Care Home: Town Thorns

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What the care home does well An up to date statement of purpose and service user guide is available. This provides useful information about the service and gives people all the information they require to help them to decide if they should move into the home. Overall the risk assessments and care plans were well written and covered a good range of information to guide staff as to how they should meet people`s needs. The kitchen in the home maintains high standards and all appropriate checks undertaken to make sure residents have a high standard of catering available to them. Food served in the home is very good and offer residents varied and nutritious meals. Residents told us that the meals are appetising and they are offered a choice in the meals they eat. The grounds to the home are well maintained and offer residents the opportunity to enjoy walking around the garden areas safely. People living in the home told us "I find the people at Towns Thorns very friendly and easy to talk to." "They (Staff) help me to feel secure and safe." What has improved since the last inspection? Advice from professionals on the care and treatment of residents living in the home had been documented and followed by staff. This helps to make sure staff have current information on the treatment and care residents must receive. Recruitment procedures had improved and staff files organised to ensure they were easily accessible to identify that all appropriate security checks had been made. Improvements have been made to care plan documentation in some units in the home. The changes made should help to make sure that the diverse needs and types of care required by people living in the home are clearly identified and suitable. The new care plan documentation offers staff the opportunity sufficient space to clearly write the care required and comment on the care delivered. What the care home could do better: The home needs to make sure that behaviour management guidelines are developed and agreed with relevant professionals. This will help to minimise risks to residents identified with behaviour problems and protect other residents in the home from the risk of harm. The home needs to make sure that people with significant communication support needs are referred to a speech and language therapist. This will enable people to have access to suitable equipment to enable them to communicate their needs more easily. The home needs to review the storage of medication in the home so that excessive amounts of medication are not routinely stored in the home. This will help staff to audit medication accurately and minimise the risk of unsafe practice. The home needs to review the opportunities for people to go out to places more often so that they enjoy a better social life and take part in community life. The home needs to review residents concerns about their clothing going missing when they are laundered by the home. This will help residents to know that their belongings are treated with respect. The home needs to address peoples concerns about staffing levels in the home. This will help to reassure people that residents care needs are being met safely at all times. Key inspection report Care homes for older people Name: Address: Town Thorns Brinklow Road Easenhall Rugby Warwickshire CV23 0JE     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: Yvette Delaney     Date: 1 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Town Thorns Brinklow Road Easenhall Rugby Warwickshire CV23 0JE 01788833311 01788833379 helen.owen@ben.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BEN - Motor & Allied Trades Benevolent Fund care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 66. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary needs on admission to the home are within the following conditions:- old age not falling within any other categories, OP, 42; physical disability, PD, 14; dementia - over 65 years of age, DE(E), 10. Date of last inspection Brief description of the care home Town Thorns is a purpose built care home and stands in more than 20 acres of grounds. It is designed as a continuing care centre to provide full nursing, residential care and sheltered housing accommodation primarily to people who are connected with the motor and allied trade. The home is divided into four units: Nursing Care, Care Homes for Older People Page 4 of 33 Over 65 10 42 0 0 0 14 Brief description of the care home Dementia Care, Residential Care and Younger Adults with Physical Disabilities. Town Thorns is situated near the village of Brinklow close to Rugby. The home has facilities for residents to engage in social activities within the home and in the community. The manager has advised that the current fees for a place in the home are from 747 pounds to 865 pounds for nursing care and 460 pounds to 574 pounds for residential care. The cost of hairdresser, chiropody, toiletries, newspapers, magazines and personal items are not included in the fees. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 Star. This means that people who use the service experience good outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. As part of the inspection process we reviewed information about the home that is held on file by us, such as notifications of accidents, complaints, allegations and incidents. The care of five people living in the home was identified for close examination by reading their care plans risk assessments daily records and other relevant information. This is part of a process known as case tracking where evidence of their daily life in the home is matched to outcomes for the people using the service. Care plans and Care Homes for Older People Page 6 of 33 monitoring records of other residents were examined randomly. The inspection included meeting some of the people living at the home, including the five people whose care was being examined. Discussions took place with some of the residents and relatives in addition to care staff and managers for the service. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Commission for Social Care Inspection will be referred to as us or we. At the end of the visit we discussed our preliminary findings with the manager. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to make sure that behaviour management guidelines are developed and agreed with relevant professionals. This will help to minimise risks to residents identified with behaviour problems and protect other residents in the home from the risk of harm. The home needs to make sure that people with significant communication support needs are referred to a speech and language therapist. This will enable people to have access to suitable equipment to enable them to communicate their needs more easily. The home needs to review the storage of medication in the home so that excessive Care Homes for Older People Page 8 of 33 amounts of medication are not routinely stored in the home. This will help staff to audit medication accurately and minimise the risk of unsafe practice. The home needs to review the opportunities for people to go out to places more often so that they enjoy a better social life and take part in community life. The home needs to review residents concerns about their clothing going missing when they are laundered by the home. This will help residents to know that their belongings are treated with respect. The home needs to address peoples concerns about staffing levels in the home. This will help to reassure people that residents care needs are being met safely at all times. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a comprehensive assessment of their care needs to ensure that they can be met before offered a place in the home. Evidence: The home has a Statement of Purpose and Service Users Guide so that prospective residents and their families can receive information about the home, and the services it offers. The manager said that this had been recently reviewed. All new residents to the home are provided with a contract, which sets out the fees payable, and terms and conditions of living in the home. Three residents and two family members spoken with said that they had received information about the home. They told us that they found all the information they received to be useful and accurate as to the services available. People who are considering moving into the home are assessed usually by the matron Care Homes for Older People Page 11 of 33 Evidence: or deputy matron. Potential residents and their family are offered where appropriate, the opportunity to visit the home. The preadmission assessment for two of the most recent residents admitted to the home was read. Pre-admission assessment records for one of the residents were fairly detailed and would provide staff with sufficient information to help meet the needs of people admitted to the home. However, the records for the second resident had not been fully completed. Pre-admission assessments are required to look at a number of key areas of need. These include areas related to health and social care needs, for example mobility and specific medical needs as well as potential areas of risk. Where appropriate, the home also seeks information from a care management assessment undertaken by social services, or other health care professionals involved in the care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with clear guidance on all aspects of residents needs. There is scope to improve the way medicines are managed in the home to ensure safe practices are maintained. People are treated with respect and their dignity maintained which helps to increase their self-esteem and quality of life. Evidence: We looked at the care of five people living in the home. One from each of the residential, nursing and dementia care units and two people living on the younger adults living unit. The records we looked at include care plans, risk assessments and medication charts. These helped us to see how their care needs are planned for and met. Documents were also sampled on four other peoples files to check that specific care needs were being addressed properly. Overall the risk assessments and care plans were well written and covered a good range of information to guide staff as to how they should meet peoples needs. This included needs such as pressure area care, moving and handling, mobility, personal care, continence, eating and drinking, sexuality and risks of falling. Risk assessments Care Homes for Older People Page 13 of 33 Evidence: are carried out for people with bed rails. Overall the risk assessment was satisfactory but did not currently include checking that the person concerned is not at risk of climbing over the bedrails and falling. The deputy matron said that she would arrange for the risk assessment to be amended accordingly. When we visited a further resident we noted that they were sitting in a wheel chair with a lap belt on. We asked a member of staff why the resident was sitting in the wheel chair and queried the restriction in their movement with the lap belt done up. It was explained that the resident sits in a wheel chair all morning and the lap belt is on due to poor balance while sitting. This resident is then transferred back to bed in the afternoon. This persons care plan did not contain written information to show that sitting strapped in a wheelchair was part of the residents care. A risk assessment had not been completed in relation to the wheelchair and the need for the lap belt. There was also no information to show that alternative seating arrangements had been considered and advice sought from appropriate professionals. Positive work has taken place to seek support from relevant health professionals to meet the needs of a person who sometimes presents challenging behaviour. This has included providing access to a psychiatrist, behaviour therapist and speech and language therapist. Comments by staff and the deputy matron indicate that there has been a reduction in challenging behaviour since these specialist health professionals became involved. A care plan has been written to help staff to adopt a consistent approach to the person concerned. Comments by staff on duty indicated a good awareness of this information. Staff also explained that there have been occasions when the person concerned has attempted to run into people in their wheelchair, which could cause injury. Consequently, this has resulted in staff taking action to temporarily immobilise the wheelchair so that it can not be operated independently. There is no current guidance in the care plan advising