Care Home: Thistlegate House

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What the care home does well The surveys from people told us that `What the home does well` is; `General care and friendship, attentive staff, excellent meals, warm and very comfortable`. `Thistle gate is a very comfortable home from home`. `Staff are all excellent and friendly, It is well run`. `Interact with and give total commitment to the residents`. Peoples` needs are assessed before they are admitted to the home. There are overall general care plans and risk assessments in place for people living at the home. Staff have a good knowledge and understanding of people and their needs. People are supported to live their chosen lifestyle. There are some organised activities at the home. There is a homely feel and communal areas of the home are decorated to good standard. People are supported by a safely recruited and trained staff group. There is a small stable staff group that people like and know well. Four members of staff have gained NVQ level 3 and two staff including one of the providers have gained City and Guilds level 2 in promoting the mental health and well being of older people. The providers/managers are available within the home each day and receive regular feedback regarding the service provided. What has improved since the last inspection? All of the requirements from the last inspection have been met. The arrangements for recording peoples` weights has been reviewed and they are now recorded separately. Nutritional, falls, and pressure area risk assessments are now completed for people. The medication policy has been updated and controlled drugs are now stored in accordance with legislation and appropriate records maintained. Where people do not have access to or are not able to use a call bell there is a risk assessment and plan in place to ensure that they are regularly monitored. The providers/managers have notified the commission of significant events affecting people living at the home. Hazardous substances are now stored securely. Writtten confirmation has been given that the laundry floor is impermeable. All staff have either attended or are booked on a First Aid course. What the care home could do better: People`s needs should be re-assessed on an annual basis or when their needs change. This is to ensure that care plans and information for staff is up to date and the home is able to meet their assessed needs. There must be specific care plans in place to minimise any risks identified in pressure areas, falls and nutritional assessments. This is so that any risks are minimised and staff know what action to take to make sure that individual`s needs are met. Care plans and risk assessments should be reviewed on a monthly basis. The monthly care plan reviews should also include a review of each person`s nutritional risk assessments and their weight. People should sign their own care plans where they are able to, to demonstrate that they have been involved in the assessment and care planning process and that they agree to their plan of care. People should be provided with appropriate activity and stimulation when they are spending time alone in their bedroom. This is to make sure that their social and emotional well being needs are met. There should be a large print easy to follow complaints procedure on display at the home. This is so people have accessible information on how to make a complaint or raise concerns. All radiators must be risk assessed to ensure that their surface temperature does not present a potential risk of scalding to people. The commission considers that the most appropriate way of reducing risk of scalding and burns from radiators is for them to be covered. The source of the mould in one person`s bedroom must be investigated, repaired and cleaned. The door that appears rotten must be repaired. This is to ensure that people`s bedrooms are clean, dry and safe. The water temperatures should be routinely tested to check whether the regulators are working or that the water is reaching the maximum temperature. The repairs to the flat roof should be made a soon as practicable. The rotas must accurately reflect the staffing arrangements in the home and include the names of staff sleeping in at the home. This is so that there is an accurate record of who has worked at the home and in what capacity. Personal Emergency Evacuation Plans (PEEP`s) should be in place and be included in the fire risk assessment. This is to ensure the fire safety in the home and the safe evacuation of all of the people who live at the home. The policies and procedures should be reviewed and dated. Surveys to the people living at the home should be anonymised. This is so that they can give their opinions without being identified. Key inspection report Care homes for older people Name: Address: Thistlegate House Axminster Road Charmouth Dorset DT6 6BY     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: Jo Johnson     Date: 2 4 0 3 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 34 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 34 Information about the care home Name of care home: Address: Thistlegate House Axminster Road Charmouth Dorset DT6 6BY 01297560569 01297560569 thistlegatehouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John A Corney,Mrs June P Webb Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named person (as known to CSCI) in the category DE(E) may be accommodated to receive care. One of the following rooms may be used as a double at any one time: 4, 15, 17, 27, 28, or 31 Date of last inspection Brief description of the care home Mr J Corney and Mrs J Webb have owned and managed Thistlegate House, a Grade II listed building since 1994. The home has an elevated south facing position with views across the countryside and Lyme Regis bay and stands in four acres of grounds, consisting of a sunken garden, landscaped garden, kitchen garden as well as an area of natural woodland. Thistlegate House is located on the outskirts of the village of Charmouth, which is approximately 2 miles from the coastal resort of Lyme Care Homes for Older People Page 4 of 34 Over 65 18 0 2 5 0 3 2 0 0 9 Brief description of the care home Regis. The home is registered to accommodate and provide personal care for up to 18 older people. Accommodation comprises 17 bedrooms, mainly for single occupancy on both the ground and first floor. The home has a large lounge, dining room and five bathrooms with additional WCs. One single bedroom and one double bedroom have ensuite WC facilities. There is no passenger lift in the home, however residents who have difficulty with the stairs are assisted by the staff using a Stairmatic chair, (this is a portable chair that can move up and down stairs and can also be used to assist residents with poor mobility around the home and out into the garden). Current Inspection reports are available and the home has a colour brochure, Statement of Purpose and Service User Guide providing information on the services and facilities available. The range of fees are available by contacting the provider. