Care Home: The Warwickshire

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What the care home does well People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem and quality of life. The home is well maintained providing a safe, homely and clean place to live. The home has achieved the Gold Standard Framework with a commendation which has helped them to provide a good standard of care to people needing end of life care Comments from residents and relatives told us: "Lovely gardens, lovely surroundings...The decor makes it feel like home, rather than a home for the resident`s. It doesn`t feel clinical." "The staff on duty always have time to answer any questions that we may have about `X` (Resident)." "I like the idea that residents do not all have to go into the one lounge. With lots of little lounges those who do not want to be in a crowd don`t have to be." What has improved since the last inspection? The manager has taken steps to address the requirements from the last inspection. This shows us her commitment to making sure that people live in a safe and well run home. Information about the home has been reviewed and updated. Information is also available in audio format. This will help to make sure that people who are thinking of moving into the home have current information about the home. The contents of residents care files and care plans have improved to provide more details on their specific care needs. This will help to make sure that residents receive care appropriate to their needs. The home has improved the level and types of activities and events that take place. Formal links have also been established with the local community. This will help to provide appropriate stimulation for people who live in the home and help them to maintain links with community life. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Relatives that live a long distance away from the home told us that they are given the opportunity to communicate with the home by email and receive a prompt reply. This helps families to keep in touch with each other. Specific staff are allocated to be available for residents at meal times. This will help to make sure that people receive their meals in a timely manner and give staff the time to support residents with eating. The level of training attended and received by staff has improved. This will ensure the safety of people who live in the care home and that staff are trained and competent to meet their care needs. What the care home could do better: The home needs to make sure that residents are weighed as part of their health and well being checks. This will help to provide information from which to monitor any deterioration or improvement in a person`s state of wellbeing. People living in the home must have a risk assessment completed so that staff can identify whether residents are at risk of decreasing weight loss or poor nutrition. This will make sure staff develop appropriate plans to manage residents care based on specific identified needs and recognise people who are at risk. There needs to be formal procedures and assessments in place before giving resident`s family members or their representative a key to the home. This will help to make sure that the safety of people living in the home is maintained at all times and that staff are aware of who is visiting in the home at all times. The owners of the home need to make sure that someone is appointed in their absence to make monthly visits to the home. This will allow them to monitor the ongoing quality of services the home provides. Key inspection report CARE HOMES FOR OLDER PEOPLE The Warwickshire Main Street Thurlaston Rugby Warwickshire CV23 9JS Lead Inspector Yvette Delaney Key Unannounced Inspection 18th September 2009 11:30 DS0000004326.V378018.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 2 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 The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Warwickshire Address Main Street Thurlaston Rugby Warwickshire CV23 9JS 01788 522405 01788 817260 WARKS97@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr R A Perry Mrs Perry Mrs Jeanette Margaret Corby Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (OP) 46 The maximum number of service users who can be accommodated is: 46 11th August 2008 Date of last inspection Brief Description of the Service: The Warwickshire Nursing & Residential Home is set in the small village of Thurlaston, near Rugby. The nearest amenities and shops are in the near by village of Dunchurch. The home can be reached via public transport although this does not run very regularly. The nearest bus stop is approximately ½ mile away, on the main Dunchurch road. The home is registered to provide accommodation, nursing, personal and palliative care for up to 46 elderly men or women who are over 60 years of age. Bedroom accommodation is in either single or shared rooms. Some of the bedrooms have en suite facilities, although not all en suites are easily accessible. The Warwickshire was originally a 19th century manor house, which has been converted and extended to make a large care home. It is set in its own extensive grounds, which are laid to lawn, meadow and flowerbeds. The manager told us that the range of fees payable for living at The Warwickshire is £500 to £850 per week. Additional charges are made for hairdressing, private chiropody and other sundries such as newspapers and toiletries. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 Star. This means that people who use the service experience adequate outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main Key Standards. Before the inspection, we looked at all the information we have about this service, such as notifications of accidents, concerns, complaints or allegations and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. We looked at the Annual Quality Assurance Audit (AQAA) which the manager completed and returned to us before our visit. This is the managers review of the service and gives us information about how the service has progressed in the last 12 months. We sent out random surveys to people who live at the home, their relatives, staff working in the home and social and health care professionals in order to gain peoples views about the service. Three were returned by residents, ten by relatives, two surveys were returned by professionals and twelve from staff working in the home. Their comments are included in this report. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We talked to people living in the house and observed their interaction with staff. We looked at the environment and facilities provided and checked records such as care plans, risk assessments, complaints records, staff training records and fire safety and other health and safety records. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view of some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 6 Throughout this report, the Commission for Social Care Inspection will be referred to as us or we. What the service does well: People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem and quality of life. The home is well maintained providing a safe, homely and clean place to live. The home has achieved the Gold Standard Framework with a commendation which has helped them to provide a good standard of care to people needing end of life care Comments from residents and relatives told us: Lovely gardens, lovely surroundings...The decor makes it feel like home, rather than a home for the residents. It doesnt feel clinical. The staff on duty always have time to answer any questions that we may have about X (Resident). I like the idea that residents do not all have to go into the one lounge. With lots of little lounges those who do not want to be in a crowd dont have to be. What has improved since the last inspection? The manager has taken steps to address the requirements from the last inspection. This shows us her commitment to making sure that people live in a safe and well run home. Information about the home has been reviewed and updated. Information is also available in audio format. This will help to make sure that people who are thinking of moving into the home have current information about the home. The contents of residents care files and care plans have improved to provide more details on their specific care needs. This will help to make sure that residents receive care appropriate to their needs. The home has improved the level and types of activities and events that take place. Formal links have also been established with the local community. This will help to provide appropriate stimulation for people who live in the home and help them to maintain links with community life. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 7 Relatives that live a long distance away from the home told us that they are given the opportunity to communicate with the home by email and receive a prompt reply. This helps families to keep in touch with each other. Specific staff are allocated to be available for residents at meal times. This will help to make sure that people receive their meals in a timely manner and give staff the time to support residents with eating. The level of training attended and received by staff has improved. This will ensure the safety of people who live in the care home and that staff are trained and competent to meet their care needs. 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. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People using the 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 wishing to use the home have access to up to date information. This will help them make informed decisions about using the home. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. EVIDENCE: People wishing to use the home now have access to up to date information about the home. We were given a copy of the statement of purpose and as we requested at our last inspection visit this document has been updated. The statement of purpose is also available on an audio tape. Information included in the statement of purpose and service user guide includes a summary of the The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 10 outcome of our last inspection visit. People also have access to the full report, which is available in the reception area of the home or on request from the home manager. Relatives and residents told us in conversation and in completed questionnaires returned to us that they had received sufficient information about the home. People said that they were invited to look around the home. This gives them the opportunity to ask questions and make sure they have enough information before deciding that they would like to move in. The care files of three people who had recently moved into the home were examined. Discussions with two of these people, a relative and staff showed that the pre-admission process followed by the home is robust. The home manager and deputy manager confirmed that either one of them or both carry out the pre-admission process. Information in the care files show that these are completed wherever the person is currently resident this includes other care homes, hospital or the persons house. The pre-admission assessment is used to find out information about a persons needs. The home can then make sure they have everything in place such as equipment and sufficient staff to meet these needs. During our conversation with one of the residents whose care file was seen they told us We made the right choice and Staff have been very friendly. This person likes their own company so to prevent isolation and help the person feel at ease in the home staff told us that when the resident first moved in they took the time to introduce them to other people living in the home. The resident chooses when they want to sit in the lounge or dining room with other residents and when they want to be by themselves. We found that the residents wishes are respected by staff working in the home. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans show improvement but do not all identify clearly the individual needs of residents or that an appropriate review of care has taken place. This will help to show that peoples health and personal care needs can be met. People are treated with respect and their dignity maintained which helps to increase their self-esteem and quality of life. EVIDENCE: The service stated in the AQAA that All residents have a personal centred care plan drawn up with the resident and representative. This sets out the action which needs to be taken by care staff to ensure that all aspects of health and The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 12 social needs are met... All care plans are reviewed at least monthly. Care plans are made for each individual resident. We looked at the care files for three people admitted to the home since the last inspection. Using generic care plans means that the same plans are used for all residents. However although care plans we reviewed show improvement in their content they did not always identify all the individual care needs of the residents. Examining the care files also showed us that instructions for residents care were not always written under the appropriate care need section of the care plan. For example a care plan on mobility contained instructions on meeting the personal hygiene needs of one of the people we looked at. When this type of plan is used, they should contain any additional information based on an individual assessment of each resident. There was evidence to show that each person and their relative or representative had been involved in the development of their care. It was not clear from the information in care plans that the care of residents are fully reviewed. We saw that risk assessments, which include mobility (risk of falls) and moving and handling, had been completed. Specialist equipment such as nursing beds, airwave mattresses (special mattresses that help to relieve the pressure on a persons body while they are cared for in bed) had been provided where identified. Other equipment seen in use includes hoists, wheelchairs and walking aids. Two staff were observed to transfer residents safely when helping them from one place to another for example from wheelchair to armchair. Nursing staff wrote daily reports in the residents care files. These identified how people spent their day to day life and gave details on their health and well being while living in the home. Entries had been signed, dated and timed by the member of staff who had made the entry. This provides information for auditing the care and attention people living in the home have received and the name of the staff member responsible for ensuring care needs are met. People have access to healthcare professionals. Evidence in the care files of the people we looked at show that people have received visits from the GP, optician, dentist and chiropodist if there were concerns about their health or for routine visits. A health care professional told us that Staff communicate well with outside agencies and relatives. There are concerns however that residents are not always referred when there are problems in relation to residents who are losing weight. This information was shared with us by the local social services and primary care trust (PCT). The home manager told us The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 13 that the GP has said that residents dont have to be weighed. The reasons given for this was because of their age and that residents were at the end of their life. We looked at the care plan of a resident who was assessed as losing weight at the pre-admission assessment. The person had their weight recorded on admission but no further weights. This area of the persons care was not well documented. For example there was no information with regard to whether a referral had been made, treatment given or how often the person should be weighed. The manager told us that the home had just purchased new sling weighing scales, which means they can also weigh residents who are bed bound. However although the PCT, social services carried out a joint visit of the home in June this year and it was agreed that residents would be weighed. Residents still had not been weighed at this inspection visit. The home manager told us that this is because staff have not received training on how to use the scales. The home intends that the maintenance man will train the staff. We were told that this means waiting for the maintenance man to familiarise himself on using the weighing scales. We discussed with the home manager and her deputy the possibility of asking the company from whom the scales were purchased whether they offer staff training. In discussion we reminded the manager that the home has a duty of care to make sure they support residents in meeting all their care needs. Any loss in weight could be due to an illness which is treatable and therefore should be referred for medical advice. In response to the draft inspection report the manager has confirmed that new sitting scales have been purchased and a room has been designated as a weighing room. This had been in place at the time of our visit to the home and these scales have been used. The progress the home has made on ensuring a formal system is in place for monitoring residents weights will be examined at our next inspection visit to the home. We looked at a sample of medication administration records (MAR) and how the medication was stored. Only trained nurses administer medication at the home. The MAR charts showed that there were no gaps on the chart and they had been signed when medication had been given. This helps to demonstrate that medication had been given as prescribed. The home has a medicines and self-medication policy, which has guidelines for residents who can self medicate. Procedures are in place for staff on the safe The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 14 receipt and disposal of medicines. Audits are carried out to make sure that safe practices are being maintained. All people spoken with told us they were happy with the care and support given to them and that all of the staff were kind and caring. We observed good interaction between staff and residents. Staff were seen to respond to requests for assistance in a safe and respectful manner. The home has been awarded the Gold Standard Framework with a commendation for the care of people at the end stage of their life. At the time of our inspection visit there were no residents receiving end of life care. Relatives expressed in a quality audit carried out by the home that: I live a distance away and I was offered a vacant room to stay overnight if necessary. The staff were very supportive and caring. Relatives also told us in the questionnaires they returned to us that they felt supported by staff and they were kept up to date on their relatives condition. Some comments include: Nurses/care workers treat the residents with respect at all times. Individual needs of all residents are well catered for. A health care professional told us that Staff demonstrate compassion and care for residents needs. Residents respond well to the staff. Staff in the home told us that Patients are well cared for as they are kept clean and they are given a wide...choice of foods. