was made aware of this at the time of the site visit. The deputy manager, manager from another Southern Cross Healthcare home, adminstrator and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the managers and Area Manager, with the opportunity for discussion and/or clarification provided. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 30 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live at the home can be confident they will be assessed prior to admission and their needs will be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Records also showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Records showed the above information is used to inform the persons plan of care. Out of 7 staff surveys returned to us, 5 staff confirmed they are given up to date information about the needs of people they support and 2 staff surveys recorded usually they are given up to date information. Care Homes for Older People Page 11 of 30 Evidence: As part of this site visit the care files for two people newly admitted since the last key inspection to the home in August 2009 were examined. Records showed that a pre admission assessment was completed for each person by the deputy manager or a senior member of staff prior to the person being admitted to the home. There was evidence to show that information recorded as part of the pre admission assessment process was informative and the deputy manager had for one person taken into account and included their personal wishes and preferences. For example the pre admission assessment detailed they require 2 pillows at night, they like to sleep with the light off and like to have a hot drink before going to bed. It was unclear from the pre admission assessment as to whether or not the prospective persons and/or their representative had visited The Squirrels Care Centre. We spoke with one person newly admitted and they were unable to tell us if they and/or a family member had visited the home prior to their admission as they could not remember. When asked by us if they found the admission process to have been smooth, they replied oh I think so. The deputy manager confirmed that usual practice is for the prospective person and/or their representative to be given the opportunity to visit The Squirrels Care Centre prior to admission so as to look around the premises, to have a meal, to meet people who already live in the home and to meet staff. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. However inaccurate information relating to the name of the Responsible Individual of Southern Cross Healthcare and the incorrect address of the Care Quality Commission was noted. Care Homes for Older People Page 12 of 30 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have the majority of their care needs identified, however further development is required to ensure positive outcomes for people. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. As previously stated, in addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care, falls, continence and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and as stated previously, from other associated information provided by external stakeholders. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs. In addition one was also looked at in relation to a recent safeguarding matter).
Care Homes for Older People Page 13 of 30 Evidence: Records showed that since the last key inspection in August 2009, improvements have been made to the care planning system so as to ensure they provide clear information about the individual persons care needs and provide appropriate guidance to care staff as to how the persons care needs are to be met. Each care plan was seen to be written in plain language and was easy to understand. At the last key inspection we advised the management team of the home to develop the care plans further by ensuring that peoples individual strengths and abilities were also recorded. At this inspection we noted that efforts had been made to demonstrate where people are independent and able to retain skills and where they still require support from care staff. In general terms each of the care plans was seen to be regularly reviewed and where changes had occured the care records were amended to reflect this. For example the care records for one person showed they had recently experienced a specific healthcare need which had resulted in them having to be referred to the local hospital for further investigations. The care plan had been updated and reviewed to reflect this and there was clear evidence to show the care provided. The care plan for one person recorded them as being diabetic. Records showed there was a plan of care in place however this was seen to be generic and not person centred. The care plan made no specific reference as to how their diabetes should be monitored and/or their treatment. In addition there was no risk assessment completed detailing measures to be taken to reduce the risk to the persons health and wellbeing. We requested sight of the District Nurses records and these provided more information. These told us that medication for the persons diabetes was administered daily by a healthcare professional and their blood glucose levels monitored and recorded regularly. We discussed with the deputy manager and Operations Director the importance of ensuring the persons plan of care reflected the above. The same persons care file also made reference to them being at risk of high blood pressure. The plan of care was seen to be lacking and not providing clear guidance for staff as to the importance of monitoring and the potential risks. Records also showed that following a visit by a healthcare professional, the resident was to be referred to the local mental health team as a result of their confusion and aggressive