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The providers/managers supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. Care Homes for Older People Page 6 of 34 Surveys were distributed by the providers/managers to people who live at the home. Three surveys from people were returned. The findings of these surveys have been included in the report. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 15th March and 24th March. The providers/managers were present during the inspection. However, in the main the inspection was conducted with one of the providers/managers, Mrs J Webb. The inspection was conducted by three different inspectors over the two visits and involved observations of and talking with people who live at the home, the staff on duty and the providers/managers. Six people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? All of the requirements from the last inspection have been met. The arrangements for recording peoples weights has been reviewed and they are now recorded separately. Nutritional, falls, and pressure area risk assessments are now completed for people. The medication policy has been updated and controlled drugs are now stored in accordance with legislation and appropriate records maintained. Where people do not have access to or are not able to use a call bell there is a risk assessment and plan in place to ensure that they are regularly monitored. The providers/managers have notified the commission of significant events affecting people living at the home. Hazardous substances are now stored securely. Writtten confirmation has been given that the laundry floor is impermeable. All staff have either attended or are booked on a First Aid course. Care Homes for Older People Page 8 of 34 What they could do better: Peoples needs should be re-assessed on an annual basis or when their needs change. This is to ensure that care plans and information for staff is up to date and the home is able to meet their assessed needs. There must be specific care plans in place to minimise any risks identified in pressure areas, falls and nutritional assessments. This is so that any risks are minimised and staff know what action to take to make sure that individuals needs are met. Care plans and risk assessments should be reviewed on a monthly basis. The monthly care plan reviews should also include a review of each persons nutritional risk assessments and their weight. People should sign their own care plans where they are able to, to demonstrate that they have been involved in the assessment and care planning process and that they agree to their plan of care. People should be provided with appropriate activity and stimulation when they are spending time alone in their bedroom. This is to make sure that their social and emotional well being needs are met. There should be a large print easy to follow complaints procedure on display at the home. This is so people have accessible information on how to make a complaint or raise concerns. All radiators must be risk assessed to ensure that their surface temperature does not present a potential risk of scalding to people. The commission considers that the most appropriate way of reducing risk of scalding and burns from radiators is for them to be covered. The source of the mould in one persons bedroom must be investigated, repaired and cleaned. The door that appears rotten must be repaired. This is to ensure that peoples bedrooms are clean, dry and safe. The water temperatures should be routinely tested to check whether the regulators are working or that the water is reaching the maximum temperature. The repairs to the flat roof should be made a soon as practicable. The rotas must accurately reflect the staffing arrangements in the home and include the names of staff sleeping in at the home. This is so that there is an accurate record of who has worked at the home and in what capacity. Personal Emergency Evacuation Plans (PEEPs) should be in place and be included in the fire risk assessment. This is to ensure the fire safety in the home and the safe evacuation of all of the people who live at the home. The policies and procedures should be reviewed and dated. Surveys to the people living at the home should be anonymised. This is so that they Care Homes for Older People Page 9 of 34 can give their opinions without being identified. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 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 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: We looked at the assessments for two of the people who have moved into the home since the last key inspection. They had pre-admission assessments completed either with the individual or with their relatives before they moved in. Both people and one relative told us that they had looked around the home and met the providers/managers before moving in. There are a number of people who have lived at the home for a number of years and whose needs have changed. It is recommended that peoples needs are re assessed on an annual basis or when their needs change. This is to ensure that care plans and information for staff is up to date. Care Homes for Older People Page 12 of 34 Evidence: The three surveys from people told us that they received enough information to help them decide if this home was the right place for them before they moved in. There were contracts in place for all of the six people who we case tracked. These included the terms and conditions. They were signed either by a relative or the individual. The three surveys also told us that they had written contracts in place. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and is in the main detailed in care plans. Evidence: We looked at the care records for six people who live at the home. Each person has a care plan that details the support that they need with washing and dressing, mobility, bathing, eating and drinking and emotional well being. The care plans have been added to as and when peoples needs change. There are also statements recorded about any changes in peoples circumstances. However, care plans are not reviewed every month and for some people the original care plan is not visible and it is not clear whether each element of the care plan has been reviewed. Since the last key inspection people have had risk assessments completed for pressure areas, nutrition and falls. One persons risk assessment identified that they were at risk of developing pressure areas. There must be a care plan in place to minimise any risks identified in assessments such as pressure areas. Care Homes for Older People Page 14 of 34 Evidence: It is recommended that care plans and risk assessments be reviewed on a monthly basis. The working care plan should be rewritten following the annual review of an individuals assessed needs. This is so that there is a clear up to date and easy to follow care plan available for the individual and staff. The care plans have been signed in the main by relatives. People should sign their own care plans where they are able to, to demonstrate that they have been involved in the assessment and care planning process and that they agree to their plan of care. Daily records are completed for each individual and these were seen for all of the people living at the home. People are weighed monthly and these records are now kept separately. It is recommended that the monthly care plan reviews also include a review of each persons nutritional risk assessments and their weight. Staff spoken with were knowledgeable about the needs of the people they care for and told us that they have enough information about them to be able to meet their needs. Staff respected peoples privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. The three surveys from people told us that they always receive the support and care they need. Discussion with the staff, surveys and observation of care plans and daily records tell us that people living in the home have access to health professionals and receive the medical care that they need. The provider/manager told us that there is not anyone currently receiving any support from community district nurses or community psychiatric nurses (CPN). They told us that they have requested CPN input for one person from their GP. The surveys from people told us that staff always (1) or usually (2) listen to them and act on what they say. The provider/manager told us that there is not anyone self medicating at the moment. The medication policy has been updated since the last key inspection and makes reference to the management of creams and eye drops. Care Homes for Older People Page 15 of 34 Evidence: We looked at the medication administration and systems in place at the home. The Medication Administration Records were all completed correctly with no gaps. Peoples prescribed creams and eye drops had been dated when opened. The provider/manager told us that they now discard all eye drops after 28 days. The provider/manager informed us that they now have a padlocked trolley for transporting medication through the house. The controlled drugs cupboard has been secured in the main drugs cupboard. The controlled drugs record book and stock were seen and were correct. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people are supported to meet their social needs and interests. People are able to live their chosen lifestyle. Evidence: From the AQAA, activity folder, daily records and discussion with people living at the home there are regular organised activities including a bi-weekly exercise class, the mobile library and talking books, visiting clergy, birthday parties, hairdressing and chiropody. The surveys from people told us that the home always (2) or usually (1) organises activities that they can take part in. People spoken with told us that they can choose how and where to spend their time. Some people told us that they prefer to spend time in their bedrooms and just join the others for their meals, others like to spend their time in the lounge. Only one person was observed to have their door open whilst in their bedroom. People and staff confirmed that this was based on individual choice. Care Homes for Older People Page 17 of 34 Evidence: One person who has dementia has their bedroom door closed and the reasons for this is detailed in their care plan. Their care plan details that they enjoy music. This person has a visitor every afternoon who spends time with them singing and talking. We visited this person briefly on three occasions during the two days of inspection and they did not have any music playing or any other suitable stimulation. The providers/manager told us that the individual does have the opportunity to join in activities, spend time with staff and spend time in the main lounge with other people. As there are some people with dementia that may spend longer periods of time in their bedrooms, we recommend that they be provided with appropriate activity and stimulation during these times. We spoke with one relative, they told us that they are made welcome at the home and can visit their relative whenever they wish. The surveys from people told us that usually (2) or sometimes like the meals at the home. Under the heading What could the home do better one survey included the comment food. People and a relative spoken with told us that they were satisfied with the meals and choices of food provided at the home. One person told us that they have put on weight since moving into the