staff on this course of action. The deputy matron agreed to raise this matter with the relevant professionals to ensure that suitable guidance is put in place for managing such situations, to ensure that a fair balance is struck between maintaining safety in the home and any restriction placed on the persons freedom. Waterlow (pressure area care) assessments are being carried out for people each month to keep track of their skin condition and risks of pressure sores developing. A wheelchair user recently had pressure sores which were treated and have since improved. The persons care plans shows that measures were put in place to remedy the sore and monitor improvements in skin condition. However it was not possible to locate the turning chart to demonstrate that the person had been regularly repositioned as necessary. The person concerned confirmed that they had been well Care Homes for Older People Page 14 of 33 Evidence: supported and that the sore had healed well. The records show that the physiotherapist in a review of the persons moving and handling assessment and appropriate equipment had been made available, including a new hoist and slide sheets (to enable the person to make transfers safely and in a manner that does not damage their skin). A communication passport was seen for a person who communicates non verbally. This document has been devised by the speech and language therapist and is illustrated with photographs and contains helpful information to enable staff to understand the persons individual means of communicating their needs. A communication care plan and a book of makaton symbols were seen for another person who communicates non verbally. However a communication passport has not yet been devised for this person. The deputy matron said that she would refer this person and others with similar needs for a speech and language therapy assessment to consider appropriate communication aids and equipment for the people concerned. A person on the younger adults living unit has epilepsy. Comments by a member of care staff and a nurse indicate that this is generally stable. The nurse explained that in the event of prolonged or frequent seizures leaving the person tired, extra medication would be administered. Currently there is no protocol in place for staff to follow, explaining the types of seizure suffered and the circumstances under which extra medication should be given. This is necessary to ensure that all staff follow the correct procedure consistently and to ensure that the medication is always given appropriately. The deputy matron agreed to refer the person concerned for assessment by an epilepsy nurse specialist so that a clear protocol can be devised. Records of GP visits and contact with specialist health services were well recorded and easy to follow. However records of contacts with dentists, opticians and chiropodist were harder to track as in some instances these had been logged in the day records amongst other information. The deputy matron said that she would arrange for this information to be recorded separately in future which would make it easier to monitor when people are due check ups and the outcomes of these appointments. We examined the systems for the management of medicines in the home. This was linked to the case tracking process by examining the medication administration records (MAR) charts for the five residents followed through the case tracking process. Medication and charts were looked at together with their care plans and daily records. Encouragement is given for people to hold their own medication where they are able Care Homes for Older People Page 15 of 33 Evidence: to do so, to support their independence. A well detailed risk assessment was seen in place for a person at the home, assessing their understanding of the importance of taking medication and keeping it safe in a locked cupboard. One person holds their own inhaler. Comments by the person concerned indicated a good awareness of when and how they should use the inhaler. A nurse explained that there is very little PRN (as required) medication given out to people currently. In the main these are painkillers such as paracetamol. The nurse explained that everyone is able to indicate when they may in pain and may need painkillers. A PRN protocol was seen on a persons care plan explaining the circumstances under which they may need a certain type of medication so that nurses are clear when it is to be given. The nurse explained that no one on the younger adults living unit is prescribed any medication that may be used for the management of challenging behaviour. A staff member explained that only nurses give out medication. The nurse in charge on the unit explained that all the nurses are provided with medication training and are assessed to ensure they understand the medication procedures. This was verified by the deputy matron. We checked the medicines of the residents whose care we reviewed to make sure that staff were following safe medicine practices in the management, administration and storage of medicines. Two peoples boxed (PRN) medication was checked on the younger adults living unit. In both cases the medicines balanced correctly. The medicines for the three residents on the elderly care units were also checked. Some of the medicines prescribed were checked as accurate. However the quantity of medicines received in the home were not always entered on the medication administration records (MAR). This made it difficult to accurately check that the balance of remaining medicines was accurate. We also found that medication for some of the residents in excess of one month or more were being stored in the home. One person had 174 paracetamol in stock and a further resident had in excess of two months supply of a controlled medication given to control pain. This would suggest that remaining stock levels were not taken into consideration when staff ordered repeat prescription requests. This was brought to the attention of the matron so that it could be addressed. Everyone spoken with confirmed that they are happy with the care and support that is provided them. All confirmed that they are treated with respect and that their views are listened to. One person said that there had been a member of staff a long time ago that they had not liked but this person had since left the home. Care Homes for Older People Page 16 of 33 Evidence: People confirmed that their privacy and dignity is respected and that staff always close doors when helping them to attend to their personal care needs. The new assessment format includes a check of peoples gender care preferences so that they may receive care from staff of the same gender where they prefer. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to maintain their independence, interests, and take part in activities, which would enhance their quality of life. People benefit from a varied and nutritious diet in a comfortable and social environment. Evidence: Comments by people that live in the home indicate that they spend in the home and make some use of the therapy unit, which puts on quizzes, board games, bowls and bingo. At the time of the site visit therapy unit had been restricted to afternoons only as the activities on sick leave. most of their time activities such as activities in the coordinator was One person explained that they are supported to go swimming at a leisure centre and make use of the hydrotherapy pool each week. They also said that they attend pottery class and enjoy painting. Some of their artwork has been used to support charitable fund raising at the home. Several people said that they enjoyed walking in the very attractive gardens in the grounds of the home. Comments by people indicate that there are occasional opportunities to go shopping in Rugby town and go on day trips. However, overall Care Homes for Older People Page 18 of 33 Evidence: most people do not get out very much each week. The deputy matron said that a trip to Ryton Gardens was planned to take place shortly. A family member told us that their relative is assisted and encouraged with their therapy treatments, which include pottery, painting and attending Further Education College. The people living on the younger adults unit confirmed that there is a flexible visiting policy and that they are able to see relatives and friends when they please. People living in each of the older peoples units received visitors throughout the day. There were no activities seen to take place on two of the units. On the dementia care unit care staff were involved in keeping residents engaged in activities such as reading, games and walks in the garden around the home. A person at the home was supported to visit their mother on the day of the site visit, which is a regular arrangement. A relative visiting on the day of the site visit said that they were always made to feel welcome and offered refreshments. They commented, I am very happy with the service and can always contact the office if ever I need to, they always consult me and are good at communicating information. People at the home confirmed that church services are held at the home in the chapel. The deputy manager explained that a faiths booklet had been devised to give staff an insight into different faiths. The manager said that support would be provided to assist people of other faiths to worship in the way they choose where necessary. An Asian, Hindu person living at the home said that their needs were met satisfactorily. They said they were happy to worship privately and did not wish to visit the temple. Similarly they confirmed that they had been consulted about the menu and were very happy with the food options provided them. Meetings are held on a regular basis to seek peoples views on the menus, activities and other matters concerning the everyday running of the home. People spoken to also confirmed that they are consulted over the menus to ensure they are happy with the options provided. They also confirmed that they are offered an alternative meal, such as a salad or baked potato if they change their minds on the day. Staff explained that Healthy eating has recently been provided on the younger adults living unit. This included engaging people in quizzes with prizes. Several people said that they had enjoyed this and now eat more healthily as a result. The main event of the day appeared to be lunch time. At this time residents sat together in either the main dining room or smaller dining areas on each unit. Staff encourage residents to have lunch in the main dining room of the home as this allows residents from each of the units in the home and people who live in the sheltered Care Homes for Older People Page 19 of 33 Evidence: accommodation area of the home to socialise and get to know each other. Staff were seen to assist people to eat in a sensitive, unhurried fashion where this support was needed. Where people are assessed as needing soft, pureed diets care is taken in the way the food is presented. Each food type is presented separately from moulds which are designed to reflect the food type, to make it more appealing for people. The home has been presented with an award from the Coventry and Warwickshire Partnership for care for the work that they achieved in this regard. People confirmed that they are free to make drinks and snacks where they are able to do so independently. One person was seen to make a cup of tea and another was seen to load the washing machine, indicating that people are not restricted from acting independently where possible. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to. The standard of care delivery in the home does not show that people living in the home are protected from harm at all times. 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. People spoken with in the home told us that they find it easy to speak to the manager or staff on duty if they have any concerns. Comments made include People are willing to listen to any queries or problems. People generally felt that their complaints are listened to. Comments by people in the younger adults unit confirmed that they have been told how to complain and raise concerns. Several people said that they would speak to a member of staff and they would resolve it. They were also aware that they could approach the matron if they needed to do so. People confirmed that they have regular meetings at which they can also raise there concerns should they wish to do so. Comments by people indicate that any concerns they may have are dealt with informally at an early stage before there is a need to formally complain. Care Homes for Older People Page 21 of 33 Evidence: Information explaining how to complain is available in the Statement of purpose and service user guide, which is on display in the entrance of the home. A complaints log for the home was checked. The log shows that there have been nine complaints in the last two years, which have been recorded and investigated by the home. The record shows that where necessary there has been additional follow up, a short while after complaints have been resolved, to check that people remain satisfied with any changes in the service that may have resulted from their complaints. Concerns about the quality of the cleaning at the home, resulted in the home contracting with a different cleaning service. 