behaviours. As part of case tracking we looked at their daily care records and other associated documentation and could find no evidence to support the rationale for the decision for this person to be referred to the local mental health team. There were no records to show that since their admission to the service they had been verbally or physically aggressive towards care staff or others or that they were non-compliant with some aspects of their care provision. Care must be taken by staff to ensure that the plan of Care Homes for Older People Page 14 of 30 Evidence: care is accurate and reflects the persons care needs and any changes. This refers specifically to the persons daily care records detailing on several occasions that they are restless at night, however their care plan continues to state [name of person] has no sleeping problems and does not have a particular bedtime. We looked at one persons care file in relation to pressure area care. Records showed that following a recent hospital stay the person was admitted back to The Squirrels Care Centre with several pressure sores on their body. We are concerned that these were not recorded within the pre admission assessment which was completed on the day of the persons re-admission to the home and that no plan of care was completed detailing how this was to be monitored and/or interventions to be provided. A risk assessment for pressure area care was in place however this did not record changes to the persons skin condition. We requested sight of the District Nurses records but were advised by the deputy manager that these were no longer kept in the home. Daily care records showed that the persons pressure area care was being monitored by a healthcare professional on a regular basis. However records also showed that as a result of no clear instructions for care staff in relation to the frequency that the person should have their body repositioned throughout the day, there was a lack of consistency by care staff, resulting on some occasions the person being turned hourly and at other times 2 hourly. The above was discussed with both the deputy manager and Area Manager and it was acknowledged that in hindsight a care plan pertaining to the persons pressure area care should have been put in place with clear guidelines in place for care staff to follow. The deputy manager advised us that following the persons discharge from hospital, no discharge form had been provided by the hospital. While we acknowledge this, the onus must be on the care home to ensure they have all discharge information from the hospital. Out of 3 care plans examined only 2 were noted to have a manual handling assessment completed. The care plan for the person that did not have a manual handling assessment recorded them as having a history of falls and they were assessed on admission as being at very high risk of falls. This was discussed with the deputy manager during feedback and they confirmed that it is the expectation of the organisation that all people living at the home should have a manual handling assessment completed, especially where they have been identified as at risk of falls. No rationale could be provided as to why this had not been completed on this occasion. The staff training matrix details that all senior members of staff have attained care planning training. The AQAA details that within the next 12 months it is hoped that all care staff will receive care planning training. Care Homes for Older People Page 15 of 30 Evidence: Records showed that people living at The Squirrels continue to have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include attendance at hospital appointments, optician, dentist, District Nurse Services, Community Psychiatric Nurse, GP, Dietician etc. Staff spoken with were able to demonstrate a good understanding and awareness of individual peoples care needs and throughout the day of the inspection, there were positive interactions between care staff and people who live at the home. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. Staff confirmed there are daily handovers and communication is good. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. A medication identification record for each person was in place providing a photograph of the individual, their name, date of birth, date of admission, name of GP, room number, known allergies and information as to whether or not they are able to self medicate. We looked at the Medication Administration Records (MAR) for a random sample of 12 people. These showed that records were of a good standard with no unexplained gaps or omissions. Where people are prescribed medication in a variable dose e.g. one or two tablets, the actual quantity was recorded each time, ensuring that people receiving this medication do not receive too much or too little medication. The temperature of the medication storage area is monitored and recorded each day. Records showed that the temperature where medication is stored was within recommended guidelines. In addition the temperature of the dedicated fridge used to store medication that requires cold storage was also recorded each day and this too was within recommended guidelines. The home carry out regular checks on the accuracy of medication records and these showed a good level of compliance achieved. The last medication audit undertaken at the home was on 24th March 2010 whereby 100 was attained. The staff training matrix showed that all staff who administer medication have up to date training. Care Homes for Older People Page 16 of 30 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home cannot always expect to have their social care needs met however the dining experience for people in the home is positive. Evidence: The deputy manager advised us that since 4th January 2010 the