home. On the second day of inspection the meal was well presented and people living at the home told us that it was good. They told us that they make their choice of meal in the mornings and that there is an alternative. The provider/manager told us that they plan the meals on a weekly basis and shop at local supermarkets and use seasonal vegetables from the garden. We noted that there was a high proportion of own brand tins and foodstuffs in the stores at the home. The providers/managers told us that one of the chefs has previously cooked for royalty and one has been awarded Bramley Chef of the Year in the past. Care Homes for Older People Page 18 of 34 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 and relatives know how to raise any concerns and complaints. A staff team who have a knowledge of how to respond to any suspicion of abuse support the people living at the home. Evidence: The complaints procedure is available in the service users guide and in peoples contracts. However, this is in small print and not easily accessible. There should be a large print easy to follow complaints procedure on display at the home. Information about Dorset Advocacy service is displayed in the home. The surveys and people spoken with told us that there someone they can speak to informally if they are not happy. Two of the three surveys told us that they know how to make a complaint. A relative spoken with knew how to raise any concerns and complaints and was confident that any issues raised would be addressed. From discussion with the provider/ manager and information provided in the AQAA, there have been no complaints in the last twelve months. Staff were spoken with and they have attended training in the Protection of Vulnerable Care Homes for Older People Page 19 of 34 Evidence: Adults (POVA) and they were aware of the different ways vulnerable people are at risk of abuse, and know how to respond and report any concerns. The home has a whistle blowing policy, that includes details of external agencies such as the commission which staff may contact. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home well furnished so that people live in a homely and comfortable environment. The uncovered radiators mean that people are potentially at risk of scalding or burns. Evidence: Communal areas and bedrooms have been decorated and furnished to a high standard. The home is set within large landscaped gardens. Communal areas comprise of a lounge which has sea views and a dining room. Overall, the home is decorated and furnished to a high standard in the arts and crafts style. There is a call system available at the home. Bedrooms are arranged on the ground and first floors. There is a mechanical aid to assist people to transfer between floors and to manage further steps within the property. Those bedrooms seen had been personalised to reflect individual tastes and preferences. Two bedrooms have en suite toilet facilities and the remainder have toilets located nearby. The laundry is situated in an outbuilding. The providers/managers have now provided Care Homes for Older People Page 21 of 34 Evidence: us with a letter from a specialist flooring company that specifies that the floor has been assessed and is impermeable. This means that it can be thoroughly cleaned. The provider/manager told us that red alginate laundry bags are now used for soiled laundry. At the time of the inspection the kitchen was clean. At the last key inspection we identified that one person did not have access to a call bell. At this inspection there were assessments completed and plans in place to minimise the risks for two people who do not have call bells. We spoke with one person who had recently moved in they told us that they had been shown how to use the call bell system. The flat roof above Room 15 is covered with a tarpaulin. The provider /manager told us that there are plans to have this lead roof repaired. On the first day of inspection we identified that was no hot water in the downstairs bathroom and in the laundry. The provider/manager told us that a new timer and hot water heater had been installed by the second day of inspection. We did not re test the water temperatures. The water temperatures are not routinely tested to check whether the regulators are working or that the water is reaching the maximum temperature. There are uncovered electric storage heater and radiators in communal areas and peoples bedrooms. These ranged in temperature from 22 C to 57 C, many were too hot to touch. There were not individual risk assessments for radiators for all of the people we case tracked. The commission considers that the most appropriate way of reducing risk of scalding and burns from radiators is for them to be covered. There was an unpleasant odour in one persons bedroom and their carpet was stretched and rucked up. Since the inspection the providers/managers have told us that the bedroom has been re decorated, re carpeted and has had new curtains. One persons bedroom had mould on the wallpaper below the window and the door to the balcony appeared rotten. Care Homes for Older People Page 22 of 34 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 are supported by a safely recruited and trained staff group. They benefit from having a small regular and well trained team of staff that know them well. Evidence: On the day of the inspection there were 12 people living at the home. There were sufficient staff to meet the physical and personal care needs of people living at the home. The three surveys from people told us that the staff are always available when they need them. People living at the home spoke highly of the staff team. The providers told us in the following text taken from the AQAA they submitted that the staffing levels are: mornings five care staff including proprietorslmanagers plus two chefs providing care for twelve clients seven of which are very low dependency and virtually self caring, afternoons five/six care staff including the proprietors/managers providing care for the same twelve residents, evenings two care staff, nights one waking and two sleep in. The providers have since told us that this does not reflect the current staffing