Care Home: Townsend House

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What the care home does well Townsend House provides a clean and safely maintained environment for the residents. There is a welcoming atmosphere for visitors, and there is information provided about the home, its services and facilities, to assist residents and their families. Residents are admitted here on the basis of an assessment of their individual circumstances, and upon admission each has a documented plan of care to address their needs. Care is delivered to a satisfactory standard, with health and social care needs met in a way that gives due consideration and respect towards individuals` privacy, dignity and choices. Residents have access to health and social care services. Residents spoke well of their care and the staff generally. We received comments such as `It`s not home but it`s the next best thing`. Some visiting health care professionals were positive about the standard of care provided at the home and about the staff. We met some visitors who also spoke positively about the welcome in the home and the care of their relative. There are opportunities for residents to remain socially active, with a coordinated activities programme available that is varied to suit different tastes and abilities. There is a choice of good quality food, with residents speaking positively about their meals. Nutritional risk management is carried out to benefit the health needs of the residents. People are assured that the home takes any complaint seriously and, despite some remaining work to address regarding mental capacity assessment, there are policies and procedures in place for the protection of the vulnerable residents. Sound recruitment practices are observed here, and there are good opportunities for staff training, development and supervision. The home is satisfactorily managed and has good arrangements for monitoring the quality of its service to residents. What has improved since the last inspection? A number of improvements have taken place in the environment, with an ongoing maintenance, refurbishment and redecoration programme in place. A more stable and cohesive staff team is being established. What the care home could do better: Although residents` needs are being met, isolated shortfalls in documented care planning require closer attention, so that any degree of risk posed to residents in this area can be removed. We have recommended that risk assessments be reviewed to ensure that they are supporting the planned care consistently, and that residents` personal wishes regardingthe management of their medications is also recorded consistently. The maintenance person`s dual role of home maintenance and also gardening has resulted in certain areas of the surrounding gardens not receiving particularly prompt attention, although efforts to address this are in hand. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Townsend House Court Farm Lane Mitcheldean Glos GL17 0BD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ruth Wilcox     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Townsend House Court Farm Lane Mitcheldean Glos GL17 0BD 01594542611 01594541449 manager.townsend@osjctglos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Orders of St John Care Trust care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 One bed in the rehabilitation unit can be used to provide respite care for service users over the age of 55 years. Date of last inspection Brief description of the care home Townsend House is situated in the centre of Mitcheldean, and is in close proximity to the local shops and amenities. The home is managed by The Orders of St John Care Trust. The home is purpose built, and is registered to provide both nursing and personal care for 40 older people. The home is able to provide respite care if there is a vacancy. A day centre, which serves the local community, is also integral to the home. The home provides forty single rooms, six of which have en suite facilities. A passenger lift has been installed to provide easy access to the first floor. Communal areas consist of a main lounge and dining space incorporating a conservatory, a second lounge and dining room, and a third separate lounge. Adapted bathing facilities are provided. The home is surrounded by gardens with an inner courtyard of flowerbeds. A number of rooms overlook the gardens and courtyard. Care Homes for Older People Page 4 of 32 Brief description of the care home Information about the home is available in the brochure, known as the Residents Guide, which is issued to prospective and current residents. A copy of the most recent CSCI/CQC report is available in the home for anyone to read. The charges for Townsend House range from 564.96 pounds to 750.07 pounds per week. The home also provides care at the Local Authority rate of funding where applicable. Hairdressing, chiropody, newspapers, toiletries and optical services are charged at individual extra costs. Care Homes for Older People Page 5 of 32 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 judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The last Key Inspection of this service was carried out on the 31st July 2007. One Regulatory Inspector carried out this inspection over two days in July 2009. Care records were inspected, with the care of four residents being closely looked at in particular. The arrangements to manage residents medications were inspected. We met and spoke to a number of residents and visitors in order to gauge their views Care Homes for Older People Page 6 of 32 and experiences of the services and care provided at Townsend House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished. Seven out of ten residents to whom we sent surveys returned them to us. Two of the four visiting health care professionals and three out of five staff to whom we sent surveys returned them to us. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service, and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to the maintenance and cleanliness. What the care home does well: What has improved since the last inspection? What they could do better: Although residents needs are being met, isolated shortfalls in documented care planning require closer attention, so that any degree of risk posed to residents in this area can be removed. We have recommended that risk assessments be reviewed to ensure that they are supporting the planned care consistently, and that residents personal wishes regarding Care Homes for Older People Page 8 of 32 the management of their medications is also recorded consistently. The maintenance persons dual role of home maintenance and also gardening has resulted in certain areas of the surrounding gardens not receiving particularly prompt attention, although efforts to address this are in hand. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 32 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 32 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. Access to information and an assessment prior to admission to the home gives prospective residents an assurance that their needs can be met. Evidence: A full copy of the homes Statement of Purpose and Residents Guide was displayed in the entrance hall, with a copy of the Guide in each residents room. We pointed out that the fee information in the Guide and our contact details, which featured on numerous pieces of information within it, were out of date. This was being addressed and updated by the second day of this inspection. Residents who responded to our survey confirmed that they had received information about the home prior to coming in here to assist them. One person told us that the change of coming into the home had not been easy, but that they had no regrets about doing so. Care Homes for Older People Page 11 of 32 Evidence: All prospective residents were assessed prior to being given a place at the home. We inspected two examples of pre-admission assessments, each of which was for a resident more recently admitted to the home. Each assessment had been carried out prior to admission being agreed, and had been recorded on the homes designated tool for the purpose. The assessments had been signed and dated, with the location where it was conducted identified. They also identified if the persons family or representative had been present. The assessments took account of their personal details and their past medical history; their health and care needs; their medications; their socialisation and cultural needs; their understanding and legal status. The manager had been out to conduct an assessment at a local hospital on the first day of our visit. The manager did not consistently do the range of risk assessments included in the assessment tool as part of the pre-admission procedure. Confirmation letters of placements were issued, although the manager told us that referrals for admission by the Local Authority were often in urgent circumstances, making it impossible to provide such a letter in advance of the admission taking place. Visiting health care professionals told us that the home usually made accurate assessments of peoples needs. One General Practitioner (GP) told us that the home could sometimes liase a bit more with new residents previous health care providers in order to be able to provide better medical details on admission, as they sometimes had little information regarding sick patients when they first saw them. Staff had endeavoured to obtain such information from previous doctors when residents moved into Townsend House. The intermediate care unit, comprising four beds, had been discontinued since our last visit, and this accommodation was now part of the home overall. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have their health and care needs met in a way that takes account of their privacy and dignity, however there are some isolated omissions in documented care planning which are posing a degree of risk with this. Evidence: Each resident had an individualised plan of care in place that had been drafted on the outcome of an assessment, having been done in consultation with them and sometimes their family. We selected four care plans to inspect more closely on the basis of needs, sometimes more complex, and on the basis of information shared with us by the home prior to this inspection. There were some good examples of risk management in relation to nutrition, falls and pressure area care. However, in one case there were a small number of assessed needs that had not been planned for in writing. In order to assess the outcomes for Care Homes for Older People Page 13 of 32 Evidence: this person we interviewed a number of staff about the persons needs in this regard, and each was well informed and was able to discuss the care that was necessary. It seemed that a good amount of information about residents needs was given to staff verbally, as well as in a documented care plan format. There were slight discrepancies between some risk assessments and associated care plans. Although some showed little risk on assessment, associated care plans had been evidently drawn up to address apparent risks. In one particular case the necessary equipment identified on the assessment to address the residents moving and handling needs did not correspond with that on the associated care plan, each specifying two different types of equipment. In the same case a pressure area care plan review identified that the plan was meeting the persons needs, despite a second care plan indicating otherwise. Despite these apparent discrepancies in recording, staff were well informed about the needs of the residents, and residents had all the necessary care, equipment and support that they required. Records showed that residents were medically reviewed and had access to all health care support. Visiting health care professionals told us that residents care needs were appropriately monitored and catered for, and that the home sought to improve peoples wellbeing. They also confirmed