home has been without an activities co-ordinator. The AQAA which was completed by a home manager from another local Southern Cross Healthcare home recorded We have a dedicated activity co-ordinator who has vast knowledge of activities designed to benefit our client group. This did not concur with our findings or from discussion with the deputy manager. The deputy manager stated that efforts are underway by the organisation to recruit a new activities co-ordinator for 40 hours per week Monday to Friday. On the noticeboard in the main reception area of the home was an activities programme. The deputy manager confirmed to us that this is not being followed at the present time as a result of the above and activities where possible are being undertaken by care staff during the morning shift. The shift planner for the day showed staff designated to provide and/or initiate activities to people in the home. On the day of inspection we were advised that people were offered by care staff a choice
Care Homes for Older People Page 17 of 30 Evidence: of activities during the morning however these were declined and they requested a quiz instead. Several people during the day were observed to watch television, to read a newspaper or magazine, to go for a walk with staff or to sit and talk with one another. Staff spoken with stated there are a lot of quizzes held as people prefer this activity. Comments from people who live at the home were variable in relation to activities and included theres not a lot to do but watch the television and the activities dont suit me. While others recorded I prefer to sit and read my newspaper and I like the quizzes. Two surveys from people who live at the home recorded we have no entertainment. No-one to come to our room for a chat. Other than my own family there are no games, I love scrabble or other board games but I have no one to give me their time and for those who sit in their rooms alone, send someone every 2 hours to peek around the door to see if we are OK. Records showed that activities undertaken by people are not being recorded at the present time and of those people case tracked there was limited and/or no information recorded in relation to peoples social care needs, including past interests and hobbies and their personal preferences. This was highlighted at the previous key inspection to the home in August 2009. People who use the service are actively encouraged and supported to maintain important personal and family relationships. There remains an open visiting policy whereby visitors to the home can visit at any reasonable time. One visitor spoken with confirmed they can visit the home when they like and are made to feel welcome by staff. The dining experience for people was observed to be positive. Twelve people were seen to eat in the main dining room and the atmosphere was calm and relaxed. The tables were attractively laid with tablecloths, placemats, cutlery, glasses, serviettes, vase of flowers and condiments. People were given a choice of drinks and choice of meals and the menu on each table was in a written and pictorial format. The lunchtime meal given to people was seen to be provided in sufficient quantity and looked appetising. At the last inspection to the home negative comments were made by people in relation to the quality of the mash potato. At this inspection it was noted that issues previously highlighted had been addressed. At the time of the site visit only one person was requiring a pureed meal and on inspection of this all items were portioned separately and the meal looked appetising. The chef was observed during the meal to ask people if they had enjoyed their meal and also offered people more food. Comments from people who live at the home included the meal was lovely, its very good and very nice. Where people require assistance and/or prompting by staff to eat their meal, this was undertaken with respect and dignity. Care Homes for Older People Page 18 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: The home has a complaints procedure that explains to people how to raise issues and the timescales by which they can expect a response. This was clearly displayed in the entrance to the home and also detailed within the Statement of Purpose and Service Users Guide. The address of the Care Quality Commission needs to be amended to reflect their new contact details as this is currently inaccurate. Since the last key inspection to the service in August 2009 there have been 3 complaints. These related to concerns about care practice issues and alleged intimidation and bullying by some members of care staff. We were made aware of these by each complainant and in line with our methodology and approach to managing concerns and complaints, requested the registered provider look into each matter under their complaints procedure. The outcome of the complaints were one complaint was not upheld and some elements of the remaining two complaints were upheld. Records of each investigation were forwarded to us prior to this inspection and these showed that each one had been investigated fully, responded to and actions identified and completed. People who live at the home are aware of how to raise concerns and said they would discuss this with their member of family, a member of care staff or the deputy manager. People spoken with also indicated they were