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their independence, interests, and take part in activities taking place in the home which would enhance their quality of life. People benefit from a varied and nutritious diet. EVIDENCE: The homes AQAA told us that Activities are available for residents who wish to participate. The manager told us that activities and events were discussed at a residents meeting and residents said that they only want to have activities in the home twice a week. We were told that links have been increased with the community, which mean that residents can take part in planned village events. One of the examples of this link is the annual village fete takes place in the gardens of the home. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 16 At the time of our visit five residents were actively taking part in a game of bingo led by one of the carers. Residents and family members said that someone also visits the home and talks about things that helps them remember events of the past, such as the war, music and special times of the year. Outside entertainers provide reminiscing, singsongs, musical movements and we have armchair line dancing. All three care plans we looked at identified peoples likes, dislikes and preferred routines. The home told us in their AQAA that they support relatives to take their family member to the local garden centre. The home will then collect the residents when they are ready to return to the home. Other activities which take place in the home include dominoes, cards and crosswords. The home has identified four members of staff who express an interest in being involved with social activities and events. Residents who do not wish to take part in these activities have the opportunity to have one to one conversations. People of varying faiths live in the home and their beliefs are respected by supporting them to access the services of local churches and other religious premises. This is done by arranging for local religious representatives to visit the home. Holy Communion is provided each month. The home has one resident who practices Buddhism and arrangements have been made for a priest from a neighbouring town to visit them in the home. The home has an open visiting policy. Residents and their relatives told us that they are able to visit as they wish. This information was confirmed by information in the visitors book which showed the times people entered and left the home and who they were visiting. Families and friends were seen visiting the home throughout the day. We were told by the home manager that family members are offered a key to the front door of the home. This is so that they do not have to wait for someone to open the door when they come to visit their relative. We discussed our concerns about this with the manager as this practice does not support making sure that residents are safe in the home. This practice is discussed further under the complaints and protection section of this report. The manager told us that the residents decide where and what they would like to eat. Mealtimes have been better organised to make sure staff are available to support people to receive and eat their meals in a timely way. For example there are two members of staff who have the responsibility of ensuring all residents have their breakfast. They chose their meal during the afternoon of The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 17 the day before. The cook showed us that she knows the residents and is aware of their likes and dislikes. The cook gave out snacks and drinks to residents and we noted that their interaction and rapport with her was very good. People who live in the home told us that the food is good, however a family member told us that they felt the menu is a little basic. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 feel that their complaints are taken seriously by the home. Appropriate policies and procedures in relation to some practices carried out in the home are not in place to make sure people are protected from the risk of harm. EVIDENCE: A copy of the complaints procedure is displayed in the home and a copy is available in the statement of purpose this makes sure that it is accessible to people living in the home, their families and staff. Questionnaires returned to us from people living in the home and their relatives said that they would know who to speak to if they were not happy. Several people said that they would speak to a member of staff and they would sort things out. They were also aware that they could approach the manager or deputy manager if they needed to do so. Comments by people indicate that The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 19 any concerns they may have are dealt with informally at an early stage before there is a need to formally complain. Relatives told us that: Management always have time to listen to concerns of patients (Residents) and relatives. This also applies to senior nurses. The manager has an open door policy for resident’s relatives and staff to discuss any problems they have. We examined a complaints log maintained by the home. Three verbal complaints were received these related to staff attitude, the lift not working and concerns that a resident did not have the nurse call