that the staff showed respect for residents privacy and dignity and were responsive to diverse needs. One visiting General Practitioner (GP) told us that they had good communication between themselves and the staff; that nurses liased with families well; and that the residents appeared well looked after. They went on to say that although the home could do with more trained nurses in their view, they had no concerns regarding the quality of nursing care, and that staff were always friendly and helpful. Residents who responded to our survey told us that they received the care, support and medical attention they needed. One person said that they were looked after very well, and that the staff were very patient and caring. A residents relative told us that they were really pleased with the care provided at Townsend House. Another told us that if the residents needed anything then the staff would go out of their way to get it. Residents we met in person during the course of our inspection spoke positively regarding their care and the way in which staff looked after them. One spoke about nice staff who did the best they could. Another said it wasnt home but was the next best thing. One lady said that this home was much better than the last one she was in, and was happier here and got her privacy. Care Homes for Older People Page 14 of 32 Evidence: Residents wishes regarding the management of their medications could be recorded on the pre-admission assessment tool, however this was not consistently filled in. Residents were able to manage their own medications if they wished and were able, and we saw one example of this taking place. A risk assessment and documented plan of care was in place in this regard, with secure storage provided for the resident. Medications were stored safely and hygienically. Medication administration charts were clearly printed by the supplying pharmacist and were neat and orderly, with a record of administrations maintained. There was supplementary guidance on the use of topical creams. There were separate records of administration in cases where the care staff were applying creams as part of personal care. In one case, a resident was prescribed a particular drug for managing agitation, to be used as necessary. Although there was a documented plan of care to address some mental health issues, the indicators and usage for this drug did not feature in the planned care. In another case the morning medications had been omitted as the resident had been asleep. Attempts to give the medications to the resident later in the morning did not appear to have been made, as they had not had them by the afternoon. There was a record of medication refusals in another case, and staff had sought the GPs advice about this, and as a consequence certain changes to the medication regime had been implemented to try to help the resident concerned. The majority of medications had been dispensed in a Monitored Dosage System, but those items that were boxed and bottled had been dated when opened in order to facilitate safe usage and auditing. Random audits we carried out on boxed items proved to be correct. Staff had access to medication policies, and nurses were undergoing updated medication training.Two medication errors had previously been reported to us, and the home had taken the necessary steps to address this at the time. Staff were attentive to residents, and appeared respectful towards their dignity and choices. At least two residents told us that they enjoyed a good level of privacy. Care was being delivered in the privacy of residents bedrooms, and where manoeuvres or tasks were required in more public areas with residents, staff were sensitive towards any possible implications relating to their dignity. Care Homes for Older People Page 15 of 32 Care Homes for Older People Page 16 of 32 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 this home have good opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. Evidence: Residents who responded to our survey told us that there were social activities that they could join in with, although one person told us that these were lacking at present and that time dragged. A residents friend told us that the home should provide more entertainment for the residents. We considered these comments during the inspection and found that the home had gone through a period of not having a designated social activities coordinator. This was no longer the case, with one having been appointed in the weeks preceding our visit. There was a planned social activity programme displayed in the home, and there was photographic evidence of events and activities that had taken place. A three monthly newsletter was being produced, which provided readers with Townsend House and The Orders of St John Care Trust news, plus articles and photographs of significant events. During the two days we spent in the home we saw at least four different group Care Homes for Older People Page 17 of 32 Evidence: activities taking place. We witnessed staff going around asking residents if they would like to participate, and many chose not to, with their choice being respected. We recommended that the coordinator consider ways to provide quality social contact time on a one-to-one basis with those residents unable to leave their rooms or join in with group activity. Staff adjusted activity to suit peoples ability. One resident told us that she didnt think she could manage card making and stencilling, but with help from the staff had managed. The coordinator had compiled individual personal histories with residents and their families to help identify their past interests and preferences for social and recreational pursuit. The home had a mini bus and the coordinator was planning to take groups of residents out regularly. There were regular religious services held in the home by a visiting minister. Ministers from other denominations could be sourced whenever necessary. The coordinator told us that she had already identified that the home