Care Homes for Older People Page 19 of 30 Evidence: confident to raise issues and felt their concerns and/or worries would be listened to and dealt with. However 2 surveys forwarded to us from people who live at the home, recorded they did not know how to make a formal complaint or know who to speak to if they were unhappy. If the latter is an issue we expect the home to manage this. Since the last key inspection there have been 2 safeguarding referrals both of which have related to alleged poor care practices. The Care Quality Commission was made aware of both issues and we referred these to Social Care Direct. At the time of this inspection one had been fully investigated by the registered provider and the other is currently being investigated by Social Care Direct. The outcome of the safeguarding referral investigated by the registered provider was not upheld however a number of actions were highlighted. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the senior in charge of the shift and/or the deputy manager. On inspection of the staff training matrix this showed the majority of staff have got up to date SOVA (Safeguarding of Vulnerable Adults) training and others require refresher training. Care Homes for Older People Page 20 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained and comfortable environment which meets their needs. Evidence: A partial tour of the premises was undertaken with the maintenance person. Since the last key inspection an extensive programme of redecoration and refurbishment is in progress. This was confirmed by the deputy manager and Area Manager who both advised that a £150,000 refurbishment project is now underway to ensure that the physical environment of the home is greatly improved for people who live at the home. At the time of the site visit communal areas of the home were in the process of being redecorated. New furniture had been purchased and delivered to the home and included new recliner chairs for the lounge areas, new assisted bath fitted on the ground floor, new armchairs, carpets fitted in the corridors, over-bed tables for peoples bedrooms, new profile and divan beds purchased, new dining chairs, new curtains and new bedroom furniture consisting of a wardrobe, chest of drawers and lockable bedside cabinet. In addition a number of small flat screen televisions have been bought for people who do not currently have a television and a larger flat screen television purchased for the large communal lounge. We were advised that new
Care Homes for Older People Page 21 of 30 Evidence: bedding is on order for all rooms. It is of concern that a recent Key Outcome Inspection in March 2010 by the organisation showed that no risk assessments had been completed whilst refurbishment works have been undertaken in the home. This is despite some of the works affecting the areas that people who live at the home occupy. A courtyard garden to the side of the property has been newly created. This now provides safe access for people in wheelchairs and for those people who have poor mobility. There are a number of raised flower beds and tubs and we were advised that a water feature is to be fitted in due course. A fence is in the process of being erected on the veranda by the dining room which will help ensure peoples safety. A random sample of hot water emitting from wash hand basins and baths were examined. The hot water temperature was observed to be satisfactory to meet peoples needs. The bathrooms were seen to be satisfactory and broken toilet seats as highlighted at the last key inspection were seen to be replaced. On inspection of the shower room on the ground floor, a number of communal toiletries were observed to have been left, some of which belonged to a person who had recently passed away. No health and safety issues were highlighted at the inspection and the premises were seen to be clean, tidy and odour free. A maintenance person is employed at the home Monday to Friday for 40 hours per week, however their hours are flexible to cover emergencies at evenings and weekends. The home also employs a driver 7 days a week to transport staff to and from the train station and to transport people who live at the home to access the local community/enjoy days out. We looked at the homes fire records. These showed the homes fire system was last checked in March 2010 and additional regular checks are undertaken by the maintenance person in relation to the fire control panels, fire alarms, door releases/closers, emergency lighting and fire extinguishers. Fire drills are conducted each month and records include the names of staff participating, date, time and problems identified. A random sample of maintenance records were inspected and these were observed to be satisfactory and in date. Care Homes for Older People Page 22 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Squirrels can expect to be cared for by sufficient numbers of competent and safely recruited staff who can meet their needs. Evidence: The deputy manager told us there were 19 people living at The Squirrels and current staffing levels are 5 staff (including 2 seniors) between 07.15 and 14.15, 4 staff (including 1 senior) between 14.15 and 21.15 and 4 waking night staff (including 1 senior) between 21.15 and 07.15 each day. The deputy managers hours are supernumerary to the staff roster and there are additional ancillary staff employed and these include a chef, kitchen assistant, housekeeper and domestic staff. An administrator is employed at the home Monday to Friday from 08.00 to 16.00. On inspection of 4 weeks staff rosters, records showed that the above figures have been maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. The staff rosters show that no agency staff have been used at the home for some considerable time however there is a pool of bank staff to cover shifts on an as and when needed basis. Deployment of staff on the day of the site visit was observed to be appropriate for the needs and numbers of people in the home. Observation at this site visit showed that staff were working effectively as a team, are available throughout the day for people in the home whether they are in the communal lounge areas or choose to spend time in their room and there was