arrangements at the home. From the rotas provided by the provider/manager during the inspection there are times when there are betwen two and three care staff in the morning and the planned Care Homes for Older People Page 23 of 34 Evidence: rotas do not detail who is sleeping in at the home and whether this is one or two staff. The providers have since told us that this is a planned rota and that there is an additional record book that details who and what hours were actually worked. The rotas and records must accurately reflect the staffing arrangements in the home including the names of the staff that are sleeping in. We looked at the recruitment records for the last three recruited members of staff. This included the new cook who had started on the second day of inspection. It was found that an ISA or POVA first check and two references had been obtained prior to the staff commencing work. Satisfactory CRB disclosures had been received for two of the staff and the new cook was being supervised whilst awaiting the receipt of their CRB disclosure. Staff complete an induction checklist when they start work. It is good practice that staff inductions meet the Skills for Care Induction Standards. We provided the provider/manager with the website details for the induction standards. The provider/manager provided us with a list of the mandatory training that has been provided to staff. This included the following training: POVA, Manual Handling, Health and Safety, Food Hygeine, First Aid, Fire and NV Qs. All staff at the home have been provided with Fire training and this is recorded in their induction and ongoing training records. Four members of staff have gained NVQ level 3 and two staff including one of the providers have gained City and Guilds level 2 in promoting the mental health and well being of older people. We were also provided with details of the training that has been booked up until July 2010 this included; medication, food hygeine, adult safeguarding awareness, Health and Safety, infection control, First aid and manual handling. The provider/manager told us that staff had completed dementia training and agreed to send us the details of this. This information detailed that the two provider/managers and four of the care staff have completed a two day dementia course. Two staff have completed one day dementia training. The providers/managers and two of the staff have also received training from a CPN (Community Psychiatric Nurse). The provider/manager identified in the AQAA that they plan to roll out dementia care Care Homes for Older People Page 24 of 34 Evidence: training for all care staff. Staff told us that they feel well supported and trained and that they have had a recent staff meeting. Staff are supervised by the providers/managers. However the records kept do not include the detail of each discussion to show that they are supported to develop their skills and knowledge. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed and people are consulted and confirmed that that their views are listened to. Evidence: The home is owned and managed by Mr J Corney and Mrs J Webb. They have both completed the Registered Managers Award and have owned and managed the home since 1994. Both providers/managers attend the same training courses as the care workers at the home. This means that they can evaluate the quality of training and how staff put it into practice. Both providers/managers are available at the home each day. This means that they are available to people and their relatives every day. They told us that they are able to spend time with people during celebrations such as Christmas and new year. One of the providers, Mrs J Webb confirmed that they live in one of the registered bedrooms at the home. Care Homes for Older People Page 26 of 34 Evidence: The providers told us that they offer community fund raising events in the grounds. This bring the local community to our clients especially those who wish not to travel out to such events, they enjoy the build-up preparations of an event as well as being directly involved with the entertainment itself. The providers/managers send out surveys to people who live at the home, there is a section for relatives to complete if they wish to. These have recently been sent out and returned. We saw these and all were positive about their experience of living at the home. However, it is recommended that the surveys be anonymised as they all had the individuals name written on in pencil. The providers/ managers told us that they do not send surveys to health and other visiting professionals as part of their own quality assurance. However, the providers/managers do distribute the professional surveys sent to them by us. We wrote to the providers/managers in September 2009 requesting clarification in relation to an isolated incident with the water supply. We requested this information again in January 2010 as we did not receive a response to our first letter. The providers have since told us that they were unable to respond at that time to our specific questions as the source of the infection was not known at the time. They have now provided us with all of the information that we require to satisfy us that they took the appropriate action to safeguard people at the home. The providers/managers completed the AQAA (Annual Quality Assurance Assessment) as requested by us. The information relating to the dates of review of the polices and procedures was not dated apart from the policy relating to Access to files by staff/service users. The AQAA is in the main the same document as submitted in December 2008, a majority of the text is the same. The information relating to the staffing levels at the home is inaccurate. The AQAA does not consider the actions or any shortfalls as identified by the key inspection of March 2009 or any new areas for improvement following consultation with people who live at the home. Most of the homes written policies need to be updated and reviewed. A number of policies were not dated so it not clear if and when they have been reviewed, others that are dated have not been reviewed. The policy on violence and aggression towards health professionals is not