needed to forge local community links, and had been asking if anyone wanted to use the local library. Some outside entertainers were brought in for residents on occasions. We were told that peoples visitors were always made welcome, and that it was just like home. We met three visitors during our visit, and each was complimentary about the home, the staff and the care their relative or friend received. Two visitors said that they loved coming in here, and that it was so friendly. One person said that they would prefer it if there were tea making facilities for the visitors, rather than them having to rely on staff to get them a drink. We saw visitors being supplied with cups of tea by staff. One resident told us that she felt able to choose what she did, saying that she told staff what she wanted and that staff didnt tell her what to do. The home had provided a variety of useful information for people, including advocacy service contact details and other Department of Health information. The residents bedrooms appeared personalised, as they had introduced many items of personal belongings, pictures and treasures. Personal belongings were proving to be very beneficial to one particular resident we met, who evidently derived a lot of comfort from her surrounding photographic memories. Residents also had a good choice of food at all mealtimes. We observed the service of breakfast and lunch, and each of these meals offered good portion sizes and Care Homes for Older People Page 18 of 32 Evidence: wholesome, nutritious, and nicely presented food. Individual table serving dishes were used for vegetables, and residents could help themselves to these if they were able to. Staff were present throughout meals offering discreet and sensitive assistance where it was needed. Special diets were catered for, with foods fortified where necessary. The cook was well informed in this area, and had consulted with residents regarding their preferences and dietary requirements, and was reviewing the menus as a consequence. The kitchen was busy but organised, and the necessary catering records were being maintained. People made coments on their survey forms and told us directly that the quality and choice of the food here was good. One resident told us that the food was spectacular. Care Homes for Older People Page 19 of 32 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 this home can be reassured by the homes complaints procedure and the policies regarding the prevention of abuse. Evidence: The home had a written procedure for dealing with complaints. The contact details for CQC were out of date, and the procedure was not displayed for people to see. The procedure was included in the homes information brochure, but again our contact details were not correct. We pointed this out, and by the end of the second day of our visit this point had been rectified, and the procedure was displayed and made more accessible for people. We had received one concern in the months preceding this inspection regarding leadership for staff on a particular shift. We had overseen the outcomes of a Care Provider investigation into this, and were satisfied that the home responded appropriately where it found there had been failings. Appropriate monitoring arrangements were still in place to address certain outstanding points of staff practices following this issue to prevent such circumstances arising again. Complaint records showed that a family had raised similar concerns with the home around the same time. Residents confirmed to us that staff listened to what they said and acted upon it, although one said that this was just sometimes. Although residents responses Care Homes for Older People Page 20 of 32 Evidence: generally confirmed that they knew there was someone they could talk to if they were unhappy, and that they could raise a formal complaint if necessary, one particular resident was unable to confirm the same. One resident who we met in person told us that, although they had no concerns to raise, felt confident that the staff would help them to resolve any that might arise. The home had policies and procedures for the protection of vulnerable residents, and staff had received training in recognition and prevention of abuse. We explored this training with a number of staff, and each was able to discuss their awareness. Only one required a prompt regarding the outside agencies that would become involved if any concerns in this area were raised. Staff had also received instruction in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had access to the Department of Health document No Secrets, and had the MCA Easy Read guide. Copious amounts of information published by the Office of the Public Guardian was available for staff. The home had procedures for addressing incidents of unacceptable staff practice, and the staff disciplinary process had been instigated on occasions. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are provided with accommodation that is suitable and safe to meet their needs. Evidence: A committed and regular maintenance person was employed, and there was an ongoing maintenance and redecoration programme in place. The maintenance person was decorating the stairs and landing at the time of our visit. The previously designated intermediate care unit accommodation had been incorporated back into the main home, and redecoration had been done to the lounge; new curtains were awaited. Bedrooms had been redecorated as needed. We were told that the home had had a new roof, new garage doors, and new fire door closers. Repairs had been carried out to parts of the exterior fascia. Profiling beds had been provided in the majority of residents rooms. One of the ground floor bathrooms had been totally refurbished, and the former intermediate care unit bathroom was now an assisted bathroom, with a shower as well. One of the dining table tops in the zone 2 lounge was loose and wobbling when touched. We asked that this be reported straight away. Care Homes for Older