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. Three staff confirmed that they had received safeguarding training in the last year and had been shown relevant policies. The training records indicate that nearly all care staff have received safeguarding training in the last year in addition to a large proportion of staff in other roles. Staff spoken to were able to demonstrate a satisfactory awareness of the different types of abuse that they may encounter and how to report such incidents. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 well maintained providing a safe, attractive, homely and clean place for people to live. Evidence: The home was clean, fresh and well presented at this inspection visit. A relative in their questionnaire told us in relation to the environment Better ventilation and more fresh air during the day in main sitting room would be appreciated. Residents have access to the laundry in the home where they can undertake their own personal laundry with support if needed. This practice helps to promote and maintain the independence of residents. On the younger adult unit, there is a shared kitchenette, where people can make snacks and light meals for themselves. The kitchen has low working surfaces that meet the needs of people who use wheelchairs. The lounge and dining area on the younger adults unit provides enough space for wheelchair users to dine together if they wish to do so. The bedrooms of the five residents we case tracked were looked at. There was evidence to show that people have been supported to personalise their bedrooms on all the units. Bedrooms were made to look individual through pictures, posters, TVs, music playing equipment and many other belongings. Care Homes for Older People Page 23 of 33 Evidence: Following an assessment people are provided with special equipment to meet their needs, such as beds, wheelchairs and hoisting equipment. Systems are in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. People commented in their questionnaire that the standard of laundering of their clothes was good but Occasionally clothing items are not returned. The standard of food hygiene and cleanliness in the kitchen and restaurant area remains high. Cleaning records, fridge and freezer temperatures are maintained within the required range to store food appropriately and safely. Residents and relatives say that the home presents a cosy, comfortable and clean environment. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels in the home are not always sufficient to meet the needs of people living in the home. Residents can be sure that competent and qualified staff are caring them for. Evidence: Staffing levels in the home were maintained with the support of agency staff on the day of the inspection. Residents and family members commented in their questionnaires that staffing levels are not always maintained. Comments made in relation to staffing include: I do feel that staffing levels are on the low side. Sometimes I feel the home is understaffed. Excellent care workers except some agency workers a resident said that staff should have more time to spend with them. Following receipt of their draft copy of this report the providers have responded to say that they have set compliance levels for staffing which they do not go below. The service acknowleged that at times agency staff are used on occassion to cover sickness and unplanned absences. However the home first tries to cover absences with their own bank staff and overtime. The home manager has advised us that staffing arrangements in the home has been discussed at a recent resident/relatives meeting. The files of three recently employed staff were checked, including a nurse, a care worker and a maintenance worker. All the files seen contained evidence to show that Care Homes for Older People Page 25 of 33 Evidence: vetting checks are carried 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. Discussions with staff indicated that they are being provided with regular training updates in Health and Safety related practices, such as food hygiene, fire safety, moving and handling and safeguarding against abuse and infection control. This was also verified in staff training records provided by the manager, which show that almost all care staff have attended these courses in the last eighteen months. The records show that not all nursing staff have received first aid training (almost 50 percent) but the deputy matron explained that there are always a number of staff trained in first aid and palliative care and syringe drivers on duty, including the matron and the deputy matron. The deputy manager explained that two staff are attending a training the trainers course, which will equip them to provide first aid training to other staff at the home. The matron reports that of 54 permanent care staff, 31 have now completed a National Vocational Qualification (NVQ) in care at level two or above and 14 more care staff will be starting this training. These courses are necessary to help staff carry out their work effectively. Staff training records show that some staff have previously attended sexuality awareness training. The matron explained that most staff have completed equality and diversity training as part of their induction training and when completing National Vocational Qualifications. This training promotes a person centred approach, recognising people as individuals, with their own specific needs and preferences which are to be respected. Training records show that most staff have received Mental Capacity Act training. The training coordinator reports that future training in