bell accessible. We found that all verbal complaints were written up and responded to by the home manager. The concern about the lift was responded to by the provider who was visiting the home at the time. There have been no formal adult protection issues reported in the home. However there are concerns related to the safety of people living in the home. These include concerns from the homes local social services and PCT which suggests that staff are not fulfilling their duty of care in relation to weighing residents who present with weight loss. We found at this inspection visit that the home has still not commenced weighing residents as part of monitoring their well being. Our other concern relates to the home manager telling us that family members are offered a key to the front door of the home. This we were told by the manager and in the homes AQAA give family members access to the home without having to wait for staff to answer the door. We discussed our concerns about this with the manager as this practice does not support making sure that residents are able to live safely in the home at all times. We asked questions such as: What is the assessment process for deciding who can have a key? What if family members were to loose the key? The home did not have a written procedure or policy that they follow for giving the keys out and to show that a formal assessment is carried out before family members are given a key. Family members are asked to leave a £20 deposit, which is returned to them when their relative leaves the home. It was also explained that the type of key offered means that family members are not able to get a duplicate cut. In response to the draft copy of this inspection report and subsequent telephone call (07/01/10) the home manager has advised that when setting up the above security key policy they sought advice from their local police service who were satisfied with the system. The manager told us that she will revisit the procedures with a view to having signed documentation which show that The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 20 people who which to have a key understand the conditions for the safety of the key and people living in the home. The home has told us that all new staff are appropriately screened and trained in protection of vulnerable adults. Ongoing training about safeguarding vulnerable adults takes place. A workbook titled Recognising and Responding to Adult Abuse and Neglect produced by the Warwickshire Safeguarding Adult Board has been introduced into the home for all staff to complete. The manager and deputy manager have attended relevant training to help them make sure that people living in the home are enabled to make decisions about their care and their freedom to live as they wish is not prevented. This information has been cascaded down to staff working in the home. Independent advocacy support is available to people living in the home and four residents are currently accessing this service. Advocacy Alliance manages the finances of some of the residents living in the home. Four staff confirmed that they had received safeguarding training in the last year. The training records show that all staff have received training in recognising abuse this year. Staff spoken with were able to demonstrate an awareness of the different types of abuse that they may encounter and how to report such incidents. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 environment is generally well maintained providing a homely place for people to live in. EVIDENCE: The Warwickshire provides services and care to people who are over the age of sixty, which include people who are frail and elderly. The facilities available show that the home is well equipped to help support their care needs. The home has well maintained grounds at the side and rear of the home these are accessible to all the residents. At the time of the inspection visit the home The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 22 looked well presented and ongoing maintenance had taken place. Relatives told us in their questionnaire that Redecoration needed in some areas. The home told us in their AQAA that all rooms have the equipment and furniture needed to meet their needs. Each room has a nurse call system, which is portable and can be positioned wherever the resident is. Multi height beds and pressure relieving mattresses have been purchased. All residents are assessed before moving into the home to identify if they will need a special bed and mattress. Residents are able to use a chairlift or a passenger lift for access to the first floor of the home. When the passenger lift was out of order residents who had not used the chairlift before were assessed to make sure they would be able to use it safely. People living in the home all have single bedrooms as they or their representative have said that they do not wish to share. The bedrooms of the residents we looked at showed that they were made comfortable and homely by using and displaying their own personal items. Examples of this include pictures, ornaments and small pieces of furniture. This shows us that people are able to personalise their bedrooms which will help them to feel comfortable and live in a homely environment. Looking around the home demonstrates that ongoing maintenance takes place to make sure that a safe environment is provided for people to live in. The home has recently changed to piped gas in the home and two new boilers with thermometers to control the water temperature have been installed. To prevent the risk of scalding all sinks and baths accessible to residents and staff have pre-set temperature valves. Water temperatures are tested monthly and recorded. A sample of the water is water is tested yearly for Legionella by an accredited testing laboratory. A dedicated person manages the laundry services in the home. Our conversation with this person and observation in the laundry showed that they took pride in their work. The member of staff was knowledgeable about procedures and health and safety practices needed in the laundry. There are well defined clean and dirty areas and the laundry is kept very