People Page 22 of 32 Evidence: Work had commenced to improve the courtyard garden area, but areas of lawn and garden around other parts of the building were untidy, with a lot of weed growth on patios. We were told that the maintenance person did the gardening as well as the maintenance in the home, and that he was very hard working and reliable, and was working round to it. Although there was a slightly stale odour on entering the home on the first day of our visit, the home was clean and hygienic throughout. All grades of clinical waste were correctly managed. There were good supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the infection control procedures. Staff had received training in Infection Control. The laundry room was well organised with items appropriately segregated and washed in accordance with infection control protocols. One resident made particular mention of the good laundry service, whilst another family indicated there were sometimes problems with it. A residents relative mentioned the lovely surroundings, and said that the home was always so clean and comfortable. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive care from a competent and safely recruited work force. Evidence: Staff rotas were maintained and there were generally consistent levels of staff each day. At least one qualified nurse was on duty throughout the twenty-four hour period, and there were seven and five carers for the morning and afternoon shifts respectively. An additional care assistant had been employed at night, making a total of three on duty with the nurse. An additional carer was on duty during the morning to provide extra assistance to those residents having their breakfast in the dining room. A developing and more cohesive staff team was reported to us, with minimal agency usage now, and there was just one part time nurse post left on day duty to fill. There was a good team of ancillary workers, which included catering, cleaning, laundry, maintenance and administrative personnel. We observed staff throughout our time in the home, and saw some sensitive, kind and hard working people. They were functioning as a team to meet the needs of the residents. Nearly all were welcoming to us, and were cooperative with the inspection process. When we spoke to some of them they appeared well informed about residents needs. Care Homes for Older People Page 24 of 32 Evidence: Residents told us that staff were usually available when they needed them. One person said that they had always found the staff caring and considerate to their needs. There was an expectation that care staff started a National Vocational Qualification in Care (NVQ). There were currently twelve care staff on day duty and four staff on night duty who were qualified to a level 2 standard. There were two senior carers qualified to level 3. Three carers were currently on the level 2 training course. We inspected recruitment files for two more recently appointed care staff. Application forms provided a full and detailed employment history. In one case where some gaps in employment history existed, the reasons for these had been explored and recorded by the manager during interview. Two references, one of which was from the previous employer, had been obtained, and proof of identity had been confirmed. Verification of why the worker had left their last place of work had been sought when applying for references. The correct Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been carried out. Medical fitness and proof of qualifications had been confirmed. Equal opportunities monitoring was being carried out, and offer letters of employment had been issued. The home had a very organised and professional training coordinator, who was part of the senior care team. This person was also an Area Trainer for the Orders of St John Care Trust, and had trained in Supervisory Management, and had done a City and Guilds training course to equip her with some teaching skills. The coordinator was working towards establishing a formal training matrix for easier access, but training schedules to meet the staff teams needs were being monitored and delivered well anyway. There were well kept training records, and individual training files had been set up for the staff that contained evidence of their certificated achievements. New staff had been given an Induction Passport. This contained instruction on the homes ethos and management structure, the in-house induction programme, the computer-based learning, and the lists of mandatory learning courses. A computerbased induction training package was provided to new staff, which delivered training in the six modules of the Common Induction Standards for Care Workers. The training coordinator gave us a practical demonstration in how the system worked. New staff had been placed to work alongside a care leader and did not have unsupervised access to residents. New staff told us that they had received very good Care Homes for Older People Page 25 of 32 Evidence: levels of induction and support, with one saying it had been brilliant. The home had a collection of training materials in a DVD format that staff could learn from with the training coordinator. These included Infection Control, Health and Safety, Abuse, Nutrition, Food Hygiene and Moving and Handling. Moving and Handling training was delivered in theory and practice by one of the homes three designated trainers for this area. Dementia care training had been delivered by the Alzheimers Society, and there were two training sessions planned for optional courses in Managing Heart Failure, and Memory Problems in Every Day Life, to be delivered by external training providers. Nurses were undergoing additional training in Care Planning and Medication Management. Staff confirmed enthusiastically that there were good induction and training arrangements in the home. One person who responded to our survey told us that they were very happy working at Townsend House, and enjoyed meeting people and learning new things. Care