this subject will also include Deprivation of Liberty safeguards training. The training records show that all staff including the team leader, working on Garden Wing, (dementia care unit) have been provided with dementia care training. This training helps staff to understand and sensitively respond to the needs of people with dementia. Comments by staff indicate that they receive periodic planned supervision to support them in their work but this varies in frequency. This was verified by the deputy Care Homes for Older People Page 26 of 33 Evidence: matron. Entries in three staff records indicate that supervision had been provided recently and is used purposefully to discuss practice and performance issues. Three staff files were all seen to include appraisal documentation showing that they have all been subject to an annual appraisal of their work. This is good practice as it provides an opportunity to take stock of the performance and identify developmental objectives for the coming year. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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: The matron is a qualified nurse with a number of years experience of working in care homes. The manager is supported by a deputy matron two deputy managers and a team leader who help to make sure the different units within the home work effectively. To help them to do this the supporting management team have some supernumerary time to carry out management duties such as audit and supervision. The manager and her deputies work well together and there is a clear management structure within the team, with staff understanding their roles and responsibilities. The service has a number of measures in place for monitoring the quality of the service and supporting communication at the home. This includes surveying peoples views shortly after they have moved in and at later dates to ensure they remain satisfied with the service. An action plan was seen to be in place, summarising the Care Homes for Older People Page 28 of 33 Evidence: findings of last years consultation (November 08). The matron said that this years consultations would include surveying the views of relatives and professionals so that their views may also be included so that they can contribute to the development of the home. A number of audits and checks are carried out of key aspects of practice, including a medication count two times daily, pharmacy audits and care plan audits. A verbal shift handover procedure is in place so that staff arriving on duty are made aware of significant events and appointments to support communication between staff. Similarly notes of staff and managers meetings show that there are a range of different forums to support teamwork and information exchange at different levels within the organisation. Records of monitoring visits show that an employee of the organisation routinely visits the home each month to assess any shortfalls in the service so that they can be addressed where necessary. The matron explained that she also has regular meetings with staff of different departments within the organisation who provide support and monitoring of various aspects of the homes administration and management, including visits from staff from the Human Resources section, finance department and payroll in addition to the chief executive, The deputy matron explained that with the exception of the dementia care unit, occasional meetings take place with the people at the home to discuss everyday issues which affect them, such as events in the home, planned activities and menu reviews. This was also verified in discussions with the people living on the younger adults unit. The records show that there have only been two meetings on the younger adults unit, so far this year and there is potential scope for increasing the frequency of meetings so that people have more opportunities to be involved. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are available. The records of the five 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. Records related to the routine maintenance and repairs in the home were seen and examined. These include maintenance, contracts and servicing documentation for electrical equipment, gas, clinical waste and all other services supplied to the home. Resident aids and equipment have also been serviced this includes hoists seen in use during the inspection visit. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 People with significant communication support needs should be referred to the speech and language therapist to assess their suitability for a communication passport and other equipment to enable them to communicate their needs more easily. Action should be taken to refer the person with epilepsy for an assessment by an epilepsy nurse specialist so that a clear protocol can be drawn up for administering extra medication. This is necessary to ensure that all nurses follow the same procedure and to ensure that extra medication is given appropriately, as necessary. A referral to an appropriate professional for advice should be considered for the person who is seated in a wheelchair with a lap strap each morning. This will provide the opportunity for a review to be carried out and decisions made on suitable seating arrangements, which will support the comfort of the resident. Action should be taken to agree behaviour management guidelines with relevant professionals, to address the risk of anyone being injured by a person driving into them in an electric wheelchair, when they are agitated or upset. Page 31 of 33 2 8 3 8 4 8 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 5 9 Action should be taken to make sure that excessive amounts of medication are not routinely stored in the home. This will help staff to audit medication accurately and minimise the risk of unsafe practice. Action should be taken to review residents concerns about their clothing going missing when they are laundered by the home. This will help residents to know that their belongings are treated with respect. The home should address peoples concerns about staffing levels in the home. This will help to reassure people that residents care needs are being met safely at all times. 6 26 7 27 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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