Care Homes for Older People Page 23 of 30 Evidence: good interaction by staff with residents. We were advised by the administrator that 2 people have been newly employed since the last key inspection. The purpose of this was to check the recruitment process in the home. Records showed there is a good recruitment procedure and process in place and required documentation is received prior to the employee starting work. Each member of staff was noted to have received the homes in house induction (Day 1 and 2) and completed Skills for Care. We requested a copy of the staff training matrix and advised the deputy manager this would be examined following the site visit. Records showed that the majority of staff working at the home have up to date training in core subject areas e.g. manual handling, fire safety awareness, health and safety, food and hygiene, infection control, safeguarding, emergency first aid, COSHH (Control of Substances Hazardous to Health) and nutrition awareness. Records also showed that in the last 18-24 months staff have undertaken training relating to pressure area care, customer care, challenging behaviour, dementia awareness and bedrail safety. Consideration needs to also be provided for those conditions associated with the needs of older people e.g. Parkinsons disease, Diabetes, oral care and sensory impairment. National Vocational Qualification (NVQ) records provided to us by the deputy manager show that 8 people have achieved NVQ Level 2 and 11 people have attained NVQ Level 3. Care Homes for Older People Page 24 of 30 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed. Evidence: At the time of the site visit the care home was being managed by the deputy manager as the registered manager was on maternity leave. In addition a manager from another local Southern Cross Healthcare home was providing support and assistance to the deputy manager. The majority of the AQAA was completed and the document returned to us when requested. The AQAA lets us know about the changes they have made, where they still need to make improvements and how they are going to do this. The evidence to support the comments made is generally satisfactory, although some of the information does not fully concur with our findings. This was partly due to the AQAA being completed by the manager from another Southern Cross Healthcare home and them not liasing with the deputy manager for accurate information. We advised the management team of the home that the AQAA was incomplete when this was returned
Care Homes for Older People Page 25 of 30 Evidence: to us and during the site visit additional information was added and a completed copy of the document handed to us. The organisation have several ways of monitoring the quality of the service provided at The Squirrels. These include monthly Regulation 26 visits, medication audits, health and safety audits and a Key Outcome Audit that is comprehensive, detailed and based on outcome groups as detailed within the National Minimum Standards and Care Homes Regulations for Older People. This was last completed on 31st March 2010 and as a result of the poor state of the environment was given an overall grading of poor. At the time of the last key inspection in August 2009 questionnaires had recently been sent out and were in the process of being collated. As a result of one of the complaints received at the home in November 2009, the Area Manager sent out satisfaction surveys to peoples relatives and/or representatives. Records showed that 13 out of 29 surveys were returned and out of these 5 identified areas of dissatisfaction relating to missing items of clothing, lack of staff at weekends-especially on Sundays, waiting a long time for the call alarm to be answered and wanting improvements to the home environment. We requested records of Regulation 26 visits and noted these have not been undertaken as regularly as they should, the last one on file being December 2009. The Area Manager confirmed that she was aware of the shortfall and this has been highlighted by the newly implemented Quality Assurance Team. Regular resident and staff meetings are held. A system is in place for staff to have one to one supervision meetings which provides opportunity and support, for example to review, training needs and care practices. A copy of the staff supervision record for 2009/2010 was provided to us by the deputy manager. This showed that the majority of staff are receiving regular formal supervision in line with the National Minimum Standards and staff spoken with confirmed this. In general terms the records were seen to be good however consideration should be given to ensuring there is a clear audit trail depicting actions agreed at the supervision, confirmation as to who is responsible for completion of the action and evidence of an outcome. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 17 Ensure where people are at risk or have sustained a pressure sore, there is a plan of care detailing equipment in situ and treatment provided. So as to ensure peoples health and welfare. 01/06/2010 2 12 16 Ensure people who live at the home are given the opportunity to participate in a varied programme of activities which meets their needs. So as to meet peoples needs. 14/06/2010 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 Ensure the Statement of Purpose and Service Users Guide contains accurate and up to date information. Care Homes for Older People Page 28 of 30 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 2 8 Ensure that every person who lives at the home has a completed manual handling assessment. Consideration to be made to provide staff with additional training pertaining to those conditions associated with the needs of older people. 3 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!