Homes for Older People Page 26 of 32 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 systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. Evidence: The manager of Townsend House has been in post for eleven years, and is registered and qualified for the role. There is an experienced deputy manager who is professional and knowledgeable, and who appeared highly influential in the standards that the home strives to promote and maintain. An Annual Quality Assurance Assessment (AQAA) had not been issued to the home by CQC in sufficient time for it to inform this particular inspection, and the manager was completing it at the time of our visit, with its submission date scheduled for the week after. We were in receipt of the AQAA at the time of writing this report, and it was generally completed to a good standard. Care Homes for Older People Page 27 of 32 Evidence: A quality assurance survey was being carried out with residents and their families at the time of our visit. We were told that the results of this would be reported on by the manager, a copy of which would be submitted to the Trusts Quality Assurance Manager. This would assist in identifying areas for improvement for the home, and an action plan would be drawn up to address them. External auditors had assessed the homes business systems earlier this year. Other forms of consultation had taken place with residents, which included reviews of their care and placement, and meetings. Recorded minutes of such events showed us that residents could have a say in how their home was run, and could influence their care. Regular staff meetings had been held, and minutes showed that these were also part of the drive to promote good standards here. Individual care plans for residents regarding their mental capacity and decision-making processes, including a best interests assessment, were being planned although these had not yet been commenced. Staff were receiving training in this area. Staff had received basic instruction in the Deprivation of Liberty Safeguards (DoLS), and this currently had a high profile in the home. The manager acknowledged that her knowledge of the safeguards needed improvement, but the deputy manager was commencing an on-line training course. Some residents had chosen to place personal money in the homes main safe for safekeeping. Records were maintained in each individual case, which contained evidence of running balances and transactions. The receipting system to account for transactions involved recording in separate books that had been set up for the homes own trolley shop; hairdressers; chiropodist and a supplying newsagent. We carried out a number of random checks on arrangements and each was in order. Two members of staff had signed records in the absence of residents being able to sign for themselves, and we saw only one example of a resident signing their own financial record. There was a formal staff supervision programme in place, with staff receiving twice yearly performance and development reviews, and four other supervision sessions throughout the rest of the year. Staff confirmed that they had good support in the home from their allotted supervisor. The home had written policies and procedures to promote the health and safety of the residents, visitors and staff, and associated training was provided for staff. Records showed us that regular safety checks and planned maintenance visits had Care Homes for Older People Page 28 of 32 Evidence: been carried out on the fire safety systems. A fire risk assessment was in place, which had been kept under review. Residents had an individual fire safety risk assessment in their care plan. Fire safety training had been delivered to all staff, which had incorporated theoretical and practical training, with instruction in evacuation procedures in the event of a fire. There was a record of fire drills, with any unplanned fire alarm sound being used as a training opportunity. Hot water temperatures were being monitored for safe levels, and a Legionella risk assessment and appropriate control measures were in place. Timely safety checks and maintenance had been carried out on utilities and equipment. First aid facilities were available and staff had received First Aid training from an accredited training provider. The home was secure and there were coded door entries to higher risk areas. We had previously been notified of two incidents of intruders in the grounds of the home. As a consequence a number of large trees had been removed to improve visibility in the area, and new hedging and fencing was being provided. We were also informed about a recent incident when a carer had sustained a needle stick injury from a lancet device that had been mistakenly left in a residents bedroom by an agency nurse. The appropriate health and safety measures were observed for the carer concerned, and the nurses error was reported to the relevant agency for action. Further to this we have ensured that the relevant CQC inspector for the supplying agency is aware of this serious incident in order that it can be pursued through further inspection work. Care Homes for Older People Page 29 of 32 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 32 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 15 The registered manager 31/08/2009 must ensure that care plans are documented which address residents every assessed need, and that these are kept under regular review. This is to ensure that care records are up to date and are appropriate to meet residents assessed needs. 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 7 The registered manager should ensure that staff review existing risk assessments for residents, to ensure that they fully support the documented care planning. The registered manager should ensure that residents wishes regarding the management of their medications is consistently recorded on admission forms. 2 9 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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