relevant for the setting and should be reviewed. One policy refers to sexual or personal relations between a member of staff and resident may not Care Homes for Older People Page 27 of 34 Evidence: be prohibited this policy and statement should be reviewed in line with local safeguarding and protection of vulnerable adults procedures. The providers/managers told us that they do not currently manage any personal monies or finances for any people who live at the home. The finance policy should be reviewed in line with best practice as it is inappropriate to refer to peoples personal monies as pocket money. At the last key inspection we identified that the home must send us Regulation 37 notifications. The home has sent us Regulation 37 notifications that relate to people who live at the home. The providers/managers did not notify us when they dismissed a member of staff. They told us that this was an omission and that they are now aware of the need to notify us of such events. A number of Health and Safety records were checked, including the fire safety log, electrical PAT testing, hoists, boiler and stairmatic. All of the servicing records were up to date. There was evidence that a hoist had been taken out if use following servicing that deemed it was unsafe to use. The provider/manager told us that they have a planned fire inspection and that they are working with the fire service on a training exercise. They have detailed records of fire drills and evacuations that have taken place that include a description of how individuals were evacuated. This is good practice. The providers/managers should complete individual Personal Emergency Evacuation Plans (PEEPs) for those people who are not able to independently evacuate the building. Staff training in mandatory areas, including health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing. Care Homes for Older People Page 28 of 34 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 29 of 34 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 7 13 There must be care plans in place to minimise any risks identified in pressure areas, falls and nutritional assessments. This is so that any risks are minimised and staff know what action to take to make sure that individuals needs are met. 01/06/2010 2 19 23 The source of the mould in one persons bedroom must be investigated, repaired and cleaned. The door that appears rotten must be repaired. This is to ensure that peoples bedrooms are clean, dry and safe. 02/08/2010 3 19 13 All radiators must be risk assessed to ensure that their surface temperature does not present a potential risk of scalding to people. The 01/09/2010 Care Homes for Older People Page 30 of 34 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 commission considers that the most appropriate way of reducing risk of scalding and burns from radiators is for them to be covered. This is to minimise the risks of scalding from hot surface temperatures. 4 27 17 The rotas and records must 01/06/2010 accurately reflect the staffing arrangements in the home and include the names of staff sleeping in at the home. This is so that there is an accurate record of who has worked at the home and in what capacity. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be updated to ensure it includes all of the information detailed in the Care Home Regulations 2001. Peoples needs should be re-assessed on an annual basis or when their needs change. This is to ensure that care plans and information for staff is up to date and the home is able to meet their assessed needs. People should sign their own care plans where they are able to, to demonstrate that they have been involved in the assessment and care planning process and that they agree to their plan of care. 2 3 3 7 Care Homes for Older People Page 31 of 34 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 4 7 The working care plan should be rewritten following the annual review of an individuals assessed needs or where there needs change significantly. This is so that there is a clear up to date and easy to follow care plan available for the individual and staff. Care plans and risk assessments should be reviewed on a monthly basis. The monthly care plan reviews should also include a review of each persons nutritional risk assessments and their weight. People should be provided with appropriate activity and stimulation when they are spending time alone in their bedroom. This is to make sure that their social and emotional well being needs are met. There should be a large print easy to follow complaints procedure on display at the home. The repairs to the flat roof should be made a soon as practicable. The water temperatures should be routinely tested to check whether the regulators are working or that the water is reaching the maximum temperature. The care staff induction should be based on Skills for Care induction standards. Both pages of the registration certificate should be visible so that people may see both the number of places and types of need that the home is registered to provide care for. Surveys to the people living at the home should be anonymised. The policies and procedures should be reviewed and dated. This should include: The policy on violence and aggression towards health professionals, the management of peoples finances and the policy that refers to sexual or personal relations between a member of staff and resident may not be prohibited. This should be reviewed in line with local safeguarding and protection of vulnerable adults procedures. Personal Emergency Evacuation Plans (PEEPs) should be in place and be included in the fire risk assessment. This is to ensure the fire safety in the home and the safe evacuation Page 32 of 34 5 7 6 12 7 8 9 16 19 19 10 11 30 31 12 13 33 33 14 38 Care Homes for Older People 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 of all of the people who live at the home Care Homes for Older People Page 33 of 34 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. © 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. Care Homes for Older People Page 34 of 34 - 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. 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