clean and organised. People living in the home were well dressed and presented at the inspection. Residents and their family did not express any concern about the laundering of their clothing. The home carried out a quality audit on the laundry service the result showed that the service had improved. The home has an infection control policy, which staff spoken with were aware of. The policy includes information for staff on the safe handling and disposal of clinical The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 23 waste. It also covers hand washing and the use of protective clothing. We saw staff using aprons and gloves when helping people to use the toilet. At the time of this inspection the lift was not working. The manager of the home had notified us about this. The home had put plans in place to support residents to access the ground floor while the lift is out of action. The home has a stair lift which residents assessed as able were helped to use. The home has been visited by the environmental health department. Their report shows that there has been improvement in practices carried out in the kitchen. However at this inspection visit it was noted that records related to cleaning, fridge and freezer temperatures and safe practices were not all available or completed. Evidence of this information would help to confirm that procedures related to good standards of food hygiene and cleanliness in the kitchen are maintained at all times. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels help to meet the needs of people living in the home. Residents can be sure that qualified staff are caring for them. Robust pre-employment checks help to safeguard people from the risk of harm from abuse. EVIDENCE: The hours worked by the deputy manager are included on the duty rota. However the hours worked by the home manager are not included on the rota. This does not demonstrate to us what management support and hours are provided in the home. The home has sufficient staff to provide a good level of care to people living in the home. We saw sufficient staff cover on the day of the inspection and staff spoken to told us that staffing levels are usually good. The home had arranged staffing to make sure that mealtimes are appropriately staffed to support residents that need help with eating. Duty rotas for a four week period show that this level of staffing has been constantly maintained. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 25 Additional staffing in the home includes the services of housekeeping, laundry, maintenance and kitchen staff. Family members who completed questionnaires told us that the home could do better with staffing. They told us that: On occasions when staffing is short it does give problems with regards to the set routines. Concerns seem on those days to increase as the day goes on, never settling to a relaxing day for my wife on that day. ...A greater staff patient ratio would assist available response time. Except when they are doing the essentials feeding, putting to bed, getting up from bed, medication etc. I feel the staff do not spend quality time with residents many of whom would benefit from one to one TLC. A further relative told us that the home could do better by: ...ensuring the staffing ratio to residents is appropriate to meet the individual needs without putting undue pressure on staff... Training records were available for examination. Records showed that staff had completed a series of training since the last inspection these include recognising abuse, dementia awareness, whistle blowing, food hygiene, moving and handling, infection control, fire safety and health and safety. New staff complete an induction programme, which is linked to an NVQ qualification in care. Comments by staff confirmed that they are provided with training designed to support people in a safe manner, such as moving and handling, food hygiene and fire safety. The files of three recently employed staff were checked. All the files seen contained evidence to show that pre-employment checks had been carried out before people start work at the service. The checks include, two references and a Criminal Record Bureau checks, as well as evidence of personal identification. The files examined Files demonstrated that good recruitment practices are in place. This will help to make sure that staff are checked as being suitable to work with vulnerable adults. Files for nursing staff show that they contain evidence of a current Personal Identification Number (PIN), which confirm that they are registered with their professional body Nurses and Midwives Council (NMC) and therefore eligible to practice as a registered nurse. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 26 Staff questionnaires we received indicates that there are some concerns about fairness in the home in relation to the allocation of tasks saying that it would be better if tasks are rotated and staff are treated the same. Staff felt that this would help staff to work better together ...without any grumbling. Staff also told us that this would also help to improve the standard of care in the home. Another member of staff expressed that staff discipline and the level of staff sickness needs to improve. Staffing levels in the home were not affected by sickness at the time of our visit and staff were observed to be working well together. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the 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 stability of the management structure within the home helps to make sure that the service is run in the best interests of people living in the home. EVIDENCE: Information in the AQAA tells us that The registered manager has been employed at the home for 16 years and has the additional qualifications in care of the elderly and management. The deputy manager has been in post for 15 years. The home is also supported by an administrator who has been in post The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 28 for 9 years and shows a good understanding of the systems involved in helping with the administration and management of the home. The home told us that Teamwork is of prime importance and the communication within the group is good. People spoken with and comments in residents questionnaires told us that: Internal communication could be improved. Staff told us that Communication between departments could improve and Staff questionnaires we received indicates that there are some concerns about fairness in the home in relation to the allocation of tasks saying that it would be better if tasks are rotated and staff are treated the same. Staff felt that this would help staff to work better together ...without any grumbling. Staff also told us that this would also help to improve the standard of care in the home. Another member of staff expressed that staff discipline and the level of staff sickness needs to improve. Staffing levels in the home were not affected by sickness at the time of our visit and staff were observed to be working well together. A formal quality assurance system has not been introduced into the home. However evidence shows that audits are carried out on the services provided by the home and areas for improvement are identified. For example a recent survey was carried out to look at peoples views about living in the home and weekly audits have been completed on the management of medicines in the home. A quality audit was also carried out on the laundry service has improved. Separate staff, residents and relatives meetings are held. These help to make sure that people are encouraged to be involved in the day to day running of the home. In January 2009 the home was awarded the Gold Standard Framework in end of life care with a commendation. There was no evidence to show that the owners of the home or an appointed person make unannounced visits to review the quality of services provided by the home. The personal monies of people living in the home are kept securely. Accurate records of income and expenditure are available. The records of the four residents followed through the case tracking process where asked for. Monies and records available show that balances are accurate and auditing is regularly carried out. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 29 Staff confirmed that they had received supervision. An example of a completed supervision form seen showed us the process involved. These include a discussion of identified issues, training and development. Information in the AQAA tells us that health and safety checks are carried out. We examined records to show that maintenance, contracts and servicing documentation for electrical equipment, clinical waste and all other services supplied to the home had been checked. Examination of records also showed that they were well organised and maintained. The home has recently changed to piped gas and two new boilers with thermometers to control the water temperature have been installed. To prevent the risk of scalding all sinks and baths accessible to residents and staff have pre-set temperature valves. Water temperatures are tested monthly and records were available to confirm this. A sample of the water is water is tested yearly for Legionella by an accredited testing laboratory. This shows us that the home has systems in place to make sure people are protected through regular maintenance of systems, equipment and records. The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must be reviewed to make sure that they provide staff with clear instructions on how to meet the care needs of people living in the home. This will make sure that people receive the care they need. The home must make sure that people living in the home are weighed as part of monitoring their health and well being. This will allow for timely treatment to be implemented. The home must make appropriate referrals for advice or treatment when concerns about the weight of people living in the home are identified. The home must have a policy and procedure in place which includes carrying out a risk assessment before giving residents family members or their representative a key to the home. This will help to make sure that the safety of people living in the home is maintained at all times. Timescale for action 31/12/09 2 OP8 13 30/11/09 3 OP8 13 30/11/09 4 OP18 13 30/11/09 The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2 Refer to Standard OP7 Good Practice Recommendations Care plans should clearly show when peoples health and personal care needs have been reviewed and be updated to show any changes in the residents care needs. This will make sure that people receive the care they need. The home should make sure that records related to cleaning schedules and safe practices in the kitchen are completed and signed for daily as the task is completed. This will help to make sure that safe practices are monitored and maintained in the kitchen at all times. The hours worked by the home manager should be included on the duty rota for the home. This will help to demonstrate what management support and hours are provided in the home. Opportunities should be available for residents and their family to discuss their concerns about staffing levels in the home. This will help to make sure that people living in the home and their family feel confident that their care needs will be consistently met and staff have the opportunity to spend time with the resident. The opportunity should be taken to review communication systems in the home for residents, relatives and staff. This will help to make sure that people using the home feel confident that they are able to communicate effectively with staff and they are listened to. Systems should be in place to make sure that staff are able to express their concerns. This will give staff the opportunity to share and discuss their ideas on how to make improvements in the home. The owners of the home should make sure that systems are in place for monthly unannounced visits by an appointed person can take place in their absence to review the quality of services the home provides. 3 OP26 4 OP27 5 OP27 6 OP32 7 OP32 8 OP33 The Warwickshire DS0000004326.V378018.R01.S.doc Version 5.3 Page 33 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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